What happens when bacteria invade the bloodstream? One of the more devastating outcomes is sepsis, or septicemia.
Patients with sepsis present with symptoms ranging from shaking to confusion – but the most dangerous indication is a rapid drop in blood pressure, which can cause a patient to go into septic shock, or life-threatening organ dysfunction. Incidence of sepsis is on the rise. It is one of the leading causes of in-hospital mortality risk, and consistently ranks among the most expensive conditions treated in hospitals in the United States and around the world.
Despite its prevalence, sepsis remains an enigma in many ways. It is not a single disease, but a syndrome with a constellation of causes and significant variation in how it affects individuals. As scientific understanding of the syndrome advances, definitions and diagnoses are evolving rapidly, making it difficult for insurers to identify underlying trends and for physicians to differentiate an uncomplicated infection from the beginnings of the syndrome. Healthcare providers are now emphasizing early detection and establishing consistent and standardized interventions.
RGA’s Dr. Daniel Zimmerman has presented at industry events on this subject. We sat down with Dr. Zimmerman to discuss the causes of sepsis and the consequences for insurers as the medical community develops a deeper understanding of this complex syndrome.
Since sepsis was first defined as a syndrome, clinical guidelines have changed multiple times. What can underwriters learn from these evolving definitions?
Various medical groups have attempted to define sepsis clinically in order to allow for a more rapid identification of the syndrome and earlier intervention – actions which help to reduce associated morbidity and mortality. The definition continues to evolve because so much is still being discovered regarding the causes and treatments of sepsis and much more remains to be learned.
Hospitalization rates for sepsis more than doubled from 2000 to 2008. But while incidence of sepsis is on the rise, mortality appears to be declining. Why?
First of all, there are many reasons for the increasing incidence rates. These include an aging population, individuals with more “co-morbid” conditions that heighten susceptibility, and increasing resistance to antibiotics by different kinds of bacteria, just to name a few. As you note, despite these higher incidence numbers, mortality rates from sepsis are in decline. This is likely due to improved early detection and treatment of sepsis and overall reduced mortality rates for patients admitted to the ICU, in general.
You describe sepsis as a syndrome, or a continuum of disease, rather than a single diagnosis. Why is sepsis so difficult to diagnose? How do clinicians determine which patients are at highest risk and require more invasive treatments?
Since sepsis can present anywhere on a broad continuum of clinical manifestations, doctors and nurses may not always recognize sepsis, especially the early stages. For example, what appears to be a relatively mild, community-acquired pneumonia may evolve into sepsis over the course of a few hours. Fortunately, new rapid assessment tools, such as the quick SOFA [Sequential Organ Failure Assessment] score, are being developed to assist medical providers in identifying patients who may be at risk of developing sepsis or are already experiencing symptoms on the sepsis spectrum.
You note that no two patients present sepsis in exactly the same way, but are there any factors that can influence survival after a sepsis diagnosis across patient populations?
I think two of the most important factors that favorably influence survival are the early recognition and immediate treatment of sepsis and, if necessary, transfer to a hospital facility with excellent ICU care. Sepsis now is treated with the same urgency as heart attack and stroke – rapid diagnosis and treatment are essential.
Treating severe sepsis leads to significant resource use in intensive care units (ICUs), and sepsis ranks among the leading causes of unplanned hospital readmission within 30 days. As the population ages moving forward, the number of cases seems likely to increase. What should insurers know about sepsis cost trends?
Sepsis is an extremely costly medical expenditure, whether it occurs during the initial hospital admission or leads to a readmission. Insurers should partner with all stakeholders in the healthcare system to ensure early sepsis identification and immediate treatment protocols are employed. By doing so, a win-win scenario can result in which patients benefit and insurers’ costs are controlled through reduced length of hospital stay and quicker patient recovery.
What is the role of anti-microbial resistance in the spread of sepsis?
As I mentioned earlier, anti-microbial resistance may be one of the reasons that the incidence of sepsis is increasing. While this may not be playing a big role at this time, there is concern that this problem will become more prominent in the future. Unfortunately, as more infections become resistant to all available antibiotics, we will likely see a greater number of patients with relatively “routine” infections that might progress to sepsis since the underlying infection cannot be treated.
