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Sepsis a 'Hidden Public Health Disaster'

Cheryl Clark, for HealthLeaders Media, October 27, 2010

Older hospitalized patients who survive sepsis develop lasting, moderate to severe cognitive impairment and functional disability at 3.3 times the rate of patients hospitalized for other reasons, according to a report from University of Michigan researchers.

"The prevalence of moderate to severe cognitive impairment increased 10 percentage points among patients who survived severe sepsis, an odds ratio of 3.34," Theodore Iwashyna MD, University of Michigan assistant professor of internal medicine, and colleagues wrote in Tuesday's issue of the Journal of the American Medical Association.

"The magnitude of these defects was large, likely resulting in a pivotal downturn in patients' ability to live independently."  The researchers added that the problem is so serious and so expensive, that improving prevention and management of sepsis "may warrant a place in the (nation's) broader brain health and disability agendas."

The sepsis study is the first large-scale effort to look at the issue in an older cohort, whose members were drawn from the National Institute on Aging's Health and Retirement Study of 16,772, which includes people over age 50. The study period covered 1998-2005.

Bloodstream infection, said to be the most common cause of critical illness in the U.S., is a major problem for the healthcare system. Those who develop it have twice the risk of death in the following five years as other hospitalized patients. 

The Michigan study shows that those who survive sepsis do not escape unscathed.  The extent of the condition's lasting impact, however, has so far been unclear.

Of these 9,223 underwent baseline cognitive and functional assessments between 1998 and 2004. Of these, 1,520 were hospitalized for severe sepsis and 5,574 were hospitalized for other reasons for comparison.

After being treated for sepsis, survivors developed 1.57 functional limitations when they had none before their hospitalization, they had an increase of 1.5 new limitations on their activities of daily living. For example, nearly one in five developed new problems with shopping or preparing a meal and many had more trouble bathing or toileting themselves.

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