PITTSBURGH -- Severe sepsis, the leading cause of death in America's non-coronary intensive care units (ICUs), is a rapidly growing problem in the United States in terms of the number of patients afflicted by the condition and the complexity of their cases, researchers from the University of Pittsburgh reported Feb. 1 at the 32nd Critical Care Congress in San Antonio, Texas. Investigating trends in severe sepsis over a seven-year period, this study is the first to identify the changing epidemiology of the life-threatening disorder and its potential financial impact on ICUs.
Using hospital discharge data from five states during a seven-year period (1992, 1995 and 1999) and federal population and healthcare data, researchers determined that the annual rate of severe sepsis cases is increasing by 6.2 percent (635,000 cases in 1992, as compared with 965,000 cases in 1999). In addition, the study team observed a 6.9 percent annual increase in the number of complex severe sepsis cases (as defined by more than one organ failure) treated in the ICU. They also noted a slight increase (2.9 percent) in the proportion of severe sepsis patients admitted to ICUs each year, although the overall proportion of ICU severe sepsis cases remained consistent for all years studied, at approximately 50 percent. Changes in the site of infection in sepsis cases in the study were relatively minor, the most notable being respiratory infections (a 4.4 percent increase) and urosepsis (a 2.5 percent decrease).
"The incessant growth of the severe sepsis epidemic in this country ought to be cause for grave alarm," said investigator Derek C. Angus, MD, MPH, FCCP, associate professor of critical care medicine, University of Pittsburgh School of Medicine. "This condition has long been one of medicine's greatest foes, taking more lives each year than breast, colorectal, pancreatic and prostate cancer combined. Mounting numbers and more complex cases will only make severe sepsis a more formidable adversary."
Although the annual incidence of severe sepsis cases increased overall by 6.2 percent, researchers noted a dramatic 40 percent increase in the number of elderly patients (older than 85 years) with the condition. This shift resulted in a one-year increase in the average age of the American severe sepsis patient, from 63 to 64 years of age. However, despite the increases in patient age and case complexity, the study team found that, overall, sepsis-related mortality decreased slightly (approximately 4 percent) over the seven-year period.
"This is the first time we've looked really closely at the changes in the actual patients who make up the towering mountain of severe sepsis statistics in this country," said Angus. "What we found is that the face of severe sepsis is, on the whole, getting older than it used to be. And yet recent improvements in critical care technology have meant some patients appear to have a better chance of evading this too often deadly stalker."
Although the decline in mortality associated with severe sepsis is welcome news, researchers conclude that the increasing complexity of patients' cases, coupled with the advancing age of the typical severe sepsis patient, may necessitate increased use of costly medical procedures to optimize patient survival -- a cause for concern in today's healthcare cost-containment environment. A recent survey by the Society of Critical Care Medicine, in fact, revealed that attempting to control medical costs through so-called "bedside rationing" of services and medications is practiced by nearly two-thirds (74 percent) of critical care providers, and that 43 percent said they would ration the only FDA-approved drug for severe sepsis, drotrecogin alfa (activated), in order to control medical costs.
The University of Pittsburgh School of Medicine is consistently ranked among the nation's leading medical schools. It is one of the university's six Schools of the Health Sciences, which include the schools of Nursing, Dental Medicine, Pharmacy, Health and Rehabilitation Sciences, and the Graduate School of Public Health. Their combined mission is to train tomorrow's health care specialists and biomedical scientists, engage in groundbreaking research that will advance the understanding of the causes and treatments of disease, and to participate in the delivery of care as a partner with the University of Pittsburgh Medical Center.
Source: The University of Pittsburgh