The economic
burden of sepsis
is huge and
increasing, and
indirect costs
of survivors
due to lower
quality of life
and follow-up
diseases remain
a ‘fuzzy zone’
References
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2 Majno G. The ancient riddle of
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5 Bone RC et al. Definitions
for sepsis and organ failure
and guidelines for the use
survivors have been underestimated. Meanwhile,
it is well known that, after the index sepsis
episode, survivors suffer for many years from
a higher risk of hospital readmissions, as well
as additional morbidities such as cognitive
impairment, cardiovascular disease, and of death.
Nearly 60% of sepsis survivors have more than
one episode of rehospitalisation, most often due
to infection. Compared with statistical life tables,
sepsis survivors also have a reduced life
expectancy, probably due to more cardiovascular
diseases, and a higher risk of cognitive
impairment. 15 Although the data are quite
consistent, strong evidence showing a causal link
between sepsis and post-acute fatality is still
missing. In studies reporting non-sepsis control
arm comparisons, sepsis was not consistently
associated with a higher hazard ratio for post-
acute mortality. The additional hazard associated
with sepsis was greatest when compared with
the general population. The presence of
comorbidities, older age, and male gender seem
to be independent predictors of post-acute
mortality in sepsis survivors, challenging a clear
and evidence-based causality relationship.
Additional epidemiologic studies with recent
patient level data that address the pre-illness
trajectory, confounding, and varying control
groups are needed to estimate sepsis-attributable
additional risk and modifiable risk factors. 16
Little is known about the long-term
consequences on functional and cognitive
recovery after sepsis. Intensivists have defined
a syndrome in survivors of critical illness,
including sepsis, termed post-ICU syndrome,
which is characterised by insomnia, nightmares,
fatigue, depression, loss of cognitive function and
loss of self-esteem. Almost half of the sepsis
survivors report at least three of these symptoms.
These individuals demonstrate cognitive deficits
in verbal learning and memory up to two years
after the hospital discharge. The consensus has
been that sepsis survivors have a moderate-to-
severe cognitive impairment 10% higher than the
general population. Equally important, patients
who survived sepsis had a much higher incidence
of new impairments than their age-matched
counterparts. 17
Needless to say, that these sequelae of sepsis
per se contribute to an increasing economic
burden; data, however, are very limited, and
especially valid analyses for add-on costs by
individuals surviving sepsis are more or less not
existing. In contrast, most analyses focus on the Conclusions
Even though surgical and pharmacological
approaches in sepsis therapy are constantly
improving, epidemiological studies show an
increase in incidence of sepsis over the last 20
years. At present, the rough estimate for new
cases of sepsis and septic shock is between 200
and 300 cases per 100,000 inhabitants and year
in Western Countries. The differences between
available studies are based on different criteria
for definition of sepsis and data resources. The
overall fatality is decreasing, with a trend for
lower mortality rates from administrative data
compared to protocol-based, prospective studies.
Current estimates are between 30% and 50%
mortality rate for sepsis/septic shock on ICUs.
The economic burden is huge and increasing,
especially in older patients and non-survivors;
in addition, the indirect costs for sepsis survivors
due to the sequelae of the disease with lower
quality of life, higher rate of unemployment, and
follow-up diseases is a still unknown ‘fuzzy zone’
of a high and probably increasing cost factor,
which requires a completely new approach for
research projects, that is, a ‘joint venture’
between acute care hospitals, insurances,
rehabilitation centres, and physicians/nurses
outside the hospitals, who take care of this
increasing group of individuals/patients.
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10
HHE 2018 | hospitalhealthcare.com
overall costs of sepsis as a disease, some of them
tried to estimate the follow-up costs, when
patients survived. There is growing evidence that
medical care costs represent a large proportion of
the gross domestic product in developed
countries, and ICUs consume a significant amount
of those resources. 18 The greatest impact is based
on the permanent staffing and other overhead
costs, and from the patient’s side, mechanical
ventilation in severely ill patients, and sepsis
management are responsible for the majority of
the economic burden. In a large, prospective trial,
Moerer et al analysed the individual patient-
related cost of intensive care at various hospital
levels and for different groups of diseases in 51
German ICUs. 19 The mean total costs per patient
and day were € 791 ± 305, with the highest cost
in septic patients (€ 1090 ± 422). An estimation
based on recent incidence rates of sepsis and
septic shock demonstrates, that this results in
direct ICU treatment costs for sepsis of 1.1–2.45
Billion € per year, or – in other words – that
between 21% and 46% of total ICU costs are spent
on sepsis management. 19
Evidence for a causal link
between sepsis and long-term
mortality: a systematic review of
epidemiologic studies. Crit Care
2016;20:101–13.
17 Hotchkiss RS et al. Sepsis and
septic shock. Nat Rev Dis Primers
2016;2:16045.
18 Pittoni GM, Scatto A.
Economics and outcome in the
intensive care unit. Curr Opin
Anaesthesiol 2009;22:232–6.
19 Moerer O et al. A German
national prevalence study on
the cost of intensive care: an
evaluation from 51 intensive care
units. Crit Care 2007;11:R69.