The recent death of an up-and-coming Brazilian model due to sepsis has again drawn attention to the common disease and how hospitalists should be wary not to miss its diagnosis in hospitalized patients.
Mariana Bridi da Costa, a 20-year-old beauty queen who participated in international competitions, died Jan. 24 from septicemia that began with a urinary tract infection. The original diagnosis did not include the urinary tract infection, leading to severe sepsis. Septicemia kills about 1,400 people a day worldwide, according to the Society of Critical Care Medicine (SCCM). The sepsis mortality rate is on a similar scale to lung, breast, and colon cancer, SCCM data shows.
"When someone comes in with high fever, high heart rate, high respiratory rate, and low blood pressure, you have to begin thinking about how well their organs are working," says Jeffrey Dichter, MD, medical director of cardiovascular intensive care at Regions Hospital in St. Paul, Minn., and former HM program director. "How sick are they? ... Hospitalists should look for the source of infection and evidence of organ failure."
According to the Mayo Clinic, about 750,000 people in the U.S. contract severe sepsis each year, and more than 200,000 people die of it.
Dr. Dichter notes that hospitalists in any setting—from acute-care hospitals to off-site clinics—can run blood tests for kidney and liver functions, as well as electrolyte levels, that serve as quick windows into the presence of sepsis. He also promotes www.survivingsepsis.org, the SCCM's program that aims to reduce sepsis mortality by 25% in five years by defining the disease more clearly and improving its diagnosis.
"Sometimes the symptoms patients come in with seem subtle," Dr. Dichter says. "Sometimes they may come in with evidence of an infection or low blood pressure, but they're awake and alert and talking and seem very normal. … Hospitalists need to be attune."