Early detection of sepsis in the ICU

Sepsis is the body's overwhelming and life-threatening response to infection, which may rapidly lead to tissue damage, organ failure and death.

In the United States alone, sepsis is attributed to more than 266,000 deaths annually (2009)1 and accounts for over $23 billion in costs each year. This makes sepsis the most expensive inpatient condition in today's healthcare system2. While sepsis is costly and impacts hundreds of thousands of patients each year, it is important to note that the life-threatening condition is not only manageable, but preventable if the risk and severity of infection is assessed quickly and treated early.

The management of sepsis, specifically septic shock, remains a challenge in the intensive care unit (ICU) today. In fact, sepsis impacts about 35 percent of patients in the ICU, with approximately 25 percent of these patients dying as a result of the syndrome3. Some of the most crucial decisions physicians make about patients' health happen in the ICU, so it is critical to monitor sepsis patients closely in order to make informed and timely decisions regarding their care.

To date, over 1704 different biomarkers have been proposed for use in the diagnosis, prognosis, and therapy management of patients with sepsis or septic shock. For decades, physicians have been monitoring the body's biological response to infection via fever, white blood cell count, and blood pressure. So what are the most reliable biomarkers for monitoring the condition? With evidence from over 3,500 publications to support this, procalcitonin (PCT) is one of the most sensitive and specific biomarker of the host inflammatory response to a bacterial infection.

Other biomarkers have been proposed as sepsis biomarkers. Specifically, lactate is often discussed as one of these biomarkers, and although it is important to note that it does not look at the same aspect of the condition, it is a marker of tissue perfusion. Lactate and PCT are synergistic, making it critical to concentrate on both. Lactate is not specific to bacterial infections, but will identify when tissue is not receiving adequate amounts of oxygen and will provide warning of organ dysfunction. PCT, on the other hand, represents the underlying cause of infection as bacterial. These two biomarkers are complimentary and are both essential for monitoring the progression of sepsis and septic shock.

Identifying sepsis can be a challenge, mostly because the body does not differentiate the initial inflammatory phases of sterile inflammation from that of bacterial inflammation. There are times when sepsis is easily identified and antibiotics are prescribed quickly. In cases where sepsis is not easily identified, biomarkers are essential in risk assessment of sepsis because they provide valuable insight on the progression and severity of a bacterial infection—both on presentation and during the course of treatment. Change in PCT over time offers physicians information regarding the patient's response to treatment, likelihood of survival and disposition.

Considering that the majority of Americans have difficulty identifying the non-specific signs and symptoms of sepsis , it is imperative that we promote awareness and education around the condition so symptoms have less risk of being misinterpreted. The goal of physicians with respect to sepsis is early identification. This enables physicians to provide our patients with early and appropriate treatment to prevent progression to septic shock. Procalcitonin is a biomarker that helps us do just that by aiding in the risk assessment of this life-threatening syndrome.

Eric Gluck, MD, Director of Critical Care Services at Swedish Covenant Hospital in Chicago, Illinois; Professor of Medicine at Finch University of Health Sciences/The Chicago Medical School.

Dr. Gluck has utilized procalcitonin in his daily critical care practices since FDA clearance in the U.S. and has collected and analyzed data for publication in Critical Care Medicine, American Journal of Respiratory and Critical Care Medicine, and CHEST.

1 Vincent JL et al: Sepsis definitions: time for change. Lancet 2013;381:774-775.

2 Torio C (AHRQ), Moore B (Truven Health Analytics). National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013. HCUP Statistical Brief #204. May 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.pdf.

3 Infectious Diseases Point of Care Diagnostics Market to 2018 – Espicom, 2015 pg. 110

4 Pierrakos, C., & Vincent, J.-L. (2010). Sepsis biomarkers: a review. Critical Care, 14(1), R15. http://doi.org/10.1186/cc8872

5 Admin, A. S. (2016, August 23). Fifty-Five Percent of Americans Have Heard of Sepsis – Nation's Third Leading Killer – Sepsis Alliance Survey Reveals - Sepsis Alliance. Retrieved October 13, 2016, from http://www.sepsis.org/sepsis-alliance-news/fifty-five-percent-americans-heard-sepsis-nations-third-leading-killer-sepsis-alliance-survey-reveals/

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