VANCOUVER—A new study has 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, a professor of pediatrics and critical care medicine at the University of British Columbia.
The study, published in medical journal The Lancet and titled “Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study,” found nearly twice as many deaths than previously thought were caused by sepsis.
Sepsis remained under the radar for so long because previous studies only looked at 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 starts attacking the body. Sepsis itself is not contagious, but it is a life-threatening illness triggered by a bacterial, viral or fungal infection.
If left untreated, it can cause organ failure and even death. Sepsis can become severe and turn into septic shock in a matter of hours, making early detection key to survival.
Picture this: A patient is in bed with the flu. Within a matter of hours, they begin to deteriorate. Breathing becomes shallow and hands start to turn blue. What started as an infection has turned into sepsis and is now attacking internal organs.
“At this point, you have little time,” said Kissoon, who has worked in hospitals across Canada for 35 years. “This is not a disease where you can sit around and come back in an hour.”
Doctors don’t know exactly what causes sepsis among certain patients, but people with compromised immune systems like children and seniors are more vulnerable.
“Sepsis is the final common pathway to death and disability for all infections,” said Kissoon.
The mortality rate of sepsis is 20 to 30 per cent in Western countries, according to a 2016 report by the Canadian Institute for Health Information and the Canadian Patient Safety Institute. About four out of every 1,000 patients are admitted to a Canadian hospital with sepsis.
In Canada, sepsis is the 12th leading cause of death, according to the Canadian Sepsis Foundation.
Children in Africa are nine times more likely to die from sepsis, compared to those who live in North America, said Kissoon.
He has also treated patients in sub-Saharan Africa — and it was his work there that led him to help initiate this study three years ago.
Kissoon and researchers from around the world reviewed the cause of 110 million deaths from 1990 to 2017, using data stored with the Institute for Health Metrics and Evaluation, based in Seattle, Washington. About 90 per cent of sepsis-related deaths in children worldwide happen in low or middle-income countries, he said.
Factors like higher infection rates, suboptimal care and lack of follow up mean patients are more likely to develop sepsis and that they are more likely to die from it, said Kissoon.
“There’s no doubt across the board it’s because of poverty and lack of access and transport to health care,” he said.
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“Sepsis is a disease of the poor and socially disadvantage.”
Kissoon, who is also vice-president at 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 health care to improving data collection practices.
But all countries could benefit from better data collection of sepsis cases, said Kissoon. He suspects some sepsis-related deaths go unrecorded because the initial reason for hospital admission could be another issue, like liver disease or pneumonia. And in Canada, residents in rural areas may be more susceptible to sepsis, he suggested.
The best thing individuals can do is be aware of possible symptoms of sepsis, said Kissoon.
Early signs of sepsis include a temperature above 101 F (38 C), a temperature below 97 F (36 C), increased breathing rate, increased heart rate and an existing infection.
“If the child is not feeling well, if they are sleepy all the time, or having tremendous breathing problems — those are signs and symptoms that would point to this is more than the usual disease,” said Kissoon.
These symptoms apply to everyone, not just children, he said. Seniors and those who have undergone chemotherapy are also more vulnerable to sepsis.
Kissoon acknowledged that it can be difficult for health care professionals to spot and treat sepsis, adding it’s “very easy to overlook.”
Patients with other life-threatening conditions like cardiac arrest or kidney failure have specialists they can call on to help, but that’s not the case with sepsis.
“It can affect everybody and there is no one discipline that is in charge of sepsis,” said Kissoon, adding that it’s important that the public is aware of some of the common signs of sepsis.
“When they come, with an infection or are not feeling well, they can ask the question, ‘Doctor, have you considered sepsis?’ ”