Sepsis Will Kill More People as Compared to Deaths Caused by Heart Attacks and Cancer by 2050, Say Experts

Due to the irrational use of antibiotics, sepsis is a potentially life-threatening complication. It can cause more death by 2050, says doctors and health experts.

Sepsis is a syndromic response to infection and is frequently a final common pathway to death from many infectious diseases worldwide, according to the World Health Organization. 

A study published in the Lancet journal showed that in 2017 there were 48.9 million cases and 11 million sepsis-related deaths worldwide, accounting for nearly 20 per cent of all global deaths. 

The study also revealed that India has a higher death rate from sepsis, a life-threatening organ dysfunction response to infections, than other South Asian countries except Afghanistan.

“Sepsis will kill more people than cancer or heart attack by 2050 — it is going to be the biggest killer. Also in developing countries like India, multi-drug resistance due to gross overuse of antibiotics is probably causing a higher mortality,” said Yatin Mehta, Chairman, Institute of Critical Care and Anaesthesiology, Medanta — The Medicity, Gurugram.

This is because sepsis can be caused by many common diseases such as dengue, malaria, UTIs or even diarrhoea.

Mehta was speaking at the recently held Sepsis Summit India 2021, organised by the health awareness institution — Integrated Health and Wellbeing (IHW) Council.

Besides the use of antibiotics, the experts also noted the lack of awareness and early diagnosis. They called for increasing awareness and education regarding sepsis at the ground level.

“Despite advancement in medicine, tertiary care hospitals see 50-60 per cent patients getting sepsis and septic shock. Awareness, and early diagnosis are needed, and unnecessary antibiotic therapy should be avoided,” Mehta said.

“Sepsis has not been given the recognition it deserves and this is very much on the backburner from the policy point of view. We need to have Standard Operating Procedures and we need to flag sepsis cases in researches by the Indian Council of Medical Research (ICMR), continuing medical education (CME), and it should be taken up on priority by policymakers,” added Lov Verma, former Union Health Secretary of Health, Indian government.

While it is a leading cause of death in newborns and pregnant women, sepsis also affects older adults, patients in intensive care units, and people living with HIV/AIDS, liver cirrhosis, cancer, kidney disease, and autoimmune diseases.

It also played a major role in most of the deaths caused by dysregulated immune response during the ongoing Covid-19 pandemic, the experts said.

“Unless we educate and aware the masses, sepsis will remain an enigma. Recently, the Paediatric Association of India has adopted a slogan called AAA — ‘Avoid Antibiotic Abuse’, as antibiotics are prescribed too much in India. Nearly 54 per cent of newborns in India die of sepsis which is worse than Africa. We need a three-pronged approach — primary prevention, secondary prevention and education and awareness,” said Kishore Kumar, Founder and Chairman, Cloudnine Group of Hospitals.

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ICU stay can lead to depression

Patients who are treated in an intensive care unit (ICU) and survive are at increased risk of depression, a new study suggests. And depression in ICU survivors was linked with a higher risk of death in the next two years, researchers found.

More than half of former ICU patients reported symptoms of psychological disorders, including anxiety, depression and past-taumatic stress disorder (PTSD), according to the study.

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“Psychological problems — anxiety, depression, PTSD — after being treated for a critical illness in the ICU are very common and often complex when they occur,” said the study’s lead author. “Patients who reported symptoms of depression were 47 per cent more likely to die from any cause during the first two years after discharge from the ICU than those who did not report these symptoms.”

The researchers followed 4,943 ICU patients who had spent at least 24 hours in one of 26 ICUs in the UK between 2006 and 2013. The patients were asked to fill out questionnaires at three and 12 months following discharge from intensive care.

 

The questionnaires probed for signs and symptoms of psychological disorders. When the responses were analysed, the researchers determined that 46 per cent of the patients were experiencing symptoms consistent with a diagnosis of anxiety, 40 per cent reported depression symptoms, and 22 per cent reported symptoms of PTSD. Often, patients had symptoms of more than one disorder. In fact, 18 per cent of the patients met the criteria for all three psychological conditions.

Patients who reported symptoms consistent with a diagnosis of depression were 47 per cent more likely to die from any cause during the first two years after discharge from the ICU than those who did not report these symptoms. Increased risk of death was not associated with symptoms of anxiety or PTSD.

 “The reason detecting and recognising psychological problems is so important, is that they are a major cause of poor quality of life following critical illness and they are potentially treatable,” Hatch said in an e-mail. “Our findings suggest that depression following care of a critical illness in the ICU may be a marker of declining health and clinicians should consider this when following up with former ICU patients.”

The new findings were somewhat of a surprise for  an associate professor of psychiatry.

“We knew that symptoms of depression were associated with a worse quality of life after a critical illness,” the Dr. said. “But this shows that they are also associated with mortality. I was struck by the fact that they were 47 per cent more likely to die.”

The Dr. said that a similar study in the US would most likely find similar results.

While the study does not explain why depression might shorten life, there are studies in other areas of medicine that might help shed light on the subject, he said. “In patients with diabetes and heart disease, depression doesn’t just affect how they feel, it affects their behaviour,” he explained. “From the diabetes literature we know that depressed patients are often not taking as good care of themselves: they don’t take their medications and they miss appointments with their doctors.” 

The solution may be better monitoring of patients after they leave the ICU, he  said. “At the hospital we’ve been talking about doing a better job of screening patients for psychological symptoms after they’ve been treated and released from the ICU,” he added. “Then we can get treatment for all of those who screen positive.” 

Steroids Given in ICU Increase Risk of Delirium

Critically ill patients who receive steroids in intensive care units (ICUs) of hospitals have more chances of developing delirium, a study by John Hopkins Medicine shows.

Delirium leads to poor memory and thinking, sometimes with disorientation, hallucinations and agitation. For the study, researchers analyzed the medical records of 330 acute lung injury patients with a collective 2,286 days in an ICU at four Baltimore hospitals between October 2004 and October 2007. They found that patients had 52 percent more chances of developing delirium if they were treated with steroids on the previous day.

Moreover, the chances of delirium increased with age, the researchers found.

Researchers said that delirium generally goes away after a few days but studies show delirium in the ICU has a long-term impact. Overall, up to 80 percent of ventilated patients develop delirium in the ICU, and researchers have been looking for risk factors.

This study found that in more than one-third of the ICU days evaluated, mechanically ventilated patients with acute lung injury were given systemic corticosteroids at a range of doses during their ICU stay.

"We need to be cautious in our use of steroids in critically ill patients and weigh the risks and benefits of using them," said lead author Dale M. Needham, an associate professor of medicine and of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. "Sometimes they are necessary, but we need to be thoughtful about minimizing the dose and duration of steroid use when possible," he said in a press release.

He explained that there are plenty of reasons why an ICU patient is given steroids. They may be ordered to respond to inflammation in the lung or elsewhere in the body. Steroids were also often used often to treat septic shock in the ICU, but more recent studies have shown fewer benefits from steroids in this condition.

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