Sepsis is a leading cause of death in hospitals, spurring investigations into how preventable it might be.
But according to research published in JAMA Network Open Friday, significant innovation is needed before it can really be addressed.
That's because most patients who die of sepsis also have multiple underlying conditions. These conditions are often potentially deadly, and frequently make patients eligible for hospice care. In fact, many of the patients who ultimately die of sepsis have been transferred between hospice and the hospital.
"Patients with sepsis who died or were discharged to hospice frequently had severe underlying diseases such as cancer, dementia, or heart failure. In addition, in the study cohort, 40.4% of patients who died with sepsis had a hospice-qualifying condition on admission, illustrating the prominent role of chronic illness as a risk factor for sepsis," Laura Evans, M.D., wrote in an invited commentary accompanying the article.
While sepsis was the immediate cause of death for 35% of the cases researchers studied, those patients had a variety of other underlying conditions. Over half had pneumonia and the rest had other infections, such as intra-abdominal infections and endovascular ones.
Meanwhile, sepsis was present and considered an important factor in many patients who died of another condition. Solid cancer killed 21% of these patients, chronic heart disease killed 15.3% and hematologic cancer killed 10.3%. Most of these patients died in the ICU or an inpatient ward.
As a result, researchers concluded that the vast majority of these deaths were not preventable with superior care. Around 1 in 8 sepsis-related deaths were considered even potentially preventable, but only 1 in 25 were definitely preventable.
"Suboptimal sepsis care, such as delays in antibiotic administration or source control, were identified in 22.7% of patients with sepsis who died, but death was still thought to be unpreventable in more than half of those patients," researchers wrote.
Sepsis is caused by the body's response to an infection, but it can overwhelm and prevent a patient's recovery. It can lead to septic shock, which causes blood pressure to drop and can kill the patient.
But this isn't easily preventable if patients have other complex conditions at the same time, researchers wrote. Therefore, they said more work needs to be done on managing coexisting serious conditions before the sepsis problem can be solved.
"Our findings do not diminish the importance of trying to prevent as many sepsis-associated deaths as possible, but rather underscore that most fatalities occur in medically complex patients with severe comorbid conditions. Further innovations in the prevention and care of underlying conditions may be necessary before a major reduction in sepsis-associated deaths can be achieved," they wrote.