Following sepsis guidelines saves lives, study finds

Although some physicians have hesitated to follow treatment guidelines for sepsis care, a study published Sunday in the New England Journal of Medicine suggests following guidelines that encourage quicker treatment can reduce patients' odds of dying from the infection.

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According to CDC, sepsis kills more than 258,000 U.S. residents annually. Sepsis results from the body's "overwhelming" response to an infection, and if detected early, it usually can be treated effectively. However, there is no specific test to identify sepsis, and symptoms vary widely.

Moreover, sepsis progresses so quickly that the difference between catching it early and late is often a matter of hours. When the condition progresses to severe sepsis, the mortality rate increases to between 25 and 30 percent. When septic shock occurs, the mortality rate climbs further to 40 to 70 percent.

Study details

For the study, researchers from several institutions, including the University of Pittsburgh School of Medicine and the New York State Department of Health (NYSDOH) examined data spanning from April 1, 2014, to June 30, 2016, on 49,331 patients that visited emergency departments (ED) at 149 hospitals in New York.

The researchers sought to determine the effectiveness of sepsis treatment guidelines, which NYSDOH implemented in 2013. The guidelines are designed to catch and treat sepsis before it progresses and call on providers to:

• Obtain blood cultures from patients;
• Measure patients' serum lactate levels; and
• Administer antibiotics, typically intravenously.

The guidelines recommend that providers complete the protocols within three hours of patients' arrival at the ED. As a result, the protocols have become known as the "three-hour bundle."

Findings

Overall, the study found that for every hour clinicians did not treat a case of sepsis according to the three-hour bundle, the patient's odds of dying increased by between 3 and 4 percent.

According to the study, failing to follow the three-hour bundle increased the risk of death from 11 to 15 percent for a typical 40-year-old patient with septic shock. Similarly, when the protocols were not followed for a 70-year-old patient with more than one serious medical condition, the risk of death rose from 29 to 38 percent, the researchers found.

Further, the researchers found that the longer it took providers to complete the protocols, the higher the risk of patient mortality. The researchers said the findings indicate an association between how timely patients receive treatment and outcomes among patients with sepsis or septic shock.

Reaction

Christopher Seymour, the study's lead author and a critical care and emergency medicine professor at the University of Pittsburgh Medical Center, said the findings show "hospitals really need to [follow sepsis treatment protocols] at the outset, especially at the [ED] when they suspect sepsis," because "it can be lifesaving."

However, hospitals across the country have been slow to implement such protocols, STAT News reports. For instance, Sean Townsend, an intensive-care physician and researcher at Sutter Health, said some of the top hospitals throughout the country comply with sepsis treatment protocols just 60 to 70 percent of the time.

Mervyn Singer, an intensive care medicine professor at the University College London, said the study does not provide enough precise data on individual treatment protocols for hospitals to start adopting them. "I think a three-hour window is reasonable for treating most cases of sepsis, and some may benefit from more aggressive antibiotic treatment," Singer said. However, he added, "The idea that every hour makes a difference forces doctors to think they're racing against time. And I'd argue that that three-hour window for some patients makes no difference whatsoever" (Tedeschi, STAT News, 5/21; Neergaard, AP/Sacramento Bee, 5/21; O'Donnell, USA Today, 5/21; Seymour et al., New England Journal of Medicine, 5/21).