September 13th marks World Sepsis Day, a global event designed to help raise awareness of a dangerous and often deadly condition. In the Asia Pacific region, the need for better sepsis care—including high-quality diagnostics to help identify and manage the condition—is particularly urgent.

Globally, as many as 50 million people suffer from sepsis every year, with more than 11 million deaths. In the Asia Pacific region, mortality rates are as high as 35%—significantly higher than those seen in most high-income countries [1]. That’s associated with lower access to high-quality healthcare, including the reliable diagnostics required for early detection, as well as low awareness about sepsis and its dangers.

Some parts of Asia suffer a particularly high toll from this illness. In India, for example, one study found that more than half of all patients being treated in intensive care units had sepsis [2]. Other low-resource countries undoubtedly face similar challenges. So what can be done?

Every minute matters

Sepsis is the result of an out-of-control reaction to infection: the inflammatory response goes haywire and can become life-threatening. It is commonly associated with infections of the lung, skin, gut, or urinary tract and is seen most often in infants, the elderly, and people with chronic illnesses or compromised immune systems.

Why is it so important to be aware of sepsis? Because this condition is unusually time-sensitive, knowing the signs and acting quickly can help save lives. Scientists have found that in the first 12 hours of care for a patient with sepsis, each five-minute delay in receiving appropriate therapy increases the mortality rate by about 1% [3]. That means it’s not only important for physicians and clinical lab teams to know about sepsis, but it’s essential to raise awareness among the general public as well.

Unfortunately, early detection is complicated by the non-specific symptoms brought on by sepsis. A patient may exhibit: high or low temperatures for no apparent reason; slurred speech or confusion; severe pain or discomfort; and low or no urine output, among other symptoms. Since sepsis stems from the response to an existing infection, it is very easy for physicians to mistake these symptoms as related to the infection or confuse them with other possible diagnoses.

Beyond its high morbidity and mortality rates, there’s another reason sepsis is a scourge in the healthcare system: it is a significant contributor to the growing epidemic of antimicrobial resistance (AMR). Whether sepsis is diagnosed correctly or not, patients suspected of it are obviously critically ill. Doctors typically and understandably respond by pulling their biggest weapons from their arsenal, prescribing cocktails of broad-spectrum antibiotics even before laboratory tests can produce results.

Overuse of these treatments, and the extended periods during which they are administered to patients, can contribute to AMR, creating negative impacts at both the individual and societal level that pose grave threats to healthcare systems everywhere. In Asia, the AMR threat is especially deadly. An analysis from the Review on Antimicrobial Resistance predicted that there would be more than 4.7 million deaths attributable to AMR by the year 2050, an order of magnitude higher than the expected deaths in Europe, North America or Latin America [4].

The importance of sepsis diagnostics

Typically, sepsis diagnosis relies on clinical observation, as well as lab evaluation via one of three biomarkers: procalcitonin (PCT), interleukin 6 (IL-6), or C-reactive protein (CRP). Testing for PCT is a popular approach to detect sepsis because it shows up on assays within two to six hours and peaks about 24 hours into the onset of the condition [5]. PCT quantification can be used to help diagnose sepsis, assess disease severity, and predict sepsis for lower respiratory tract infections.

Another benefit of the PCT biomarker is that it can also be used to guide treatment selection for sepsis patients to ensure the more appropriate use of antibiotics and comply with antimicrobial stewardship protocols [6,7]. With concerns mounting about the impact of AMR, we may see greater uptake of these protocols, even in low-resource settings, which will necessitate better testing strategies.

IL-6 is less specific for sepsis than PCT, but since it peaks earlier, many clinical labs have begun testing for this general inflammation biomarker to try to spot sepsis as soon as possible. Testing for IL-6 gained traction during the COVID-19 pandemic; now, more laboratories have validated IL-6 assays that can be deployed for the diagnosis of sepsis as well. CRP, meanwhile, is the least helpful biomarker for early diagnosis since it is not detectable until 12-48 hours after onset.

If you are a clinician treating sepsis patients, consider expanding your use of PCT to support clinical decision-making around the duration of antibiotic treatments. This can help to reduce the risks and incidence of AMR.

If you work in a clinical laboratory, there are a number of ways you can help raise awareness of sepsis to give patients a better chance of survival. Here are a few examples:

• Raise the topic in meetings with your clinical colleagues to ensure that physicians know when to order tests for sepsis biomarkers
• Create and distribute brief educational materials in your healthcare system to let clinicians know which sepsis biomarker tests you offer and when they should be used
• Seek out volunteer opportunities in your community to give talks or provide educational materials about the dangers of sepsis and how to spot the symptoms

September is Sepsis Awareness Month, and to help raise awareness for the value of biomarkers to better manage sepsis, Roche Diagnostics Asia Pacific will be hosting an upcoming webinar, Procalcitonin (PCT)-based antimicrobial stewardship, on the 28th of September. Click here to register and find out more about it. 

To learn more about how we’re advancing the standard of care for sepsis in the region, contact Stijn Vullinghs, Commercial & Disease Area Manager for sepsis, at [email protected].

References:

[1]  Asia Pacific Sepsis Alliance. Available at: https://www.asiapacificsepsisalliance.org/sepsis.

[2] Sepsis claims more lives in India than in other South Asian countries. here’s all you need to know about the disease (2023) Hindustan Times. Available at: https://www.hindustantimes.com/lifestyle/health/sepsis-claims-more-lives-in-india-than-in-other-south-asian-countries-here-s-all-you-need-to-know-about-the-disease-101673665488600.html.

[3] Funk, D.J. and Kumar, A. (2011) ‘Antimicrobial therapy for life-threatening infections: Speed is life’, Critical Care Clinics, 27(1), pp. 53–76. doi:10.1016/j.ccc.2010.09.008.

[4] Antimicrobial resistance: Tackling a crisis for the health and wealth of nations. Available at: https://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf 

[5] Reinhart, K. and Meisner, M. (2011) ‘Biomarkers in the critically ill patient: Procalcitonin’, Critical Care Clinics, 27(2), pp. 253–263. doi:10.1016/j.ccc.2011.01.002.

[6] Leveraging PCT to optimize antibiotic utilization, LabLeaders. Available at: https://lableaders.roche.com/global/en/articles/how-laboratory-leaders-are-leveraging-pct-to-optimize-antibiotic-utilization-2036.html

[7] Antibiotic stewardship: Convincing hcps that less is more, LabLeaders. Available at: https://lableaders.roche.com/global/en/articles/antibiotics-convincing-infectious-disease-physicians-that-less-is-more-2113.html