Hospital admissions for sepsis have risen 78% in 20 years, with infants and the elderly most at risk. Photo / 123RF
By Kate Green of RNZ
Hospital admissions for sepsis have risen steeply in the past 20 years, with new research showing infants, people over 70, Māori and Pacific peoples and those living in areas of high deprivation are more at risk.
Sepsis is an acute, life-threatening condition that happens when the body’s immune system has an extreme response to an infection, damaging the tissues and organs.
Globally, it was estimated to be responsible for one in three deaths, with more than 166 million cases reported in 2021, and in New Zealand, it was responsible for almost 5% of all deaths – nearly four times as many as car accidents.
The research from the University of Otago, Wellington, titled “Temporal trends in sepsis hospitalisations and mortality in Aotearoa New Zealand, 2000-2019” and published in The Lancet Regional Health – Western Pacific, found hospitalisation rates increased by 78% between 2000 and 2019.
There were 217 admissions per 100,000 people in 2000, which increased to 386 admissions per 100,000 people in 2019.
Māori and Pacific peoples were 1.7 and 2.3 times respectively more likely to be hospitalised with sepsis than those of non-Māori, Pacific or Asian descent, and more than one-and-a-half times more likely to die of the condition.
Patients living in areas of high socioeconomic deprivation were twice as likely to die from it than those in the areas of least deprivation.
Lead author Sharla McTavish, a Tangata Tiriti PhD student from the Department of Public Health, said the study was the first to report long-term epidemiological trends for all public hospital admissions for sepsis in Aotearoa.
Sepsis had a large impact on health and wellbeing, she said – in total, it caused about 260,000 hospitalisations and 27,400 deaths over the two decades.
The number of hospitalisations had increased significantly year-on-year, but the number of deaths had remained comparatively stable, with survival rates improving markedly, particularly for those aged over 70, she said.
But she said cases were likely to continue to rise as the population aged and the number of people living with chronic conditions, such as diabetes, increased.
“People living with multiple long-term health conditions are at higher risk of developing sepsis, and where this is combined with inequalities, such as household overcrowding, the risk increases even more.”
Otago public health Professor Michael Baker, another of the study’s authors, said taking action to prevent the condition should be high on the Government’s list of priorities.
“Many cases and deaths from sepsis are preventable, but we need to use all the public health measures we have to combat the toll it is taking on New Zealand families.”
Health NZ has been approached for comment.
Sepsis Trust NZ founding trustee Dr Paul Huggan said sepsis created a significant burden for the healthcare system.
“Around one in five sepsis patients require intensive or high dependency care, yet only half receive treatment within the recommended three-hour window, which is well below global best practice, and is putting lives at risk.
“We have strong international evidence which shows investing in early recognition and prevention will reduce hospital stays, ease pressure and costs on ICU and our ACC system, and deliver strong economic returns.”
HNZ’s national chief quality and patient safety officer, Dr Sarah Jackson, said the agency would read this study with interest and welcomed the opportunity to explore its findings further with Huggan.
The agency recognised that sepsis was a life-threatening condition that could appear suddenly, with signs that were subtle and often under-recognised. “New Zealanders can be assured we treat it with the seriousness it demands.”
Sepsis Trust NZ chief executive Ally Hossain said progress was being held back by a lack of coordinated action, and a national sepsis action plan was needed.
“This plan must address sepsis prevention, early recognition and treatment, the careful use of antibiotics and wider public health surveillance, as well as providing equitable and effective wraparound support for sepsis survivors, particularly in the first 12 months following hospital discharge.”
She said New Zealand was already falling behind comparable countries, and it was costing lives.
“We know that millions of dollars would be saved within even the first 12 to 24 months of the action plan’s implementation, let alone the number of deaths it would prevent.”
Cancer and surgical patients were most at risk, she said, so improving their outcomes could reduce hospital stays and lessen pressures on ICUs.
In 2017, the 70th World Health Assembly asked countries to adopt prevention, diagnosis and management of sepsis as a priority, and develop a national action plan by 2030. “Comparable countries”, including Australia, Switzerland, parts of Canada, the UK, Belgium, Ireland, and the USA, had already adopted them.
The trust had created resources for use in hospitals to help staff recognise sepsis early, and choose the right treatment. “But as it stands at the moment, this has not been implemented nationwide.”
Hossain said after meeting with the Health Minister Simeon Brown late last year, he had sent a letter saying he had passed on the trust’s requests to HNZ for consideration, and Hossain said frontline clinicians had been very supportive.
A spokesperson for Brown’s office said the Government was focused on prevention and improving health outcomes for all New Zealanders, including for conditions like sepsis, and encouraged health agencies and stakeholders to work together to strengthen coordination.
HNZ’s Jackson said consideration of a national sepsis action plan was ongoing.
She said the agency endorsed sepsis pathways and e-learning developed by the Health Quality and Safety Commission and Safety New Zealand, and was developing a national empiric antimicrobial guideline to improve the efficiency and consistency of the use of antimicrobials, which are used to treat sepsis.
“The implementation of e-vitals across hospitals will also help with early recognition of sepsis and response to acute deterioration. This system identifies patients whose condition worsens due to severe infections and sepsis, which triggers a clinical graded response, to bring urgent care quickly to the sickest patients.”
- RNZ