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What is Sepsis?

Sepsis is a common and frequently fatal medical condition that is the result of the body's inflammatory response to an infection. Angus, D. et al., reported in Critical Care Medicine that 751,000 severe sepsis cases occurred in the US in 1995 and mortality was 28.6%, or 215,000 deaths nationally.

Hall, M.J. et al., reported in a Centers for Disease Control and Prevention (CDC) NCHS Data Brief that US hospitalizations for septicemia or sepsis as the principal or a secondary diagnosis increased from 621,000 in 2000 to 1,141,000 in 2008 (ICD-9-CM diagnosis codes of 038.xx, 995.91 and 995.92). In 2009, septicemia or sepsis was the single most expensive condition treated in U.S. hospitals. Costs for stays with a principal diagnosis of septicemia totaled nearly $15.4 billion.

Sepsis is defined as a documented or suspected infection together with two or more systemic inflammatory response syndrome (SIRS) criteria (see table below).

SIRS and Sepsis Definition (American College of Chest Physicians (ACCP)/Society of Critical Care Medicine (SCCM)-criteria)
SIRS (Systemic Inflammatory Response Syndrome)	2 or more of the following criteria: Temperature >38 °C or <36 °C Heart rate >90 beats/min Respiratory rate >20 breaths/min or PaCO₂ <32 torr (<4.3 kPa) WBC >12,000 cells/mm³, <4000 cells/mm³, or >10% immature (band) forms
Sepsis	Documented or suspected infection together with 2 or more SIRS criteria.
Severe Sepsis	Sepsis associated with organ dysfunction, including, but not limited to, lactic acidosis, oliguria, hypoxemia, coagulation disorders, or an acute alteration in mental status.
Septic Shock	Sepsis with hypotension, despite adequate fluid resuscitation, along with the presence of perfusion abnormalities. Patients who are on inotropic or vasopressor agents may not be hypotensive at the time when perfusion abnormalities are detected.

The importance of early intervention

Early identification and intervention is crucial to improving sepsis outcomes. A retrospective study by Kumar, A. et al., (1989 - 2004) showed that administration of an effective antimicrobial therapy within the first hour of documented hypotension was associated with a survival rate of 79.9%. Each hour of delay in antimicrobial administration over the ensuing 6 hours was associated with an average decrease in survival of 7.6%. However, early identification of sepsis can be challenging due to its non-specific symptoms.

References

Angus DC, et al., Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29(7):1303-1310.

Hall MJ, et al., Inpatient Care for Septicemia or Sepsis: A Challenge for Patients and Hospital. CDC NCHS Data Brief; June 2011; 62.

Elixhauser A, et al., Septicemia in U.S. Hospitals, 2009. HCUP Statistical Brief #122, October 2011, Agency for Healthcare Research and Quality, Rockville, MD., http://www.hcup-us.ahrq.gov/reports/statbriefs/sb122.pdf

American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992; 20(6):864-74.

Levy M, et al., 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31(4):1250-56.

Kumar A, et al., Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34(6):1589-1596.

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