An exciting new report from our friends at the University of Pittsburgh Medical Center shows that sepsis is in fact several distinct conditions requiring different treatment approaches. This important research could be a powerful breakthrough in sepsis care. Read the full release below:
PITTSBURGH, May 19, 2019 – Much like cancer, sepsis isn’t simply one condition but rather many conditions that could benefit from different treatments, according to the results of a University of Pittsburgh School of Medicine study involving more than 60,000 patients.
These findings, announced today in JAMA and presented at the American Thoracic Society’s Annual Meeting, could explain why several recent clinical trials of treatments for sepsis, the No. 1 killer of hospitalized patients, have failed. Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs.
“For over a decade, there have been no major breakthroughs in the treatment of sepsis; the largest improvements we’ve seen involve the enforcing of ‘one-size fits all’ protocols for prompt treatment,” said lead author Christopher Seymour, M.D., M.Sc., associate professor in Pitt’s Department of Critical Care Medicine and member of Pitt’s Clinical Research Investigation and Systems Modeling of Acute Illness Center. “But these protocols ignore that sepsis patients are not all the same. For a condition that kills more than 6 million people annually, that’s unacceptable. Hopefully, by seeing sepsis as several distinct conditions with varying clinical characteristics, we can discover and test therapies precisely tailored to the type of sepsis each patient has.”
In the “Sepsis ENdotyping in Emergency Care” (SENECA) project, funded by the National Institutes of Health (NIH), Seymour and his team used computer algorithms to analyze 29 clinical variables found in the electronic health records of more than 20,000 UPMC patients recognized to have sepsis within six hours of hospital arrival from 2010 to 2012.
The algorithm clustered the patients into four distinct sepsis types, described as:
Alpha: most common type (33%), patients with the fewest abnormal laboratory test results, least organ dysfunction and lowest in-hospital death rate at 2%;
Beta: older patients, comprising 27%, with the most chronic illnesses and kidney dysfunction;
Gamma: similar frequency as beta, but with elevated measures of inflammation and primarily pulmonary dysfunction;
Delta: least common (13%), but most deadly type, often with liver dysfunction and shock, and the highest in-hospital death rate at 32%.
The team then studied the electronic health records of another 43,000 UPMC sepsis patients from 2013 to 2014. The findings held. And they held again when the team studied rich clinical data and immune response biomarkers from nearly 500 pneumonia patients enrolled at 28 hospitals in the U.S.
In the next part of the study, Seymour and his team applied their findings to several recently completed international clinical trials that tested different promising therapies for sepsis–all of which had ended with unremarkable results.
When trial participants were classified by the four sepsis types, some trials might not have been failures. For example, early goal-directed therapy (EGDT), an aggressive resuscitation protocol that includes placing a catheter to monitor blood pressure and oxygen levels, delivery of drugs, fluids and blood transfusions was found in 2014 to have no benefit following a five-year, $8.4 million study. But when Seymour’s team re-examined the results, they found that EGDT was beneficial for the Alpha type of sepsis patients. Conversely, it resulted in worse outcomes for the Delta subtype.
“Intuitively, this makes sense–you wouldn’t give all breast cancer patients the same treatment. Some breast cancers are more invasive and must be treated aggressively. Some are positive or negative for different biomarkers and respond to different medications,” said senior author Derek Angus, M.D., M.P.H., professor and chair of Pitt’s Department of Critical Care Medicine. “The next step is to do the same for sepsis that we have for cancer–find therapies that apply to the specific types of sepsis and then design new clinical trials to test them.”
Additional authors on this research publication are Jason N. Kennedy, M.S., Shu Wang, M.S., Chung-Chou H. Chang, Ph.D., Zhongying Xu, M.S., Gilles Clermont, M.D., M.Sc., Hernando Gomez, M.D., M.P.H., David Huang, M.D., John A. Kellum, M.D., Qi Mi, Ph.D., Victor Talisa, M.S., Shyam Visweswaran, M.D., Ph.D., Yoram Vodovotz, Ph.D., and Donald M. Yealy, M.D., all of Pitt; Corrine F. Elliott, M.S., and Scott Berry, Ph.D., both of Berry Consultants in Texas; Steven M. Opal, M.D., of Rhode Island Hospital; Tom van der Poll, M.D., Ph.D., of Pitt and the University of Amsterdam; Jeremy C. Weiss, M.D., Ph.D., of Carnegie Mellon University; and Sachin Yende, M.D., M.S., of Pitt and the VA Pittsburgh Healthcare System.
