Sepsis Treatment: What this Means for Chances of Survival

First Posted: Mar 18, 2014 03:54 PM EDT

Each year, statistics show that sepsis, the body's response to severe infections, kill more people than breast cancer, prostate cancer and HIV/AIDS combined.

A recent study takes an in-depth look into treatments for the health issue and survival rates. The randomized, clinical trial conducted by experts at the University of Pittsburgh School of Medicine showed that survival rates, even with treatments, are unfortunately, not so high.

"We found no overall differences in two protocolized approaches when compared to conventional treatment. The study provides strong evidence that will have immediate consequences," said Derek C. Angus, M.D., M.P.H., Distinguished Professor and Mitchell P. Fink Chair, Department of Critical Care Medicine at Pitt, and investigator of the study, via a press release. "Many organizations have endorsed structured guidelines for sepsis treatment that often call for invasive devices early in care. But with prompt recognition and treatment of the condition, we found that these approaches do not improve outcomes but do increase the use of hospital resources."

The five-year, multicenter study, called "Protocolized Care for Early Septic Shock," was sponsored by an $8.4 million grant from the National Institute of General Medical Sciences (NIGMS), part of the National Institutes of Health.

"More than 750,000 cases of severe sepsis and septic shock occur in the U.S. each year, most receiving care initially in an emergency department. We've found that if early recognition and treatment happen, one approach to supporting circulation while giving antibiotics is not better than another," said Donald M. Yealy, M.D., a ProCESS investigator and professor and chair of Pitt's Department of Emergency Medicine, via the release.

"ProCESS set out to determine whether a specific protocol would increase the survival rates of people with septic shock. Instead, it showed something far more important-that over the past decade, the care of people with sepsis has significantly improved nationwide," said Sarah Dunsmore, Ph.D., who managed the ProCESS trial for NIGMS. "ProCESS showed that regardless of how the delivery of the interventions was monitored, sepsis patients in these clinical settings are receiving effective treatments."

Between March 2008 and May 2013, researchers note that 1,351 patients had septic shock at 31 U.S. hospital emergency departments who were enrolled in the trial. They were randomly chosen to receive early, goal directed therapy (EGDT), PSC or unusual care over the first six hours of their resuscitation period.

The study showed no differences in outcomes among the three interventions: at 60 days post-intervention, 21 percent of the EGDT group, 18.2 percent of the PSC group and 18.9 percent of the standard care group had died in the hospital. There were also no differences in mortality after 90 days or one year.

"There have been many improvements in the management of sepsis in the past decade. We examined whether giving the medical team step-by-step instructions to monitor and treat the effects of sepsis could improve survival rates as the previous study suggested," Dr. Angus said. "EGDT, PSC and usual care all offer early diagnosis and methods to deliver fluids, restore blood pressure and monitor cardiovascular function; one was not better than the other to treat the condition effectively." Added Dr. Yealy, "We are not suggesting that sepsis care should be delayed or can be limited."

What do you think?

More information regarding the study can be found via the New England Journal of Medicine.

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