Sepsis has recently been attracting significant attention from both medical and non-medical communities. The condition is now considered a medical emergency of equal importance with myocardial infarction (MI) and stroke. The early warning signs and symptoms of the latter two are well known to the public and have established emergency treatment protocols. With sepsis, the medical community is strengthening education for the general public about its risks, but work remains to be done. However, there is now a growing consensus among health care professionals that sepsis protocols are beneficial and can provide both life- and cost-saving outcomes.
Somewhat controversially, implementation of sepsis protocols is being mandated by some U.S. states in an attempt to decrease its mortality rate.
One of the great difficulties in assessing, diagnosing and treating sepsis has been its ever-changing medical definition. As sepsis’ pathobiology becomes clearer and medical understanding evolves, so too does its definition. Sepsis does not have one etiology and one clinical manifestation: it is a syndrome with varying findings, and no gold standard diagnostic test yet exists.
The many and diverse definitions sepsis has had over the years has made it difficult to track and observe its true epidemiology, thus complicating analysis and comparison of clinical studies on the condition.
In 2016, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)2 was released – the first revision of sepsis definitions since 2001. It defines sepsis as “life-threatening organ dysfunction caused by a dysregulated host response to infection,” and septic shock as “a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality.”
The Sepsis-3 clinical definitions are shown in Table 1.
It is hoped that these new definitions will enable better case definition, leading to earlier identification of sepsis, rapid and goal-directed clinical intervention, improved outcomes, and better standardization of epidemiologic and research data.
Historically, most incidence studies of sepsis were done using insurance claims data, due to its greater availability. However, due to coding issues and the changing definitions of sepsis over time, the reliability and comparability of past studies is questioned. Additionally challenging is the fact that incidence rates and trends vary between Western and low- and middle-income countries,3 making comparisons more difficult. Nonetheless, most studies would suggest that incidence rates have been increasing for at least 10 years. Speculation of cause include an aging population, increasing use of immunosuppressive therapies, and individuals in general having more comorbid conditions. A recent study, however, which compared clinical and claims data from 2009 through 2014, demonstrated no increased incidence based on clinical data. Claims data, however, suggested a 10% per year increase over that same period. The study’s authors emphasized the importance of using clinical data to establish more accurate incidence trends.4 If incidence rates are truly increasing, health insurers and medical reimbursement policies will clearly be impacted. In addition, since sepsis is one of the costliest medical conditions to treat, given the high likelihood of intensive care unit admissions and prolonged hospital stays, stop-loss portfolios may be increasingly affected as well.
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