Sepsis is more likely to kill poor people and those with existing health problems, according to a recent study, with the researchers saying their findings should help with earlier diagnosis and treatment of the condition.
Sepsis, or blood poisoning, is a potentially fatal condition triggered when the body reacts to an infection by attacking its own tissues and vital organs. It leads to an estimated 48 000 deaths a year in the UK, reports The Guardian.
An analysis of 248 767 cases of non-Covid sepsis in England between January 2019 and June 2022 – by researchers from the University of Manchester – found that the most deprived people are twice as likely to die from sepsis within 30 days.
The findings, published in the journal eClinicalMedicine, also show that:
• People with learning disabilities are almost four times more likely to get sepsis.
• People with liver disease have about three times greater risk.
• Patients with stage 5 chronic kidney disease are more than six times as likely to develop it.
People with cancer, brain disease or immunosuppressive conditions are also at higher risk, as are those who have received multiple courses of antibiotics, said the team led by Professor Tjeerd van Staa and Xiaomin Zhong.
“This study shows socioeconomic deprivation, comorbidity and learning disabilities are associated with an increased risk of developing non-Covid related sepsis and 30-day mortality in England,” they added.
They were not sure why exposure to multiple courses of antibiotics increases patients’ risk of sepsis.
“But it’s reasonable to speculate that the adverse effects of antibiotics on the beneficial bacteria in the gut could lead to increased susceptibility to infection. It could also be down to underlying differences in immune status or comorbidities,” said Zhong.
The authors say their findings should help health professionals worldwide to help diagnose and treat sepsis earlier. Clinical staff can struggle to identify sepsis as symptoms – which include a rash, blotchy skin and slurred speech – are also possible signs of many other illnesses.
Last month, the NHS ombudsman said people were dying avoidably because of the health service’s persistent “serious failings” in sepsis and failure to learn lessons in how it handles the condition.
Recurring failings included delays in diagnosing and treating people with sepsis, poor communication and record-keeping, and missed opportunities to provide follow-up care, said, the ombudsman.
Study details
Clinical and health inequality risk factors for non-Covid-related sepsis during the global Covid-19 pandemic: a national case-control and cohort study
Xiaomin Zhong, Diane Ashiru-Oredope, The OpenSAFELY Collaborative, et al.
Published in eClinicalMedicine on 23 November 2023
Summary
Background
Sepsis, characterised by significant morbidity and mortality, is intricately linked to socioeconomic disparities and pre-admission clinical histories. This study aspires to elucidate the association between non-Covid-19 related sepsis and health inequality risk factors amidst the pandemic in England, with a secondary focus on their association with 30-day sepsis mortality.
Methods
With the approval of NHS England, we harnessed the OpenSAFELY platform to execute a cohort study and a 1:6 matched case-control study. A sepsis diagnosis was identified from the incident hospital admissions record using ICD-10 codes. This encompassed 248,767 cases with non-Covid-19 sepsis from a cohort of 22.0 million individuals spanning January 1, 2019, to June 31, 2022. Socioeconomic deprivation was gauged using the Index of Multiple Deprivation score, reflecting indicators like income, employment, and education. Hospitalisation-related sepsis diagnoses were categorised as community-acquired or hospital-acquired. Cases were matched to controls who had no recorded diagnosis of sepsis, based on age (stepwise), sex, and calendar month. The eligibility criteria for controls were established primarily on the absence of a recorded sepsis diagnosis. Associations between potential predictors and odds of developing non-Covid-19 sepsis underwent assessment through conditional logistic regression models, with multivariable regression determining odds ratios (ORs) for 30-day mortality.
Findings
The study included 224,361 (10.2%) cases with non-Covid-19 sepsis and 1,346,166 matched controls. The most socioeconomic deprived quintile was associated with higher odds of developing non-Covid-19 sepsis than the least deprived quintile (crude OR 1.80 [95% CI 1.77–1.83]). Other risk factors (after adjusting comorbidities) such as learning disability (adjusted OR 3.53 [3.35–3.73]), chronic liver disease (adjusted OR 3.08 [2.97–3.19]), chronic kidney disease (stage 4: adjusted OR 2.62 [2.55–2.70], stage 5: adjusted OR 6.23 [5.81–6.69]), cancer, neurological disease, immunosuppressive conditions were also associated with developing non-Covid-19 sepsis. The incidence rate of non-COVID-19 sepsis decreased during the Covid-19 pandemic and rebounded to pre-pandemic levels (April 2021) after national lockdowns had been lifted. The 30-day mortality risk in cases with non-Covid-19 sepsis was higher for the most deprived quintile across all periods.
Interpretation
Socioeconomic deprivation, comorbidity and learning disabilities were associated with an increased odds of developing non-Covid-19 related sepsis and 30-day mortality in England. This study highlights the need to improve the prevention of sepsis, including more precise targeting of antimicrobials to higher-risk patients.
The Guardian article – Poor people much more likely to die from sepsis, study finds (Open access)
See more from MedicalBrief archives:
UK health ombud flags high sepsis death rate
Only one of four sepsis screening tools ‘reasonably accurate’ – German study
CDC issues new guidelines on sepsis management