Researchers Conclude That For Sepsis Treatment, It's Not How Agressive, It's How Soon
Researchers at the University of Pittsburgh have concluded that a standardized approach to diagnosing and treating sepsis in its early stages does not affect survival rates.
The five-year, $8.4 million study examined 1,351 patients with septic shock in 31 hospitals across the U.S. and found no difference in treatment effectiveness.
Dr. Donald Yealy, chair of Pitt’s Department of Emergency Medicine, was one of the lead researchers in the study. He said it doesn’t matter what type of treatment a patient receives, as long as it’s early.
“Nowhere in our paper do we say that delayed treatment is good thing,” he said. “Your physician and you as a patient have to recognize this early on and recognize how fatal it can be.”
Sepsis, the body’s response to severe infections, kills more people each year than breast cancer, prostate cancer and HIV/AIDS combined. More than 750,000 cases of severe sepsis and septic shock are reported in the U.S. every year.
Patients in the study were chosen at random to receive one of three treatments: Early Goal Directed Therapy (EGDT), Protocolized Standard Care (PSC) or physician directed treatment.
EGDT uses a central line catheter inserted in the jugular vein to monitor blood pressure and oxygen levels, while administering drugs and fluids. A 2001 study claimed this method reduced mortality by 16 percent. PSC is similar in that it requires vein access, but doesn’t use catheters.
60 days after the initial treatment, researchers found that mortality rates for the three treatments were similar. 21 percent of the EGDT group, 18.2 percent of the PSC group and 18.9 percent of the physician directed treatment group died in the hospital. The results were the same 90 days and one year after the initial treatment.
Yealy said teaching physicians to spot and treat sepsis early is the key to successful treatment.
“I wouldn’t describe it as a negative trial,” he said. “Instead of thinking one option is dramatically better, you really have three options, some of which are less technical and more physician judgment driven.”
Yealy said this study could have some economic impacts.
“Every hospital has the opportunity to deliver this type of improvement in care,” he said. “They don’t have to have that catheter technology-driven approach that was going to be very difficult to deliver at some sites anyway.”
The study, “Protocolized Care for Early Septic Shock," was funded by the National Institute of General Medical Sciences.