UPMC, Pitt med school play role in redefining sepsis, shock
February 22, 2016 11:33 PM
University of Pittsburgh
UPMC and the University of Pittsburgh School of Medicine played a central role in three studies updating the 2001 definition of sepsis and septic shock.
By David Templeton / Pittsburgh Post-Gazette
The Greeks first described sepsis in 700 B.C. as an infection leading to organ decomposition and death. Medical science still doesn’t fully understand the syndrome that is the major cause of hospital deaths in the United States.
But now researchers have redefined sepsis and its most severe form of septic shock while creating a diagnostic protocol for the body’s inflammatory over-response to infection that leads to tissue damage and organ failure.
With UPMC and the University of Pittsburgh School of Medicine playing a central role, three studies published online Monday in the Journal of the American Medical Association update the 2001 definition of sepsis and septic shock, with a method to diagnose sepsis at an early stage, allowing for more timely management of the condition and fewer deaths.
It further describes sepsis as a syndrome rather than a disease. Syndromes are medical conditions involving concurrent symptoms.
“Considerable advances have been made in the study and care of sepsis and septic shock in the past 15 years, and there is an urgent need to help the medical community do a better job in identifying septic patients quickly and start lifesaving treatment,” said Derek C. Angus, chairman of Pitt medical school’s department of critical care medicine who was involved in the studies.
Sepsis can result from the body’s inflammatory over-response to bacterial, fungal or viral infections, even after successful antibiotic treatment. The U.S. Centers for Disease Control and Prevention said 1 million people get sepsis each year and as many as half of them die from it. It also notes the difficulty in diagnosing and treating sepsis, which can result from the spread of a minor infection.
The new definition says sepsis is a life-threatening organ dysfunction due to the immune system’s dysregulated (or chaotic) response to infection. Septic shock also is redefined as “a subset of sepsis in which particularly profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone.”
“Our intent is that this definition results in greater consistency for epidemiological studies, clinical trials, and perhaps, most important, better recognition and more timely management of patients with, or at risk of developing, sepsis,” Dr. Angus said.
Two years ago, 19 experts in the European Society of Intensive Care Medicine and the Society of Critical Care Medicine formed a task force to re-examine the definition of sepsis and septic shock, with Dr. Angus and Christopher W. Seymour, assistant professor in the Pitt medical school’s departments of critical care medicine and emergency medicine, serving as participants.
In the JAMA studies, Dr. Seymour was instrumental in defining the diagnostic protocol based on three symptoms — an altered mental status, low blood pressure and a fast respiratory rate. He said that patients with infections who show two of the three symptoms should be considered likely to have sepsis because patients with at least two represent 75 percent of sepsis deaths. Sepsis data from the Veterans Administration and Kaiser Permanente of Northern California were used in the study to develop the diagnostic protocol.
“This is one of the largest collaborative studies ever conducted in the field of critical care medicine,” Dr. Seymour said, noting it represents the first step in “an iterative process” to gain more understanding of sepsis.
Indeed, the studies themselves acknowledge that sepsis is “incompletely understood” with “no simple and unambiguous clinical criteria or biological, imaging or laboratory feature that uniquely identify a septic patient.”
A JAMA editorial written by Edward Abraham, dean of the Wake Forest School of Medicine, said the new definition represents a step forward but also said more information is needed to understand how molecular and cellular alterations lead to organ failure and death, with the discovery of biomarkers for sepsis necessary to improve care and reduce deaths.
“Such evolution will be required to truly transform care for the millions of patients worldwide who develop these life-threatening conditions,” Dr. Abraham said.
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