Most sepsis-associated deaths were linked to other underlying causes and were not preventable with better sepsis care alone, according to a retrospective review.
On an annual basis, sepsis affects about 1.7 million American adults and the infection is linked to more than 250,000 deaths.
The current research focused on sepsis-associated deaths at six academic medical centers and community hospitals, where sepsis was the most common immediate cause of death.
“However, most underlying causes of death were related to severe chronic comorbidities and most sepsis-associated deaths were unlikely to be preventable through better hospital-based care. Further innovations in the prevention and care of underlying conditions may be necessary before a major reduction in sepsis-associated deaths can be achieved,” the researchers wrote.
They reviewed the case histories of more than 500 randomly selected patients who either died in the hospital or were discharged to hospice care. The researchers reported that 300 of the patients had sepsis, and the infection was the immediate cause of death in 198 of those patients (34.9%) of the total study cohort.
The second most common immediate cause of death was cancer, which claimed 92 patients (16.2%) of the total study cohort, while the third most common immediate cause of death was heart failure (39 patients or 6.9%).
For the 300 patients with sepsis, the top underlying causes of death were solid cancer (n=63 patients), chronic heart disease (46), hematologic cancer (31), dementia (29), and chronic lung disease (27).
Suboptimal care such as delayed administration of antibiotics was found in 22.7% of the 300 sepsis cases, but only 12% of sepsis-associated deaths were deemed potentially preventable
These findings call into question prior views of sepsis care, the researchers wrote.
“The high burden of sepsis and the perception that most sepsis-associated deaths are preventable with better care has catalyzed numerous sepsis performance improvement initiatives in hospitals around the world. The extent to which sepsis-associated deaths in adults might be preventable, however, is unknown.”
They also pointed out that sepsis-associated mortality may not be as preventable as previously considered. “Sepsis disproportionately affects patients who are elderly, have severe comorbidities, and have impaired functional status. Some of these patients may receive optimal, guideline-compliant care yet still die due to overwhelming sepsis or from their underlying disease,” they wrote.
The researchers acknowledged that their conclusions are at odds with earlier studies that have shown positive outcomes from efforts to improve sepsis care.
“Our findings are notable in light of many sepsis quality improvement initiatives that reported substantial decreases in mortality rates after implementation of sepsis care improvement initiatives. These studies imply that many sepsis-associated deaths are preventable,” they stated.
They outlined two possible explanations for the discrepancy: Hospitals may have already improved sepsis care, which impacted the preventability of sepsis-associated deaths. Also, sepsis-care improvement initiatives may have overestimated the impact on mortality. A common element of improvement initiatives is better recognition of sepsis, which leads to identification of more subtle cases of the infection and the impression of lower mortality rates, the authors explained.
To decrease sepsis-associated deaths, hospitals may have to expand the scope of care for patients afflicted with the infection, the researchers wrote, cautioning that “Our findings do not diminish the importance of trying to prevent as many sepsis-associated deaths as possible, but rather underscore that most fatalities occur in medically complex patients with severe comorbid conditions.”
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