Sepsis-Associated Mortality Unlikely to be Prevented Through Enhanced Hospital-Based Care

Most sepsis-associated deaths are caused by severe chronic comorbidities and are unlikely to be prevented through enhanced hospital-based care, according to researchers who published their findings in JAMA.

In this retrospective cohort study, researchers examined the medical records of 568 randomly selected patients (50.9% male, mean age, 70.5) admitted to six US academic and community hospitals from January 2014 to December 2015, and who died in the hospital or were discharged to hospice care without readmittance. They reviewed medical records from January 2017 to March 2018, searching for sepsis-related deaths during hospitalization using Sepsis-3 criteria, hospice-qualifying criteria on admission, immediate and underlying causes of death, and suboptimal sepsis-related care such as inappropriate or delayed antibiotics, poor source control, or other medical errors. They then rated the preventability of each sepsis-related death on a 6-point Likert scale.

Sepsis Caused by Various Comorbidities

Researchers unveiled the presence of sepsis in 300 hospitalizations (52.8%, 95% CI:48.6%-57.0%) and was the leading immediate cause of death in 198 cases (34.9%, 95% CI:30.9%-38.9%). Following sepsis, the second most common immediate causes of death were progressive cancer (92, [16.2%]), and heart failure (39, [6.9%]). Moreover, the most common underlying causes of death in patients with sepsis were solid cancers (63/300 [21%]), chronic heart disease (46/300 [15.3%]), hematologic cancer (31/300 [10.3%], dementia (29/300 [9.7%]), and chronic lung disease (27/300 [9.0%]). Conditions which qualified patients for hospice care were present upon admission in 121 sepsis-associated deaths (40.3%, 95% CI:34.7%-46.1%), and were most commonly attributed to end-stage cancer. Furthermore, suboptimal care, typically the result of delays in antibiotics, was identified in 68 sepsis-related deaths (22.7%). Ultimately, only 11 sepsis-associated deaths (3.7%) were deemed definitely or moderately preventable, with another 25 (8.3%) considered to be possibly preventable.

Preventing Underlying Conditions is Critical

“Sepsis is a leading cause of death,” said Chanu Rhee, MD, MPH, critical care physician at Brigham and Women’s Hospital and lead author of this study, in a press release. “But since most of these deaths are occurring in very complex patients with severe comorbidities, many of them may not be preventable with better-hospital care. For me, as a critical physician, that resonated with what I see in my clinical practice. A lot of sepsis patients we treat are extremely sick, and even when they receive timely and optimal medical care, many do not survive. It was important for me to see that borne out of the more rigorous study we did.”

Dr. Rhee and colleagues will aim to replicate these results in different hospital settings to further elucidate their findings.

“The point of this study is not to diminish the importance of sepsis-quality improvement issues in hospitals – even one preventable death is too much,” Dr. Rhee continued.  “In addition, since we only reviewed medical records for patients who died, our study doesn’t highlight all the other patients with sepsis for whom timely recognition and care in the hospital actually did prevent death. One of the takeaways, however, is that further innovation in the prevention of underlying conditions might be necessary before we can see a really large reduction in sepsis mortality.”