Sepsis—a condition that arises when the body’s response to an infection injures its own tissues and organs—is the No. 1 killer of hospital patients, and more than 1 in 5 do not survive. At least 1.5 million sepsis cases occur in the U.S. annually.
Dr. Derek Angus
Derek Angus, M.D., M.P.H., chair of the Department of Critical Care Medicine at the University of Pittsburgh and UPMC, has been deeply involved in global efforts to improve sepsis diagnosis and treatment. He served as chair of the International Sepsis Forum for the last two years. In that capacity, he was on the council of the Global Sepsis Alliance, which was the organization that proposed this recommendation to the WHO. Along with Christopher Seymour, M.D, M.Sc., assistant professor in Pitt’s departments of Critical Care Medicine and Emergency Medicine, Angus has several on-going research efforts helping to try to promote the best sepsis care not only in the U.S., but in less well-resourced, lower-income countries.
Q: What is the significance of the WHO setting this global priority?
A: WHO has a very deliberative process to try to ensure that governments around the world can be asked to engage in a focused way on particularly pressing problems. That sepsis per se, and not specific infectious challenges, should be seen as reaching this threshold emphasizes the magnitude and importance of this global problem.
Q: Please explain the background that led to this decision.
A: Sepsis is incredibly common, a source of great mortality and morbidity, and yet potentially amenable to a number of corrective actions. None of these happen without raised awareness and attention. Furthermore, sepsis ravages all societies and all age groups. The agenda that ensues from this attention-raising has implications both of basic health care delivery systems, focusing on ‘doing simple things well,’ and for researchers in academia and industry, focusing on harnessing advances in biomedical science to improve diagnostics and implement better tailored precision therapies to support the immune system, combat highly resistant bacteria, advance the provision of effective, safe organ support for vital failing organs, etc.
Q: How is sepsis a different problem in third world countries, compared to the U.S.?
A: Sepsis disproportionately affects vulnerable populations, like the very young, the very old and the poor. Lower middle income countries have less infrastructure to deliver timely therapies, less monitoring capacity, less acute care delivery capacity, etc., and all of this is magnified in a setting with more poverty. In addition, sepsis is more common in settings of malnutrition, poor sanitation and where there are endemic infectious disease problems—for example, bacterial sepsis can be more severe in patients with a history malaria.
A: It aligns perfectly. Our epidemiologic and health services research focuses on ‘doing the simple things well’ in both rich and austere settings; our translational research on better patient phenotyping and more sophisticated manipulation of the body’s immune system, as well as better monitoring and care of vital organ dysfunction, is relevant too, because even when ‘current’ care is delivered optimally, as many as 1 in 4 patients still die. Thus, we need to not only ensure everyone gets the best version of today’s care, but we also need to keep an eye on how to deliver better care tomorrow.
