Sepsis remains a critical health challenge globally, with 48.9 million cases annually, contributing to significant morbidity and mortality. Despite being a preventable, treatable disease – due in part to advancements in therapeutics – sepsis claims the lives of 11 million individuals each year (20% of all global deaths), making it a leading cause of mortality worldwide.
Nearly half (20 million) of all cases occur in children under five years of age. The highest incidence rates are seen in low- and middle-income countries (LMICs). Sepsis drives hospital mortality and incident disability; patients who survive hospitalisation develop an increased risk for negative health outcomes, including new morbidity, deterioration, hospital readmission and death. The World Health Organization (WHO) Global Antimicrobial Surveillance System report underscores the serious global impact of antimicrobial resistance (AMR), which exacerbates the substantial burden that sepsis poses on patients, the health community and health systems.
Globally, 4.95 million and 1.27 million deaths are, respectively, associated or attributed to AMR. Projections estimate ten million deaths by 2050 with cost of care compounding the burden: a UK report calculated a $100trn global economic impact, particularly due to AMR. These factors focus our lens on modern sepsis management strategies like rapid early diagnosis and intervention, for better health outcomes, and benefit to the medical community, health systems and governments.
Impetus for early recognition and treatment
Given its frequency, high morbidity and mortality, timely sepsis management at the point of care (POC) is a globally recognised public health priority – the urgent need underscored by the World Health Assembly resolution (2017) towards improving the prevention, diagnosis, rehabilitation from, and management of, sepsis. Regional disparities exacerbate the burden; sepsis is common in high-income countries (HICs) – 1.7 million and 48,000 deaths annually, for the US and the UK, respectively. LMICs face a heavier burden due to limited access to healthcare services, few qualified healthcare providers (HCPs), and inadequate diagnostics and lab services. Mitigating the burden, particularly in low-resource settings, requires the adoption of easy-to-use low-cost diagnostic instruments, alongside provider education, to enhance sepsis management. Clinical decisioning support tools, including biomarker diagnostics like C-reactive protein (CRP) and procalcitonin (PCT), widely used in HICs, are also potentially efficacious in LMIC populations to avert antibiotic overuse and improve patient outcomes.
Challenges in point-of-care management
Significant challenges persist in managing sepsis in POC settings across diverse healthcare systems and resource settings. Late presentation and delayed or missed diagnosis, which occur in HICs and are more pronounced in LMICs, result in negative health outcomes. Clinical symptoms of sepsis often present like other conditions. There is no single definitive diagnostic test, which can lead to variable triage and recognition. Furthermore, diversity in patient populations from varying health conditions and immune responses, and the prevalence of healthcare-associated infections (HAIs) are major factors in treatment failure and rapid progression to sepsis and septic shock.
Collaborative international initiatives, like the Surviving Sepsis Campaign (2021) and National Institute for Health and Care Excellence (NICE) updates to the NG51 guideline (2024) have focused on evidence-based guidelines and practices to address high sepsis mortality rates stemming from persistent delays in recognition, diagnosis and treatment. Given that 918,000 patients are hospitalised each year in the UK with ‘suspicion of sepsis’, and that 80-87% of sepsis hospitalisations in the US present from the healthcare community setting, there are opportunities for early identification and response from patient-provider encounters in the time frame before sepsis hospitalisation. Recognising sepsis early in the disease continuum, when clinical symptoms first manifest – rapid heart rate, fever, abnormal white blood cell count in response to infection – is essential to timely therapy to halt the cascade to multi-organ dysfunction and failure. This narrow window of opportunity also presents challenges. Treatment delays dramatically worsen outcomes; one analysis shows patients admitted to intensive care units (ICUs) with severe sepsis have a 39.8% risk of death, each hour of delay in antibiotic administration contributes up to a 9% increase in mortality.
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