Growing Burden of Sepsis Projected to Rise Higher

Season Osborne

March 20, 2020

With an estimated 1.7 million Americans developing sepsis each year and nearly 270,000 dying from it, concern is escalating that the burden of sepsis, which cost more than $62 billion in 2019, according to estimates based on the largest-ever study of sepsis in Medicare beneficiaries, could rise even higher in 2020 in the backdrop of the COVID-19 pandemic.

"The burden of sepsis in this country is enormous," said Kimberly Sciarretta, PhD, manager of the Solving Sepsis program at the Biomedical Advanced Research and Development Authority (BARDA). And the elderly, people with chronic conditions, and those with compromised immune systems — the groups most at risk for poor outcomes related to COVID-19 — are often hardest hit.

Researchers at BARDA and the Centers for Medicare and Medicaid Services joined forces "to understand the contemporary burdens of sepsis in the Medicare population and the contemporary costs," Sciaretta explained.

She and her colleagues looked at data for almost 9.6 million sepsis patients admitted to acute care hospitals from January 2012 to December 2018.

During that 7-year period, the number of fee-for-service Medicare beneficiaries hospitalized with sepsis increased about 40%, while the increase in the Medicare population was just 22%.

Medicare costs for hospitalization and nursing care rose, too, from $27.7 billion in 2012 to more than $41.5 billion in 2018, Sciarretta reported during her presentation at Society of Critical Care Medicine 2020 Critical Care Congress in Orlando, which coincided with publication of the data in Critical Care Medicine.

"There is no definitive test for sepsis, and measuring rates is challenging," said Runa Gokhale, MD, a medical officer at the Center for Disease Control and Prevention (CDC).

The "CDC has a national education campaign, Get Ahead of Sepsis, to help raise awareness about the importance of early recognition and timely treatment, as well as the importance of preventing infections that could lead to sepsis," she explained.

Get Ahead of Sepsis

The program targets patients, healthcare professionals, and the general public, specifically adults 65 years and older, and the CDC is developing tools to track sepsis.

Because it is so important to identify sepsis early, BARDA is partnering with industry and academia to develop and invest in novel diagnostic technologies, some of which focus on the patient's response to the pathogens, rather than the pathogen itself, Sciarretta explained. These diagnostics are being used in emergency departments, which are often the first point of contact between patients with sepsis and the healthcare system.

One surprise revealed by the analysis is the large number of people who present to the hospital with sepsis, said Sciarretta.

Many think sepsis is a hospital-acquired infection. In fact, the majority of cases of sepsis arrived at the hospital.

"This is a very important point that's often misunderstood," she told Medscape Medical News. "Many think sepsis is a hospital-acquired infection. In fact, the majority of cases of sepsis arrived at the hospital."

The rate of sepsis cases that arrived at the hospital increased from 87% in 2012 to 93% in 2018. In contrast, after a concerted effort by hospital staff and regulators, the rate of hospital-acquired sepsis has actually gone down, she reported, from 13.0% in 2012 to 7.5% in 2018.

Three-year mortality rates were also a surprise. For those who experienced septic shock, the 3-year rate was 75%, and for those who experienced nonsevere sepsis, it was 60%. In comparison, the 3-year mortality rate for patients hospitalized for causes unrelated to sepsis was 40%.

"Even if they survive sepsis, the high incidence of mortality was reported even after 3 years. That is something I don't think anyone fully grasped," said Sciarretta. "We need to monitor these patients and make sure we are paying attention to them once they've recovered."

Crit Care Med. 2020;48:276-288, 289-301, 302-318. Part 1, Part 2, Part 3

Society of Critical Care Medicine (SCCM) 2020 Critical Care Congress.

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