This research was funded by NIH grants R35GM119519, P50GM076659, R34GM102696, R01GM101197, GM107231, R01LM012095, K08GM117310-01A1 and GM61992.
Read the release online: https://www.upmc.com/media/news/051919-seymour-seneca.
Here at the Foundation, we are guided every day by our memories of Rory. Rory was a leader, an advocate, a believer in the ability of the individual to make a difference. That’s why we are always especially delighted to recognize the work that young people–the leaders of tomorrow (and in some cases, today!)–are doing to further sepsis awareness.
In honor of World Hand Hygiene Day, we’d like to recognize several young people whose dedication to educating their communities about sepsis fills is with hope:
1. Caroline Robitaille of Union Township, New Jersey, is a Girl Scout Cadette in the eighth grade. After reading an article about Rory and the work of our Foundation, Caroline dedicated herself to raising awareness of sepsis ahead of World Sepsis Day. Caroline developed the “Pink Day Out” campaign and persuaded the Union Township PTA and School Board to support it and to supply the elementary school classes in her district with copies of Ouch! I Got a Cut!, the Foundation’s book for young readers. She was able to take a day off school to read the book to all five elementary school classes and educate them further about sepsis. According to Caroline, “The week after my talk at the elementary school, my family and I were out in town and we saw the parents of one of the students I read to. The mom came up to me and thanked me for teaching her daughter about proper wound care as she was so impressed what she learned about sepsis and what her daughter taught her family. That made me very proud.” We’re proud of you too, Caroline! Caroline is now in the running the receive the Girl Scout Silver Award for her work raising awareness of sepsis.
2. Talia Coopersmith is a high school junior in Atlanta, Georgia. Talia chose to implement sepsis education in her school district for her Girl Scout Gold Award project after being inspired by the Foundation’s work. She designed presentations for elementary and middle school students in her district and thoughtfully took note of the different levels of knowledge she encountered at different schools. “This disparity helped me to understand the importance of the foundation’s lesson plans. They are very accessible to their targeted age group and do a very good job of building up information,” she said. Talia deserves our sincere thanks and appreciation for teaching hundreds of children a potentially lifesaving lesson!
3. Many of you know Kathleen Staunton, Rory’s younger sister. Kathleen adored her big brother and her life will never be the same after losing him. Kathleen was inspired to write Ouch! I Got a Cut! with her mother after watching a wound on a basketball court go untreated–exactly as Rory’s was. The read-along book for young children teaches the importance of caring for cuts and scrapes to prevent infection. Kathleen led a reading of the book with elementary classes at her school. “I’m glad I got to share the three C’s with the Lower School: If you get a cut, clean and cover it. Our three C’s campaign can protect everyone from dirt and germs that cause infection and help them stay healthy and strong!”
Dr. Martin Doerfler, senior vice president of clinical strategy and development and associate chief medical officer at Northwell Health and Medical Advisor to the Rory Staunton Foundation has co-authored a new study that assesses the differences between hospital-presenting sepsis (HPS) and emergency department-presenting sepsis (EDPS). “In an effort to continue finding solutions that curtail the concerning numbers of fatalities as a result of sepsis, we set out to explore how this condition manifests itself both in the in-patient and emergency room locales, and the various challenges associated with recognition, treatment and monitoring,” said Dr. Doerfler. “As clinicians, we need to better to understand this knowledge gap so that we can correct the origins of the disparities.”
The findings appeared on April 8 in the Journal of Hospital Medicine, the official peer-reviewed journal of the Society of Hospital Medicine. The study finds the HPS disproportionately results in adverse patient outcomes, concluding that increased efforts were needed to improve recognition of sepsis during hospitalization. Read the full journal article here.
