Sepsis - A Global Crisis
Sepsis (blood poisoning) is a life-threatening conditon that requires immediate medical attention. It occurs when an infectious organism is present in large numbers in the blood stream, overwhelming the body's immune system and leading to a generalised whole-body inflammatory response and shutting down of the vital organs.
Each year in the UK more than 200,000 people are admitted to hospital with Sepsis and 74,000 will die as a result of the condition: a mortality rate of 37%. Even among survivors, Sepsis causes serious ongoing health problems. Many of the 126,000 patients who recover from Sepsis each year will go on to experience major permanent life-altering and life-limiting effects as a result of the condition.
Globally, it is estimated that there are 22 million patients and 8.5 million deaths from Sepsis each year, and the numbers of cases in the UK and around the world are increasing at an average rate of 10% annually.
Instances of Sepsis are as common as a heart attack, and in the UK Sepsis kills more people each year than breast, bowel and prostate cancer combined.
Early presentation and diagnosis is vital and can increase the chances of survival significantly. However, serious limitations in the current methods for detecting the causative pathogens in Sepsis present a major obstacle to increasing the speed of diagnosis and thus improving patient outcomes in a condition that is time critical.
When a clinician suspects Sepsis, several blood tests are carried out in order to reach a definitive diagnosis. The gold standard test for identifying the causative organisms in Sepsis is currently blood cultures, which require a minimum of 48 hours and up to 5 days to provide results.
Until results are obtained, patients only receive supportive treatment in the form of oxygen, fluids and broad-spectrum antibiotics. A large proportion do not survive this delay: in many cases patients will become critically ill and die before the results of the tests become available to clinicians.
Hospital admissions for Sepsis in the UK annually
Of Sepsis patients will not survive
Deaths from Sepsis every hour in the UK
Sepsis - Costs and Consequences
In addition to the increased possibility of mortality and co-morbidities, delays to conclusive diagnosis in cases of Sepsis lead to significantly increased costs for healthcare providers. Extended periods of emergency treatment for serious complications arising from infections contribute to an enormous cost burden on the healthcare system.
UK Gov figures reveal that treatment for patients of Sepsis costs the NHS in excess of £2bn per year in England alone.
This does not include costs for ongoing care and treatment for recovered patients experiencing troublesome sequalae as a result of Sepsis, which are considerable.
Over 1.5% of all NHS expenditure in England in 2019 was used for the acute treatment and care of patients suffering from Sepsis, and the numbers of Sepsis cases have seen a 66% compound growth rate in the last 5 years.
Furthermore, current practices of prescribing broad spectrum antibiotics cause an imbalance in the bacterial population of the body in already weakened patients, and contribute to the proliferation of antibiotic resistance.
The need for an effective solution for the rapid diagnosis of Sepsis has never been greater.
Each year in NHS expenditure on Sepsis patients in England
Compound growth rate in Sepsis cases
Of all NHS expenditure in England on Sepsis
Sepsis - The Route to Diagnosis
When a clinician suspects Sepsis, several blood tests are carried out in order to reach a definitive diagnosis. These tests include: Full Blood Count (FBC), C-Reactive Protein (CRP) and Blood Cultures.
FBC and CRP are only used to monitor a patients' inflammatory response. The gold standard test for identifying the causative organisms in Sepsis is currently blood cultures, which require a minimum of 48 hours and up to 5 days to provide results. A blood culture test is considered negative if it shows no growth of infectious microorganisms after 5 days.
Until results are obtained, the only therapies available are oxygen, fluids and broad-spectrum antibiotics. A large proportion of patients do not survive this delay: in many cases patients will become critically ill or die before the results of the tests become available to clinicians.
This delay to clinical decision making and the application of targeted treatment is the principal reason why Sepsis is so dangerous. Numerous previous attempts have been made to improve the speed of Sepsis diagnosis, however they have failed for a combination of the following reasons:
An inability to provide results rapidly enough
An inability to provide results that are accurate enough
Tests that are labour intensive and require large resource capacity
Tests that are cost prohibitive and cannot be used routinely
The National Institute for Health and Clinical Excellence (NICE) concluded that there is insufficient evidence to recommend the routine use of these new tests to identify the pathogens responsible for the cause of Sepsis. The NICE guidance is available here.