In his recent editorial article in the Journal of the American Medical Association, McGowan Institute for Regenerative Medicine
affiliated faculty member Derek Angus, MD, MPH (pictured), vice chair for research, Department of Critical Care Medicine, University of Pittsburgh Medical Center, and professor in Critical Care Medicine as well as Health Policy and Management at the University of Pittsburgh, noted that sepsis, the syndrome of infection complicated by vital organ dysfunction, is a medical emergency that affects more than 750,000 patients in the United States each year and remains one of the world's leading causes of death. Without prompt resuscitation, antibiotics, and institution of life support, patients can quickly develop shock, multisystem organ failure, and death. It is not surprising, therefore, that the main goal of care and of research has been to reduce short-term mortality. Assuming a patient survives the initial insult, traditional medical wisdom holds that the crisis has been averted and the patient should do well. However, this conventional thinking is being seriously challenged.
According to researchers from the University of Michigan (U-M) Health System, older adults who survive severe sepsis are at higher risk for long-term cognitive impairment and physical limitations than those hospitalized for other reasons. Their research published in the Journal of the American Medical Association showed that 60 percent of hospitalizations for severe sepsis were associated with worsened cognitive and physical function among surviving older adults. The odds of acquiring moderate to severe cognitive impairment were 3.3 times higher following an episode of sepsis than for other hospitalizations.
Severe sepsis also was associated with greater risk for the development of new functional limitations following hospitalization, says the study’s lead author, Theodore (Jack) Iwashyna, M.D., Ph.D., assistant professor of internal medicine at U-M. Among patients who had no limitations before sepsis, more than 40% developed trouble with walking. Nearly 1 in 5 developed new problems with shopping or preparing a meal. Patients often developed new problems with such basic things as bathing and toileting themselves.
“We used to think of sepsis as just a medical emergency, an infection that you get sick with and then recover,” said Dr. Iwashyna, “But we discovered a significant number of people face years of problems afterwards. Those problems are bigger and more common than we expected. Most older Americans suffer real brain and body problems. We need new treatments, not just for the sepsis infection, but to prevent these new disabilities afterwards.”
Physicians should use these results in discussing probable outcomes with patients and families, commented Dr. Angus. Longer-term survival and functional outcomes may need to supplant the current main goal of simply getting patients through the acute illness, he suggested.
Reasons for the long-term effects after sepsis might include ICU-acquired weakness thought to be caused by muscle and nerve injury from inflammation and ischemia, as well as by prolonged immobilization and corticosteroid and neuromuscular blockers commonly used in sepsis treatment, Dr. Angus noted. Direct damage to the brain from similar mechanisms as well as encephalopathy and delirium likely also contribute, he added.
Illustration: McGowan Institute for Regenerative Medicine.
University of Michigan Health System Press Release (10/26/10)
Medical Daily (10/27/10)
Medical News Today (10/27/10)
RTT News (11/01/10)
Bio: Dr. Derek Angus
Abstract (The Journal of the American Medical Association; 2010;304(16):1787-1794)
Editorial (The Journal of the American Medical Association; 2010;304(16):1833-1834)