As Rhode Island moves ever closer to adopting statewide sepsis regulations, we’re bringing you the stories of the children who inspired them. Below is the story of Lucas, a beautiful, bright-eyed little boy who tragically lost his young life to sepsis. His parents have played a large role in the successful campaign for regulations in their state.
LUCAS, by Courtney Dewar, Lucas’ Mom
“Our sweet Lucas blessed us with his happy, little face for 13 months and 8 days before he gained his angel wings. Never, ever did I expect to lose a child and certainly not as suddenly and unexpectedly as I lost my sweet baby.
Lucas was admitted to the hospital in the early morning hours of Sunday, April 29th, 2018. In the days prior he had some minor cold symptoms, but nothing alarming. I took him to his pediatrician on the morning of April 28th and although his fever had spiked to 105 degrees, she wasn’t alarmed. She said he looked like he might be developing an ear infection and sent us on our way with antibiotics. I am haunted by that interaction and wish I had questioned that diagnoses, but as a mother of two young boys who have had countless colds, stomach bugs, ear infections, etc., I simply figured a round of antibiotics and some rest would do the trick.
By the time Lucas was admitted on Sunday morning, he was deteriorating quickly. His breathing was labored and he wasn’t responding well to breathing treatments. A chest x-ray confirmed pneumonia and several types of antibiotics and fluids were given intravenously. After several hours without improvement, his lungs were filling with fluid, his oxygen levels were low, as was his blood pressure, and his heart rate was dangerously high. This was all happening so quickly, my husband and I simply could not grasp how our healthy boy was suddenly so dangerously ill. We had no idea that when he was sedated to insert a breathing tube and a tube to drain his lungs, that he would never again wake up. The drainage was unsuccessful, and he was still failing.
By Monday morning, the doctors were educating us about sepsis and discussing a very risky, yet possibly life-saving procedure. He would be put on an ECMO machine, or a heart-lung bypass machine, which would allow his lungs and heart to heal and ultimately “buy some time” so his little body could fight this infection. The procedure came with many risks, mainly kidney failure, internal bleeding, blood clots and stroke. My husband and I were terrified but without it, we were told Lucas wouldn’t survive another 24 hours. After two days of being on the ECMO machine, he was showing great progress. I thought, just maybe, that the odds had turned in our favor and that we’d walk out of the hospital with our sweet boy.
On Thursday, May 3rd, 2018, my husband and I returned from the hospital cafeteria to see a group of doctors and nurses outside Lucas’ room. We knew this wasn’t good. We were told that they suspected bleeding on his brain and immediately ordered a CAT scan. We dropped to the floor. Although we were hyper-aware of complications, we were cautiously optimistic about his progress. Shortly after, while my husband and I prayed fiercely in the hospital’s chapel, we were given the news. Our sweet Lucas suffered a massive stroke and there was nothing more that they could do.
That afternoon, I crawled into the hospital bed with my sweet baby and held him as they disconnected the machines. That is something no mother, no parent, should ever have to do. The cause of Lucas’ death was technically a stroke, with the secondary causes being sepsis and pneumonia. However, sepsis is the true cause of death in my mind. The infection ravaged his body, making it too weak to fight the bacterial pneumonia and causing him to have to be put on the ECMO machine, resulting in his stroke. I will spend my life remembering Lucas and educating others about his brief battle with this devastating illness. No parent should have to witness their child go through that, ever.”
Looking for something fun and educational for the kids to do over the Easter/Passover break? How about a coloring book that teaches kids about the importance of infection prevention and caring for cuts and scrapes with the help of some wacky characters? Teach your kids “the three ‘C’s” of effective wound care–Cut, Clean, Cover!
Please send us photos of your completed pages (or pictures of the coloring process!) to email@example.com. We’d love to see them (and will post to Facebook)!
