What is sepsis?
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The document discusses sepsis, highlighting its high treatment costs, mortality rates, and evolving definitions over time, notably through the sepsis-1, sepsis-2, and sepsis-3 frameworks. It emphasizes the challenges in diagnosing and treating sepsis, including the absence of standardized diagnostic tests, and presents the qSOFA scoring tool for identifying high-risk patients. Additionally, it raises concerns about the recent sepsis-3 criteria and the reliance on data science solutions for better monitoring and treatment in hospitals.
What is sepsis?
- 1. Confidential What is Sepsis? Damian Mingle What is Sepsis? Damian Mingle WPC Healthcare
- 2. Confidential The Severity of Sepsis 1 What lies beneath the healthcare cost and mortality rates Notable Fact Details High cost to treat Most expensive condition treated in the United States $23.7B High ICU costs 40% of all ICU costs High mortality rate 60% for septic chock High readmission rate 62% Rapid decline Move to septic shock within 36 hours of identification Challenging No standard diagnostic test, often appears with no co- morbid conditions SOURCE: Gary T, Mingle D, Yenamandra A (2016) The Evolving Definition of Sepsis. Int Clin Pathol J 2(6): 00063. DOI: 10.15406/icpjl.2016.02.00063
- 3. Confidential The Evolving Definition and Monitoring of Sepsis 2 Shifting overtime Stage 1: SIRS Stage 2: Sepsis Stage 3: Severe Sepsis Stage 4: Septic Shock Mortality Rate 7% 16% 40% > 50% Clinical Indicator Flu-like symptoms SIRS + infection Sepsis + signs of organ failure Persistent severe sepsis When stage was used to define sepsis 1989-2015 Sepsis-1 & -2 1915-1989 Pre- Sepsis-1 2016 – present Sepsis-3 400BC – 1917 Hippocrates Challenges for each stage Misidentification: inflammation could be due to a wide variety of other medical conditions. Time: It could take days to verify source of infection. Treatment: Limited treatment options when organs begin to fail. High mortality rate: Often too late for successful treatment.
- 4. Confidential Sepsis-1 3 Key outcomes • Establishment of the term “systemic inflammatory response syndrome” (SIRS) • No definable presence of bacterial infection was required to diagnose sepsis • The terms “severe sepsis” and “septic shock” were introduced to differentiate degrees of severity
- 5. Confidential Sepsis-2 4 Key outcomes • Recognized the sepsis-1 definition has limitations • Expanding the list of diagnostic criteria for sepsis • Recognized the separate characteristics or stages of sepsis designated by the acronym PIRO: predisposition, infection, response to the infectious challenge, and organ dysfunction
- 6. Confidential Sepsis-3 5 Key outcomes • Sepsis is a life-threatening organ dysfunction caused by a deregulated host response to infection. • Septic shock is a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associate with a greater risk of mortality that with sepsis alone. • Introduces a new diagnostic tool, qSOFA
- 7. Confidential What is qSOFA? 6 Predicting poor outcomes in infection patients Criteria Point Value Altered mental status +1 Respiratory rate > or = 22 +1 Systolic blood pressure < or = 100 +1 qSOFA scoring A qSOFA score of > or = 2 suggest a high-risk of poor outcome and an indication that these patients have sepsis and should have their lactate levels tested for evidence of organ dysfunction.
- 8. Confidential Controversy Surrounding Sepsis-3 7 Raising concerns • Focus on adult patients without including newborn and pediatric patients • Research was generate from patients in the U.S. and Europe, but not from economically poorer countries • No experts from emergency medicine or other important groups to weigh in • The lack of comparison to the prior 25-year body of sepsis research (which focused on 4 clinical stages and the new stages have been reduced to two) • A significant reliance on qSOFA to diagnose sepsis • Missing endorsements by all societies (i.e. Latin American Sepsis Institute, American College of Chest Physicians, and American College of Emergency Physicians).
- 9. Confidential Beyond Controversy 8 Data Science Solution While several hospitals use computer algorithms to monitor patients, these are almost exclusive to the following scenarios: • Using electronic medical records • Monitoring vitals • Focusing on ICU patients …results in these areas are wonderful, however, we should consider other approaches…
- 10. Confidential Sepsis Through the Eyes of Data Science 9 Two Primary Reasons for Our Success 1. For patients, “time is tissue”. Mortality is not the only measurement for sepsis performance, but “quality of life” for a patient. 2. Almost all sepsis cases have come to the hospital via the emergency department, however many diagnostic criteria are not met until hours or days after first arrival. Interested in results from our implemented solution? Send us a note. We are expanding our network of hospital partners. Popular questions we get: How is sepsis diagnosed?, sepsis bundle, sepsis mortality rate, diagnosing sepsis, what does sepsis mean?, sepsis criteria, what is sepsis?, sepsis guidelines
- 11. Confidential Damian Mingle Chief Data Scientist WPC Healthcare (615) 364-9660 WPCHealthcare.com [email protected] @DamianMingle