Patients with sepsis, one of the most time-sensitive and hard-to-detect illnesses in medicine, are more likely to survive the life-threatening condition when treated at a hospital that sees a higher volume of sepsis cases. New research from the Perelman School of Medicine at the University of Pennsylvania shows a clear relationship between hospitals that treat the most cases of severe sepsis and lower rates of inpatient deaths among those patients. The study, led by David F. Gaieski, MD, an associate professor of Emergency Medicine at Penn, is published online in the American Journal of Respiratory and Critical Care Medicine.

“One of the main barriers to treatment of sepsis is recognizing its early stages, since the symptoms are non-specific and often similar to those of a viral infection. However, early diagnoses and treatment are key to surviving sepsis and it may be that physicians at hospitals that see a larger volume of patients with severe sepsis are more attuned to these non-specific symptoms and have put protocols in place to aid in the detection of these critically ill patients,” Gaieski said. “Our results provide preliminary support for the idea that severe sepsis patients may benefit from treatment at higher-volume specialty centers much the same as the reality that patients who’ve suffered severe injuries are brought to designated trauma centers and those who’ve had strokes typically come to certified stroke centers.”

Sepsis is an illness caused by the body’s inflammatory and anti-inflammatory responses to bacteria and other pathogens, including viruses and fungi — so it’s not solely caused by the pathogens themselves, but also by the cytokines the body releases in response to the pathogens. A bacterial infection anywhere in the body may set off the response that leads to sepsis, which can then cause blood pressure to drop, and major organs and body systems to stop working properly because of poor blood flow. Not only is severe sepsis becoming more common, but the in-hospital mortality rate can be as high as 38 percent, and the illnesses costs the United States health system approximately $24 billion annually. The Centers for Disease Control and Prevention (CDC) currently lists septicemia as the 11th leading cause of death in the U.S., and the burden is expected to increase as the population ages.

The recent Penn study looked at hospital admissions — examining the relationship between annual case volume, urban location, organ dysfunction and survival — over a seven year period (2004-2010) among a total of 914,200 patients with severe sepsis, culled from the largest national database of publically available inpatient information. The study found an inverse relationship between severe sepsis case volume and inpatient mortality, in both urban and rural hospitals. Overall in-hospital mortality was 28 percent, but the study found that patients treated at higher-volume hospitals (those who treated 500 or more cases per year) had a 36 percent increase in their odds of inpatient survival compared to those treated at lower-volume hospitals (less than 50 cases per year). Typically, the highest volume hospitals are academic medical centers, which tend to be located in urban areas.

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