VANCOUVER: A new study found that sepsis, not heart disease or stroke, is the leading cause of death in the world.
Sepsis is responsible for one in five deaths worldwide and killed 11 million people in 2017 alone, according to one of the study’s co-authors, Dr. Niranjan “Tex” Kissoon, professor of pediatrics and critical care medicine at the University of British Columbia. .
The study, published in the medical journal The Lancet and entitled “Incidence and mortality from sepsis worldwide, regionally and nationally, 1990–2017: analysis for the Study of the global burden of the disease,” found almost twice as many deaths from those that were thought to be caused by sepsis. .
Sepsis remained under the radar for so long because previous studies only analyzed sepsis rates in resource-rich countries, where the survival rate is much higher, said Kissoon, the only Canadian author of the study.
So what is sepsis?
It occurs when the immune system overreacts to an infection and begins to attack the body. Sepsis itself is not contagious, but it is a life-threatening disease triggered by a bacterial, viral or fungal infection.
If left untreated, it can cause organ failure and even death. Sepsis can become severe and become septic shock in a matter of hours, which makes early detection a key to survival.
Imagine this: a patient is in bed with the flu. Within hours, they begin to deteriorate. Breathing becomes shallow and hands begin to turn blue. What started as an infection became sepsis and is now attacking the internal organs.
“At this point, you have little time,” said Kissoon, who has worked in hospitals throughout Canada for 35 years. “This is not a disease in which you can sit and come back in an hour.”
Doctors do not know exactly what causes sepsis among certain patients, but people with compromised immune systems, such as children and the elderly, are more vulnerable.
“Sepsis is the final common path to death and disability for all infections,” said Kissoon.
The death rate from sepsis is 20 to 30 percent in Western countries, according to a 2016 report by the Canadian Institute for Health Information and the Canadian Patient Safety Institute. Approximately four out of every 1,000 patients are admitted to a Canadian hospital with sepsis.
In Canada, sepsis is the twelfth leading cause of death, according to the Canadian Sepsis Foundation.
Children in Africa are nine times more likely to die of sepsis, compared to those living in North America, Kissoon said.
He has also treated patients in sub-Saharan Africa, and it was his work there that led him to help start this study three years ago.
Kissoon and researchers around the world reviewed the cause of 110 million deaths between 1990 and 2017, using data stored with the Institute for Health Assessment and Metrics, based in Seattle, Washington. About 90 percent of sepsis-related deaths in children worldwide occur in low- or middle-income countries, he said.
Factors such as higher infection rates, suboptimal care and lack of follow-up mean that patients are more likely to develop sepsis and that they are more likely to die from it, Kissoon said.
“There is no doubt in all areas, it is due to poverty and lack of access and transportation to medical care,” he said.
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“Sepsis is a disease of the poor and a social disadvantage.”
Kissoon, who is also vice president of the Global Sepsis Alliance, is working with the World Health Organization to create guidelines to help low-income countries address high sepsis rates. That could mean everything from devoting more resources to medical care to improving data collection practices.
But all countries could benefit from a better collection of sepsis case data, Kissoon said. He suspects that some deaths related to sepsis are not recorded because the initial reason for hospitalization could be another problem, such as liver disease or pneumonia. And he suggested that in Canada, residents in rural areas may be more susceptible to sepsis.
The best thing people can do is to be aware of the possible symptoms of sepsis, Kissoon said.
The first signs of sepsis include a temperature above 101 F (38 C), a temperature below 97 F (36 C), increased respiratory rate, increased heart rate and an existing infection.
“If the child does not feel well, if he is sleepy all the time or has tremendous breathing problems, those are signs and symptoms that point to this being more than the usual illness,” Kissoon said.
These symptoms apply to everyone, not just children, he said. Older people and those who have received chemotherapy are also more vulnerable to sepsis.
Kissoon acknowledged that it can be difficult for health professionals to detect and treat sepsis, adding that it is “very easy to overlook.”
Patients with other life-threatening conditions, such as cardiac arrest or kidney failure, have specialists who can turn to help, but that is not the case with sepsis.
“It can affect everyone and there is not a single discipline that handles sepsis,” Kissoon said, adding that it is important for the public to know some of the common signs of sepsis.
“When they arrive, with an infection or they don’t feel well, they can ask the question:” Doctor, have you considered sepsis? “