September 27, 2017

We're not making progress against sepsis after all, study suggests

Daily Briefing

    Both sepsis incidence rates and sepsis mortality rates remained stable between 2009 to 2014, according to a new study in JAMA—contradicting prior research suggesting that sepsis mortality rates were falling, Maria Castellucci writes for Modern Healthcare.

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    For the study, Chanu Rhee, an assistant professor of population medicine at Harvard Medical School, and colleagues looked at the clinical data of 2.9 million patients from 409 different hospitals. The researchers categorized patients as having sepsis if their EHR indicated they had organ dysfunction and an infection—the criteria for sepsis approved by both the Society of Critical Care Medicine and the European Society of Intensive Care Medicine.

    The researchers argue this approach yields more accurate results than past studies that relied on claims data, as hospitals vary in how they diagnose and code sepsis.

    Key findings

    Overall, the researchers determined that the sepsis incidence rate remained relatively stable between 2009 and 2014. According to researchers, this contradicts prior studies that found rising sepsis rates.

    Further, they found that while the in-hospital mortality rate declined, "there was no significant change in the combined outcome of death or discharge to hospice"—again contradicting prior research that found declines in the combined outcome of death or discharge to hospice.

    The researchers found that, from 2009 to 2014, sepsis was present in 6 percent of hospitalizations and accounted for around 15 percent of in-hospital deaths and 6.2 percent of discharges to hospice.

    Overall, the findings suggest that in 2014, there were 1.7 million hospitalizations for sepsis and 270,000 deaths due to sepsis in the United States, the researchers said.

    Comments

    "I think our study has really emphasized that using claims data is problematic," Rhee said. "With the increasing awareness of sepsis and changing coding practices, I think it's fair to say that diagnosis is increasing, but (the occurrence of) the disease as a whole hasn't changed significantly in recent years."

    Rhee added that the relatively stable rate of mortality for sepsis patients could be linked to the rate of discharge to hospice and the overall poor health of sepsis patients. "I think one of the implications of this for hospitals is asking what can we do to help patients before they get to the hospital," Rhee said (Castellucci, Modern Healthcare, 9/25).

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