Is There a Global Sepsis Crisis?
A new study by the York Health Economic Consortium revealed last month that there are far more cases of sepsis in the UK annually – approximately 260,000 cases - than had previously been thought.
Other recent research suggests that this may be a global issue. A recent study of sepsis in Spain stated that 'there has been a substantial increase in the incidence of sepsis during the last decades and it appears to be rising over time, with an increasing number of deaths, despite a decline in overall in-hospital mortality.'
What is Sepsis?
Sepsis is a fast-spreading, potentially fatal response to an infection in the body which can lead to tissue damage, multiple organ failure and death. It occurs when the body over-reacts to an infection, causing widespread inflammation.
Sepsis Incidence Worldwide
It is thought that there may be as many as 20,000,000 cases of sepsis per year worldwide with a mortality rate of approximately 35%, equating to a possible 7 million deaths from sepsis around the world each year.
It is a condition that devastates communities across the world, with evidence suggesting an incidence rate in Australia of approximately 76 per 100,000 people, 95 in France, over 100 in Spain and possibly over 300 people per 100,000 in the USA.
In the developing world, sepsis is thought to be responsible for 60 – 80% of child deaths per year.
Globally, sepsis appears to be competing with heart failure as the number one cause of death.
Is Sepsis Increasing?
Research in Germany over the last 2- 3 years has shown that the number of cases of sepsis rose in that country by an average of 5.7% per year from approximately 200 000 cases in 2007 to 280 000 cases in 2013. As a result, around 130 people die from sepsis in Germany every day.
Likewise, in the USA, evidence suggests that cases of sepsis are rising dramatically, from approximately 221 cases per 100,000 people in 2007 to 377 people per 100,000 in 2013 – an increase of 23.5% over six years. In fact, statistics prepared for World Sepsis Day in 2013 identified that, in the USA, hospitalisation for sepsis had more than doubled in 10 years.
Severe Sepsis and Septic Shock
Similar increases are being identified in cases of severe sepsis, where the body's inflammatory response begins to impact on organ functioning, and septic shock where the blood pressure drops to life-threatening levels.
In Germany, research identified that the number of new cases of severe sepsis and septic shock is higher than the number of new cases of HIV/AIDS, breast cancer or colon cancer. The number of patients with severe sepsis rose from 27% in 2007 to 41% in 2013.
In Spain, there is evidence that cases of severe sepsis rose from 64 per 100,000 people in 2006 to approximately 106 per 100,000 people in 2011. Likewise, cases of septic shock were also rising.
Why might sepsis be increasing?
A number of possible factors which might be contributing to the rise in cases of sepsis have been suggested.
- A rising global population would be significant in explaining an increase in overall numbers of sepsis cases but not an increasing percentage of the population. Also, some reports suggest that the number of sepsis cases is increasing at a greater rate than the population increase
- The increasing age of the population is likely to be a factor as the elderly are one of the groups most susceptible to sepsis. One study in the USA found that two-thirds of cases of sepsis were in people over the age of 65. As more people live longer globally, it would seem logical that the number of cases of sepsis will also rise
- Improvements in accurately identifying sepsis and recording it as present in patients in hospital could also account for rising numbers
- The increasing number of severe sepsis and septic shock cases may be due to continuing failures to diagnose and treat sepsis quickly enough to prevent its deterioration into a more serious condition.
- Variations in incidence from country to country may be due in part to differing definitions of what sepsis is.
What can be done?
Areas of improvement seem to focus on improving recognition and treatment of the condition. Perhaps up to 40% of cases of sepsis develop in the home so patient and GP awareness is important. Suggestions have included the following:
- Improved training of medical practitioners to produce greater awareness of the condition
- Greater clarity and specificity of red flag symptoms
- Quicker investigation where signs of sepsis are present
- Quicker response to sepsis with antibiotics and life-support to prevent deterioration to severe sepsis
Medical Negligence
Recent research seems to agree that prompt diagnosis and treatment is the key to increasing chances of survival from sepsis. Where sepsis goes undiagnosed for too long, allowing the deterioration to severe sepsis and septic shock, the patient may be entitled to claim for compensation.
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