Penn study: Sepsis patients fare better in hospitals with higher case volumes

Results suggest value of regionalized severe sepsis care centers

2014-09-03

(Press-News.org) PHILADELPHIA – Patients with sepsis, one of the most time-sensitive and hard-to-detect illnesses in medicine, are more likely to survive the life-threatening condition when treated at a hospital that sees a higher volume of sepsis cases. New research from the Perelman School of Medicine at the University of Pennsylvania shows a clear relationship between hospitals that treat the most cases of severe sepsis and lower rates of inpatient deaths among those patients. The study, led by David F. Gaieski, MD, an associate professor of Emergency Medicine at Penn, is published online in the American Journal of Respiratory and Critical Care Medicine.

"One of the main barriers to treatment of sepsis is recognizing its early stages, since the symptoms are non-specific and often similar to those of a viral infection. However, early diagnoses and treatment are key to surviving sepsis and it may be that physicians at hospitals that see a larger volume of patients with severe sepsis are more attuned to these non-specific symptoms and have put protocols in place to aid in the detection of these critically ill patients," Gaieski said. "Our results provide preliminary support for the idea that severe sepsis patients may benefit from treatment at higher-volume specialty centers much the same as the reality that patients who've suffered severe injuries are brought to designated trauma centers and those who've had strokes typically come to certified stroke centers."

Sepsis is an illness caused by the body's inflammatory and anti-inflammatory responses to bacteria and other pathogens, including viruses and fungi — so it's not solely caused by the pathogens themselves, but also by the cytokines the body releases in response to the pathogens. A bacterial infection anywhere in the body may set off the response that leads to sepsis, which can then cause blood pressure to drop, and major organs and body systems to stop working properly because of poor blood flow. Not only is severe sepsis becoming more common, but the in-hospital mortality rate can be as high as 38 percent, and the illnesses costs the United States health system approximately $24 billion annually. The Centers for Disease Control and Prevention (CDC) currently lists septicemia as the 11th leading cause of death in the U.S., and the burden is expected to increase as the population ages.

The recent Penn study looked at hospital admissions — examining the relationship between annual case volume, urban location, organ dysfunction and survival — over a seven year period (2004-2010) among a total of 914,200 patients with severe sepsis, culled from the largest national database of publically available inpatient information. The study found an inverse relationship between severe sepsis case volume and inpatient mortality, in both urban and rural hospitals. Overall in-hospital mortality was 28 percent, but the study found that patients treated at higher-volume hospitals (those who treated 500 or more cases per year) had a 36 percent increase in their odds of inpatient survival compared to those treated at lower-volume hospitals (less than 50 cases per year). Typically, the highest volume hospitals are academic medical centers, which tend to be located in urban areas.

The study also examined the association between inpatient severe sepsis mortality and organ dysfunction type, finding that the most common organ system dysfunctions were renal, respiratory and cardiovascular. Additionally, the study found that mortality from severe sepsis increased as the number of organ dysfunctions increased.

Severe sepsis treatment efforts in the Hospital of the University of Pennsylvania's (HUP) emergency department have been focused on early measurement of serum lactate — which can help indicate whether enough oxygen is being delivered to tissues in the body — as a marker of impending shock. The results are then used to identify potentially critically ill patients more quickly and then deliver protocolized resuscitation during their first hours in the hospital. Since these new protocols were adopted in 2005, Gaieski says that deaths among severe sepsis patients admitted to HUP through the emergency department dropped from 24 percent in 2005 to 11 percent in 2009.

"While it's important that we are getting it right at our tertiary care center, this paper highlights the variability in outcomes across the U.S. The real question here is: can we take the critical next step of disseminating best practices from high performing centers to the rest of the health care system?" says Brendan Carr, MD MS, assistant professor of Emergency Medicine and Epidemiology and senior author on the study. "We need large scale strategies that ensure the best possible outcome for critically ill patients no matter where they are when they get sick. We've built good systems for a few conditions that require early aggressive diagnostics and intervention — like trauma and stroke — but our response to the unplanned critically ill patient requires us to cooperate across public health, public safety and most importantly, competing healthcare systems."

INFORMATION: The study's other Penn authors included Michael Kallan, MS, and Mark Mikkelsen, MD, MSCE. The study was supported by an unrestricted educational grant from the Beatrice Wind Gift Fund. Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2013 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2013, Penn Medicine provided $814 million to benefit our community. CONTACT: Anna Duerr
O: (215) 349-8369
C: (215) 796-4829
anna.duerr@uphs.upenn.edu

ELSE PRESS RELEASES FROM THIS DATE:

Pesticide risk assessments seen as biased

2014-09-03

In the October issue of BioScience, a group of ecotoxicologists argue that the US Environmental Protection Agency's (USEPA) current practices for evaluating pesticide safety are inadequate and likely to result in decisions biased toward industry interests. In their article, Michelle Boone of Miami University and her colleagues note that most pesticide toxicity tests used in risk assessments are conducted by pesticide manufacturers themselves, which the authors believe can result in untenable conflicts of interest. Moreover, rigid inclusion criteria often mean that potentially ...

