Sepsis mortality likely unpreventable with better hospital care

Sepsis is a leading cause of mortality in U.S. hospitals. However, most of these deaths are unlikely to be prevented with better care in hospitals, according to a new study published in JAMA Network Open. 

“Sepsis disproportionately affects patients who are elderly, have severe comorbidities, and have impaired functional status,” wrote lead author Chanu Rhee, MD, MPH, of Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston. “Some of these patients may receive optimal, guideline-compliant care yet still die due to overwhelming sepsis or from their underlying disease.”

Interestingly, researchers at both the Massachusetts Institute of Technology and Imperial College of London have developed AI-based systems in an effort to curb fatal outcomes in patients with sepsis. 

Sepsis-associated deaths are difficult to distinguish from administrative data and death certificates because hospital discharge codes do not designate whether the death was caused by sepsis, Rhee and colleagues noted. Furthermore, death certificates are often completed incorrectly. 

In this retrospective study, researchers sought to determine the prevalence of sepsis-associated mortality in acute hospitals and also establish the preventability of such deaths. They assessed medical records of 568 randomly selected adults who were admitted to six U.S. academic and community hospitals from January 1, 2014 to December 31, 2015. Patients in the cohort had died in the hospital or were discharged to hospice and not readmitted. 

The researchers reviewed the cases for sepsis during hospitalization and also rated the preventability of each sepsis-associated death on a 6-point Likert scale.

Rhee et al. found sepsis was present in approximately 53 percent of hospitalizations and was the immediate cause of death in 35 percent of those cases. 

The most common underlying cause of death in patients with sepsis were solid cancer (21 percent), chronic heart disease (15 percent), hematologic cancer (10 percent), dementia (9.7 percent) and chronic lung disease (9 percent). Their assessment also showed:

  • 4 percent of sepsis-associated deaths were potentially preventable through better hospital-based care.
  • 8 percent of sepsis-associated deaths were judged as “definitely” or “moderately” preventable.
  • 40 percent of sepsis-associated deaths had hospice-qualifying conditions, most commonly end-stage cancer.
  • 23 percent of sepsis-associated cases occurred because of suboptimal care—including delays in antibiotics.

The researchers noted their findings do not reduce the importance of trying to prevent sepsis-related deaths. They do highlight that most deaths occur in “medically complex” patients with severe comorbid conditions. Preventing sepsis itself is also important, as previous research has shown patients exhibiting sepsis are at a greater risk for heart attack and stroke in the four weeks following hospital discharge. 

“Further innovations in the prevention and care of underlying conditions may be necessary before a major reduction in sepsis-associated deaths can be achieved,” Rhee et al. concluded.