News: Most sepsis-related deaths caused by severe coexisting conditions, study suggests

On an annual basis, sepsis affects about 1.7 million American adults. The infection is reportedly linked to more than 250,000 deaths.

But new research says sepsis may not be true cause of the majority of those deaths. The research published in the Journal of the American Medical Association (JAMA) states that in most of cases, the “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 reviewed the case histories of more than 500 randomly selected patients from six academic medical centers and community hospitals who either died in the hospital or were discharged to hospice care, HealthLeaders Media reported. The case history reviews generated several key findings.

• 300 of the patients were afflicted with sepsis and the infection was the immediate cause of death in 198 of those patients, or 34.9% of the total study cohort
• The second most common immediate cause of death was cancer, which claimed 92 patients, or 16.2% of the total study cohort
• The third most common immediate cause of death was heart failure, which claimed 39 patients, or 6.9%
• For the 300 patients with sepsis, the top underlying causes of death were solid cancer (63 patients), chronic heart disease (46 patients), hematologic cancer (31 patients), dementia (29 patients), and chronic lung disease (27 patients)
• 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, according to HealthLeaders Media.

“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,” the researchers wrote.

Sepsis-associated mortality may not be as preventable as previously considered, they wrote.

“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.”

The researchers acknowledge that their conclusions are at odds with earlier studies that have shown positive outcomes from efforts to improve sepsis care, HealthLeaders Media reported.

“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,” the researchers wrote.

They say there are two possible explanations for the discrepancy.

• The hospitals in the JAMA study had already improved sepsis care, thus affecting the preventability of sepsis-associated deaths.
• Sepsis-care improvement initiatives have over-estimated their effect on mortality. A common element of these 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.

To decrease sepsis-associated deaths, hospitals may have to expand the scope of care for patients afflicted with the infection, the researchers wrote.

“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.”

Editor’s note: This article originally appeared in HealthLeaders Media. To read the full JAMA study, click here. To read about one of the contrary studies about improving sepsis mortality, click here.