This coloring book comes to us from Judy Brohm, a registered nurse and Sepsis Champion at Clark Memorial Hospital in Indiana. With the creative help of a colleague, Bill Greene, Judy created this coloring book for Child Safety Day after meeting Ciaran and hearing his story at a conference of the Indiana Hospital Association. We love the concept, which shows that we can ALL do our part to protect families from sepsis.
Christmas is a raw lonely time when you bury a child. Awake early this morning working on Rory’s book I found this treasure my brother wrote a year after Rory died. Always missing you Rory…
“A memory of a boy and a Christmas past casts a long shadow.
In the beginning of that day around 2005 in the Christmas time, I remember we arrived at their house in Queens to help with the tree trimming and enjoy the compliments of the season.
It was cold outside and hot coffee and an Irish breakfast helped line our stomachs and prep us for the task on hand.
The little red-headed boy had spread his train tracks all around the tree.
Bobbing and weaving the tracks ran in and out, and a vintage old train steamed along whenever it didn’t come off the rails.
The boy was already adept at fixing every little wobble on his track and explained excitedly that the train had been modeled on one from the old Indian railways. He explained in precise detail that India had an amazing rail system that he had been studying.
We took it all in as uncles and aunts and cousins do, would have stroked our beards if we had them and concluded what a clever little lad.
The tree itself was bare but as soon as we began to dress it the Christmas lights sparkled and the ornaments, many from our childhood that my sister saved, went up one by one.
Decorating the tree was like meeting a familiar friend a year later, reminding me of the bond that Christmas brought especially to emigrant families, transferring us across an ocean back to a time and place where seven of us children dressed a tree and our parents stood by.
Here we were in Queens, New York, in the same ritual timeless as it was, knowing that bond that connected us for generations was renewed again by this very act.
My parents had touched these same Christmas ornaments now our kids were touching them. The great stream of life continued to flow.
Back then the box holding the tree was full of old shoes to make sure the tree stood up straight as there was only a bare bark with no stand to secure it.
It was the boy’s turn to place the angel on top of the tree and he did so as I and his father lifted him up remarking how heavy he had become from the previous year.
After that, the bedraggled uncle was pulled aside by the boy to discuss the North Star and the positioning that Santa would use.
He indicated that the light from the star was hundreds maybe thousands of years old and that we only saw it as it was back then. How could Santa navigate with such uncertain lodestars, he asked me.
I had no clue but there was no escaping his keen intelligence, his eyes boring into me as the questions flowed about time travel and how Santa could make Australia and Europe in one 24 hour period. This conversation was about four years too early, I thought.
I knew enough to say nothing merely to point out that Santa was capable of all things, and that I would not be surprised at all if he had a special magic to do all that.
The boy sat down with an extremely dubious look on his face and I escaped to gulp my first glass of red wine, welcome after the endeavors, physical and mental.
The boy was special; there was no doubting it. What he would become is impossible to say.
Your child or nephew or niece is your ambassador to the future the person who will bear the memory of you when all have forgotten and carry it on to the next generation.
That is incredibly important for us humans incapable of time travel that someone is there to tell the future generation who and what we were, that we walked the earth, dressed Christmas trees and loved each other.
The boy would never get to carry that information or fulfill his incredible promise. He was dead a few years later killed in a case of dreadful medical malpractice that made it to page one of the New York Times for all the wrong reasons.
That house in Queens will be dark this year, no tree trimming. The family will instead be in Ireland to be near to where he was laid to rest with his beloved grandmother and grandfather, It is the toughest time of year next to his birthday.
Our Christmas now? It is never the same, and we do our best for those left behind and ourselves. But that shining North Star has dimmed forever in my mind.
Rory Staunton, wherever you are, we miss you and love you this Christmas and forever.”
Your Uncle Niall
I walked around lower Manhattan a few days ago; it’s an area I try to avoid because it’s where our Rory died. I could feel the terror start to build up again in my body as it does when I am around there, near the hospital where he died. It’s like a newsreel rolling continuously in my head, reliving the last few days, the last few hours of his life, of our lives, as we knew it.
