How preventable is sepsis-related death?

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How preventable is sepsis-related death?
How prevalent and preventable is death from sepsis? A new study, recently published in the journal JAMA Network Open, investigates.
woman on hospital bed looking at her friend
New research reviews the care that people receive when hospitalized for sepsis.

Sepsis is a potentially fatal condition that develops from the body’s overactive response to an infection.

According to the National Institute of General Medical Sciences, over 1 million people in the United States develop severe sepsis each year, and 15–30 percent of these people die as a result.

Other studies estimate that sepsis may contribute to over 250,000 deaths every year. But what precisely is the role of sepsis in these deaths and how many of them are preventable?

A team of researchers led by Dr. Chanu Rhee, a critical care physician at the Brigham and Women’s Hospital in Boston, MA, set out to investigate.

Dr. Rhee and colleagues carefully reviewed the clinical management of people who died with sepsis and reached some interesting conclusions.

Reviewing cases of sepsis death

The researchers examined the medical records of 568 people from six acute care hospitals between January 2014 and December 2015. The individuals included in the study either died in the hospital or hospice care.

Dr. Rhee and his team of clinicians used a standardized form to review the medical records of these patients.

The researchers looked for the presence of sepsis, comorbidities, “immediate and underlying causes of death,” indicators of inadequate sepsis care, such as inappropriate or late administration of antibiotics, “inadequate source control,” and the goals of care for each patient.

Using a 6-point Likert scale, the clinicians evaluated the preventability of each sepsis-related death. The scale ranged from “definitely preventable” to “definitely not preventable owing to rapidly fatal illness present on admission or goals of care on admission that precluded aggressive care.”

90 percent of deaths not preventable

The study confirmed that sepsis is highly present in hospitals and that it contributes significantly to patient deaths.

More than half of all terminal hospitalizations had sepsis, and the condition was the immediate cause of death in 198 people — almost 35 percent of them.

Importantly, however, the analysis also found that almost 90 percent of the deaths that resulted from sepsis were unpreventable, at least from the point of view of hospital-based care.

According to the review, only 1 in 8 sepsis-related deaths were deemed “potentially preventable with better hospital-based care,” and only 1 in 25 were judged “moderately” or “definitely” preventable.

In the few cases where suboptimal care was the reason why sepsis turned fatal, the most common causes were late antibiotic administration or source control.

Why do people still die from sepsis?

So why are some sepsis-induced deaths still not preventable? “Our findings do not diminish the importance of trying to prevent as many sepsis-associated deaths as possible,” conclude the authors, “but rather underscore that most fatalities occur in medically complex patients with severe comorbid conditions.”

In other words, most of the patients included in the study were older and had several other co-occurring chronic conditions, such as cancer, heart disease, and lung disease.

“Sepsis is a leading cause of death,” explains Dr. Rhee, “but since most of these deaths are occurring in very complex patients with severe comorbidities, many of them may not be preventable with better hospital-based care.”

“For me, as a critical care physician,” continues the senior investigator, “that resonated with what I see in my clinical practice. A lot of sepsis patients we treat are extremely sick, and even when they receive timely and optimal medical care, many do not survive. It was important for me to see that borne out of the more rigorous study we did.”

“The point of this study is not to diminish the importance of sepsis quality-improvement issues in hospitals — even one preventable death is too much,” adds Dr. Rhee.

But, the researchers highlight the fact that their study does not account for all the other cases in which adequate hospital care did prevent death. However, “further innovation in the prevention of underlying conditions might be necessary before we can see a really large reduction in sepsis mortality,” concludes Dr. Rhee.

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