Seizures and sudden death: When SUMO 'wrestles' potassium channels

2014-09-03

A gene crucial for brain and heart development may also be associated with sudden unexplained death in epilepsy (SUDEP), the most common cause of early mortality in epilepsy patients. Scientists at The University of Texas MD Anderson Cancer Center have created a new animal model for SUDEP and have shown that mice who have a partial deficiency of the gene SENP2 (Sentrin/SUMO-specific protease 2) are more likely to develop spontaneous seizures and sudden death. The finding occurred when observing mice originally bred for studying a link between SENP2 deficiency and cancer. "SENP2 ...

Researchers unlock new mechanism in pain management

2014-09-03

It's in the brain where we perceive the unpleasant sensations of pain, and researchers have long been examining how calcium channels in the brain and peripheral nervous system contribute to the development of chronic pain conditions. Neuroscientist Gerald Zamponi, PhD, and his team at the University of Calgary's Hotchkiss Brain Institute have discovered a new mechanism that can reverse chronic pain. Using an animal model, their research has found that pain signals in nerve cells can be shut off by interfering with the communication of a specific enzyme with calcium ...

Changing temperature powers sensors in hard-to-reach places

2014-09-03

A centuries-old clock built for a king is the inspiration for a group of computer scientists and electrical engineers who hope to harvest power from the air. The clock, powered by changes in temperature and atmospheric pressure, was invented in the early 17th century by a Dutch builder. Three centuries later, Swiss engineer Jean Leon Reutter built on that idea and created the Atmos mechanical clock that can run for years without needing to be wound manually. Now, University of Washington researchers have taken inspiration from the clock's design and created a power ...

Tweets during 2013 Colorado floods gave engineers valuable data on infrastructure damage

2014-09-03

Tweets sent during last year's massive flooding on Colorado's Front Range were able to detail the scope of damage to the area's infrastructure, according to a study by the University of Colorado Boulder. The findings can help geotechnical and structural engineers more effectively direct their reconnaissance efforts after future natural disasters—including earthquakes, tsunamis and tornadoes—as well as provide them data that might otherwise be lost due to rapid cleanup efforts. "Because the flooding was widespread, it impacted many canyons and closed off access to communities ...

Galapagos invasion is global warning

2014-09-03

A new study led by a PhD researcher at The University of Western Australia has revealed that parts of the iconic Galapagos Islands have been overrun by invasive plants from other parts of the world. "People may be shocked that a place considered so iconic for biodiversity is so overrun with weeds in some areas despite ongoing control effort by National Park rangers, but this is really a global story," lead author from the UWA School of Plant Biology Mandy Trueman said. The results published in the open access journal Neobiota confirm that in the humid highland part ...

Peptoid nanosheets at the oil-water interface

2014-09-03

From the people who brought us peptoid nanosheets that form at the interface between air and water, now come peptoid nanosheets that form at the interface between oil and water. Scientists at the U.S. Department of Energy (DOE)'s Lawrence Berkeley National Laboratory (Berkeley Lab) have developed peptoid nanosheets - two-dimensional biomimetic materials with customizable properties - that self-assemble at an oil-water interface. This new development opens the door to designing peptoid nanosheets of increasing structural complexity and chemical functionality for a broad ...

How well does bariatric surgery work?

2014-09-03

SEATTLE—The number of bariatric surgeries done each year in the United States has ballooned. Now, in an August 27 state-of-the-art review in The BMJ and a September 3 editorial in JAMA, David Arterburn, MD, MPH, weighs the evidence on the benefits and risks of the various types of this surgery. "It's critical that we find effective—and cost-effective—ways to treat severe obesity," said Dr. Arterburn, an associate investigator at Group Health Research Institute, a Group Health physician, and an affiliate associate professor of medicine at the University of Washington School ...

Are human breast milk microbiomes 'neutral'?

2014-09-03

Human breast milk is considered the most ideal source of nutrition for infants and it should have played a critical role in the evolution and civilizations of human beings. Unlike our intuitive perception, human milk contains a large number of bacterial species, including some opportunistic pathogens of humans. This phenomenon comes as no surprise to scientists and physicians. Indeed, the existence of milk microbiome is considered to be the result of co-evolutionary and co-adaptive interactions between the microbiome and human host. Furthermore, the dynamic balance in ...

The Lancet Respiratory Medicine: Household air pollution puts more than 1 in 3 people worldwide at risk of ill health and early death

2014-09-03

Household air pollution, caused by the use of plant-based or coal fuel for cooking, heating, and lighting, is putting nearly three billion people worldwide at risk of ill health and early death, according to a new Commission, published in The Lancet Respiratory Medicine journal. A third of the world's population use plant-based solid fuels such as wood or charcoal, or coal, to cook, heat, and light their homes, primarily in Asia and Africa. These smoky, dirty fuels are often used in an open fire or simple stove, resulting in high levels of household air pollution in poorly ...

Penn study: Sepsis patients fare better in hospitals with higher case volumes

ELSE PRESS RELEASES FROM THIS DATE:

LAST 30 PRESS RELEASES: