Google “leading cause of death in the United States” and right there in the top spot, page one, is a link to the Centers for Disease Control and Prevention (CDC), which declares heart disease the winner.(1) Yet, the American Association for Clinical Chemistry (AACC) passes this rank to sepsis. In its special sepsis issue of The Journal of Applied Laboratory Medicine, the AACC states that sepsis kills more people in the U.S. than heart attacks every year.(2)
Let’s turn to the numbers.
- According to CDC, around 1.7 million Americans develop sepsis each year, with about 270,000 dying from the disease annually.(3)
- The American Heart Association states that cardiovascular disease is the underlying cause of about 1 in 3 deaths (nearly 836,546 deaths) each year in the U.S.(4)
So it’s roughly 270,000 vs. 836,564. That makes cardiovascular disease the clear number one killer. What’s going on here?
It turns out that physicians face significant challenges when it comes to identifying sepsis – let alone citing the life-threatening disease as cause of death.
- A 2016 CDC study(5) reveals that varying – and fuzzy – estimates in sepsis-related mortality rates are frequently due to a death certificate requirement. Death certificates indicate a specific disease or injury that initiated a series of events that led to death. This specific disease or injury becomes the underlying cause of death. Because sepsis is often viewed as the final common pathway, rather than the initial underlying cause of death, it’s often omitted from the death certificate.
- Many sepsis symptoms(6), such as fever, rapid breathing, rash, heart rate, disorientation, and difficulty breathing, are common in other conditions – including heart disease (5). This makes an early-stage sepsis diagnosis difficult and easy to confuse with other possible diagnoses.
- The current definition(7) of sepsis remains complicated and difficult to apply in a clinical setting.
- Identifying the best sepsis screening tools(7) and refining a biomarker to definitively identify patients who have sepsis remains elusive.
- Diagnosing sepsis in patients with altered physiology(7), such as infants or pregnant and early postpartum women, poses yet another challenge – as clinical features may be non-specific.
A Quick Refresher
According to the AACC, sepsis occurs when there is an exaggerated reaction by the immune system to an infection, such:
- The flu
- Pneumonia
- Skin infection
- Urinary tract infection
- Infection in the bloodstream
- Infection in the digestive system
These infections may be viral, bacterial, or fungal.
Sepsis progresses to septic shock when specific changes in the circulatory system, the cells of the body, and the way the body utilizes energy become increasingly abnormal(8). In severe cases, one or moreorgans collapse. In the most critical cases, a drop in blood pressure occurs and the heart becomes weak. It’s at this point that the patient begins to go into septic shock and multiple organs,(6) such as the lungs, kidneys, and/or liver, may fail – leading to death.
With no fast, efficient, single test(9) that can definitively say if a patient does or does not have sepsis, consistently diagnosing early-stage sepsis – when it’s most treatable – can feel like a crapshoot. That’s a darn shame, since the survival rate for patients treated during the earliest stage of sepsis is relatively high. At a later stage, which can occur within hours of disease onset, septic shock becomes an issue and the mortality rate increases by 40 to 70 percent(2).
That said, progress is being made. In the last two years, new tests have been implemented that may support early diagnosis and treatment for sepsis. Look out for an even closer look at this topic in next week’s part two, “A Need for Speed – New tests to help diagnose sepsis.”
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Resources
1) Mortality in the United States, 2017
4) Heart Disease and Stroke Statistics 2018 At-a-Glance
6) Sepsis
7) Recognizing and managing sepsis: what needs to be done?
8) Sepsis – Symptoms and causes
9) Testing for Sepsis – Sepsis Alliance
