Septicemia is always fatal

Knowledge is power: does sepsis have to be fatal?

06/17/2019 - Imagine a medium-sized passenger plane crashes every day in Germany - and nobody notices. Something like this is the case with sepsis, also known as blood poisoning: 162 people die from it every day in this country; in road traffic there are nine. At the Capital Congress Medicine and Health (HSK) 2019, experts discussed the question: Does sepsis have to be fatal? It showed that the use of big data and artificial intelligence could open new doors in the fight against the underestimated disease.

It is a "terrible clinical picture", explained Prof. Dr. Michael Adamzik ​​from the University Clinic Knappschaftskrankenhaus Bochum. "Sepsis always occurs when microorganisms such as viruses, bacteria and fungi attack our organism, the immune system then gets out of control and the body's own organ systems attack during this defense reaction." The cause can be a visibly inflamed wound, but also an infection such as one Lung infection.

The following applies to sepsis: Every second counts. Because sepsis can lead to shock, multiple organ failure and death. And not too seldom: sepsis is the third most common cause of death in Germany after myocardial infarction.

This does not appear in the statistics because only the respective underlying diseases are listed here. "140,000 patients in Germany develop sepsis every year," says Adamzik. About 59,000 of them die directly; another 28,000 in the first year after discharge from hospital. The expert, who has been researching the sepsis syndrome for over 20 years, puts the economic damage caused by the disease at 7.7 billion euros. "I think these numbers speak for themselves."

Sepsis and its long-term consequences

How devastating sepsis is was also reported by Dr. Stefanie Schmitz from the Institute for Health Services Research of the German Pension Insurance Knappschaft-Bahn-See Bochum. In a retrospective study with health insurance data from the Knappschaft, she and her colleagues examined over 117,000 sepsis patients who were in hospital between 2009 and 2016 - and divided them into three degrees of severity: “I can see clearly that the septic shock is a very poses a high risk of death in the hospital; the average mortality is 66 percent. The second group is sepsis: I still have a high risk of death with an average of around 31 percent. And the third group, those with severe infection without organ failure, have a 13 percent probability of death in the hospital. "

But even after discharge, sepsis harbors a great danger - especially in the first year: "Of those who have had sepsis or septic shock and come out of the hospital alive, 35 percent do not survive." The Knappschaft data also show: “Those who go to rehab after discharge from the hospital have a significantly higher probability of survival than those who are transferred home.” Schmitz therefore appealed: “With sepsis, the focus must be much more on it be guided how one can sustainably improve aftercare. "

Sepsis: an incredibly complex system

Research in the field of sepsis did not stand still: "In the last 80 years several hundred thousand publications on this topic have been published," says Adamzik. Nevertheless, nothing has changed in terms of mortality (probability of death) since then. “Neither resistance nor bad therapies are the problem. The problem is millions of complex cascade-like processes that are triggered by the infection and that cannot be stopped at the moment. "Even if the trigger has been eliminated - for example a bacterium by an antibiotic - the downward spiral of the sepsis syndrome continues, explained Adamzik. Because sepsis is complex and not linear. There are an unbelievable number of variants and manipulated variables, according to the expert: "If I tap below, something moves in a completely different place and that leads to new movements in another place."

The good news is: “For a few years now it has been possible in principle to describe such complex or chaotic systems mathematically by not only generating big data from the patient, but also creating mathematical patterns on this basis that are used to estimate the therapeutic Acute and long-term prognosis as well as for the implementation of personalized therapy in everyday clinical practice can be used, ”says Adamzik ​​(see HSK website).

Immune system: "Ocean of data" for sepsis analysis

According to Adamzik, the "ocean of data" as the basis for a comprehensive sepsis analysis is provided by the immune system itself. Using flow cytometric techniques, summarized in so-called OMICs technologies, the entire genome, transcriptome or proteome of a cell can now be recorded. The German Cancer Research Center (DKFZ) explains on its website: "With these technologies, molecular changes associated with diseases [...] can be recorded comprehensively and in detail." Adamzik: "We are trying to generate the data using these techniques, and use artificial intelligence ”. The aim is to discover certain patterns in this way that may provide information about survival and therapeutic success in sepsis. In addition, clinical data such as skin temperature can be collected and analyzed.

Adamzik's hope is that the researchers will soon be able to understand the clinical picture of sepsis in a completely new way thanks to the new technologies. On this hope, the "SepsisDataNet" was founded in North Rhine-Westphalia - funded by the European Fund for Regional Development (ERDF). According to Adamzik, four university and six miners' offices are networked in it; 150 patients are already included.

The website of the project states: “Biomarkers or clinical test procedures that characterize this complex immunological syndrome well do not exist, so that causal therapy that is adapted to the immune status is currently not possible. The lack of characterization seems to be partly responsible for the still high mortality of sepsis. Furthermore, the time sequence and the strength of the inflammatory and anti-inflammatory response are subject to great intra-individual variability ”. In principle, it is a matter of using an extensive analysis of patient data to create “a coherent picture” from the many pieces of the mosaic and finally to transfer the results “within the framework of suitable products into routine clinical diagnostics in hospitals”. Ultimately, this should make it possible to make prognostic statements about the course of the disease in clinical practice and to provide personalized therapy “on the basis of the analyzed immune status”.

Largest sepsis biobank in Europe

As Adamzik ​​said, every day two medical technical assistants (MTAs) drive from the University Clinic Knappschaftskrankenhaus Bochum to the participating clinics: They “take blood there and prepare it so that at the end of the funding period we will certainly have the largest biobank in Europe on this topic ". However, for financial reasons only a small part of the possible data can be analyzed so far. “We have to go on. We have to dramatically reduce this number to 162 deaths per day, ”Adamzik ​​appealed with a view to politics and science funding. Building on the “SepsisDataNet”, “SYMBARA” was launched.

Leading experts in sepsis research in Germany are united here. According to the website, the aim is to "sustainably maintain a long-term biobank of around 500 patients" and to provide a "complete picture of the dynamics of sepsis".

There is still a long way to go before that happens. Heike Gebhard, state politician (SPD) in North Rhine-Westphalia, said at the HSK event: "It would indeed be irresponsible not to use these opportunities that arise [from Big Data]". In addition, she called for the possibilities of sepsis prevention to be brought into greater public awareness: This includes, for example, increasing the willingness of the population to vaccinate in order to avoid infections. But careful use of antibiotics is also important - keyword resistance.