I remember being in the room when the nice doctor came in to tell us Rory had died, and I remember screaming at that nice doctor who had tried so hard to save him in the Critical Care Unit. I remember screaming at him: “I brought him here, I brought him here and you (the hospital) sent him home, ” screaming, wailing, at the top of my voice. When we brought Rory to the hospital and to his pediatrician a few nights earlier they sent him home with a diagnosis of gastric flu even though he had all the symptoms of sepsis and indeed was in septic shock.
But Rory was gone and we will never get those days, hours or minutes back. All the good parenting, the safe parenting we had been practicing for our entire lives-the intentional parenting of bike helmets and knee pads, the baby gates, the seat belts… everything we do and did as good parents… gone, because noone, not one single person that we brought Rory to who SHOULD have known to check him for sepsis, did so. And so he is dead and our lives will never be the same.
What Sepsis Awareness Month means to me is using the opportunity to spread the word about sepsis everywhere we can. Wherever you see articles about sepsis this month share them, talk about sepsis, make sure your loved ones know about this preventable death. Please share.
The Rory Staunton Foundation offers downloadable resources to help you understand sepsis and its causes. We provide printable brochures and fact sheets explaining what symptoms to look for, how to treat this illness as well as prevention tips to stay healthy.
Check out all the resources available by clicking on the Library tab above and navigating to the Downloads section. Through sepsis awareness and education, we believe that lives will be saved so we provide these valuable resources free so everyone asks “could it be sepsis?” and thinks sepsis!
Our beautiful eight-month-old baby girl Stella was a twin to her brother Nash and a little sister to her four-year-old brother Hayden. My husband and I went through eighteen months of fertility treatments until finally we became pregnant with our twins: Nash and Stella. For us, it was a perfect picture. After Hayden was born we wanted him to have a sibling. So, our lovely babies were born on July 8th, 2017. Nash was baby A at 6lbs 13ounces and Stella was baby B at 6lbs 8ounces. From the start Stella was our crier and quite the diva. She was always hungry and we lovingly called her our “bottle alarm”. She was what they call a “happy spitter”. I think she probably went through four costume changes a day; sometimes she came home from daycare in her brother’s clothes.
It’s been six years since Rory died, six awful years of fighting for change in the world of sepsis, as he would have wanted us to do, and as we want to do.
A major announcement occurred last week that is going to save thousands and thousands of lives from sepsis in the future. The announcement was made quietly but it will have a huge effect on the future of sepsis.
We haven’t been very familiar with the work of the Biomedical Advanced Research and Development Authority (BARDA) or the Office for Preparedness and Response (HHS) and our guess is that most people haven’t -but now is a good time to learn about what they are doing. Last week BARDA’s Director, Rick Bright, announced plans that will save thousands of lives from sepsis.
BARDA is an agency of the United States Government (Health and Human Services) and it works extremely well to protect us from future threats. “Sepsis is one of the country’s most urgent systemic health threats,” they said last week when Rick Bright, and Robert Kadlec, his boss, announced a new division that will search the world to find start-ups that will give us solutions to health security risks… specifically sepsis.
Today if you show up at a hospital with a diagnosed infection you will be administered a broad spectrum antibiotic in the hope that it will stop the infection, a blood sample will be taken and then between 24-48 hours the results will indicate what the disease is and what pathogen is responsible. This system is ridiculously slow and people are dying because with sepsis it is a race against the clock which determines if you live or die. BARDA wants to find technology that will identify infections immediately so your body won’t even have to fight off sepsis.
Simply stated: Right now we are too slow to recognize sepsis and act. The concern for the Federal Government is the future and how dangerous this slow reaction would be in the aftermath of a chemical, biological, radiological or nuclear event because those who survive the initial assault are at high risk to develop sepsis.
Sepsis now has the attention of the federal government and soon the attention of scientists and industry and the medical community and capital markets nationwide. This is a HUGE step forward. This effort will save many lives in the future and we will be offering complete support for their actions. The fact that this level of attention is long overdue for sepsis is heartbreaking but we are looking to the future.
A new website was launched last week with details. Click here to visit the site.