April 16, 2003 -- The number of people who suffer from a potentially life-threatening type of inflammatory syndrome that affects the entire body -- called sepsis -- has grown by an average of nearly 9% each year over the past 22 years. A new study shows more people are dying from this rapidly progressing syndrome despite advances in treatment.
Researchers say the study is the most comprehensive look at the prevalence of sepsis to date and is based on discharge data from 750 million hospitalizations at a national sample of 500 hospitals from 1979 to 2000.
Sepsis begins with an infection that activates a person's entire immune system, which then sets of a chain reaction of events that can lead to uncontrolled inflammation in the body. This whole-body response to infection produces changes in temperature, blood pressure, heart rate, white blood cell count, and lung function. More severe forms of sepsis can also cause organ dysfunction or shock.
The study, published in the April 17 issue of TheNew England Journal of Medicine, found the number of sepsis cases rose from about 164,000 in 1979 to nearly 660,000 in 2000. Sepsis was also more common in men than in women and affected a greater proportion of non-white persons than whites.
Although the percentage of people who died of sepsis while in the hospital dropped from nearly 28% in the first five-year period of the study to 18% in the last five-year period, and although the length of the average hospital stay decreased, researchers found the total number of people who died in the hospital tripled from 43,579 in 1979 to 120,491 in 2000.
According to the National Center for Health Statistics, sepsis is the 10th leading cause of death in the U.S.
Until recently, the only way doctors could treat sepsis was with powerful antibiotics and other supportive care. In 2001, the drug Xigris became the first available therapy for sepsis and has been shown to reduce the risk of death due to the condition.
In addition, researchers found the incidence of sepsis caused by fungal infections increased by 207% over the 22 years studied, with a rise in certain types of bacteria after 1987.
Though the study did not look at what factors may be fueling the rise in sepsis cases, researchers suggest that several might play a role, such as:
- An increase in antibiotic resistance;
- More invasive procedures being performed (including transplantation);
- More frequent use of chemotherapy and immunosuppressive drugs;
- Changes in billing practices that might influence the appearance of disease;
- Faster discharges from hospitals to other medical facilities.
Researchers say the findings show that rapid identification and appropriate use of antibiotics is critical to effective treatment of sepsis.
"Not only do we need to treat sepsis aggressively, we must also must focus on early identification of septic patients to maximize their benefits from available therapies," says researcher Greg S. Martin, MD, of the Emory University School of Medicine, in a news release. "Studies show that if you wait for even four to eight hours to begin antibiotic therapy, the mortality [death rate] from sepsis worsens considerably."