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Research Shows Septic Shock Starts Earlier Than Understood And Develops Distinct Levels Of Patient Risk

Sept. 22, 2020
CONTACT: Doug Donovan
Cell: 443-462-2947
dougdonovan@jhu.edu
@dougdonovan

Johns Hopkins University researchers have found that hospitals could save more lives with a tool that offers earlier identification of patients most at risk of septic shock.

The new research from the Department of Biomedical Engineering and the Institute of Computational Medicine indicates that the onset of septic shock likely begins much earlier than when the final stage of the deadly condition is understood to start.

In addition, the process used by the researchers would help hospitals classify sepsis patients into four distinct categories to better prioritize effective, early interventions for those most at risk of dying from one of the deadliest, most costly medical conditions in the United States.

Ran Liu

Ran Liu

“We were able to reliably assign patients to these risk categories based on their risk score trajectories,” said Ran Liu, a doctoral student in biomedical engineering and lead author for the study. The research, published today in the eLife online journal, was supervised by Liu’s advisor, Raimond L. Winslow, director of the Institute for Computational Medicine.

Sepsis and septic shock are the leading causes of in-hospital deaths. The biomedical researchers from the Whiting School of Engineering and the Johns Hopkins School of Medicine say their findings could help to provide earlier identification of the patients who are closest to the rapid period of septic shock when infection overwhelms the immune systems, leading to organ failure and death.

The research utilized more than two dozen physiological indicators from more than 200,000 individual admissions at 208 U.S. hospitals. “The transition from sepsis to pre-septic shock on average occurs on a rapid time scale, with a sharp increase in risk occurring within 30-60 minutes immediately preceding time of early warning.”

The quick change is indicated by rapid shifts in blood pressure, lactate levels and heart rate. With the immune system overwhelmed by infection, the body begins to lose all ability to halt a patient’s plummeting trajectory. The researchers state that they believe septic shock actually begins in that period currently known as “pre-shock.”

“When patients enter what we have previously called the pre-shock state, they are in fact in a state of septic shock,” the paper states. Members in the highest risk category “are in a state of septic shock on average 10 hours before they satisfy the current clinical definition of shock.”

“Clearly entry into the pre-shock state is sufficiently rapid that its detection will require intelligent automated monitoring of patients,” it states.

The researchers recommended that more hospitals should begin implementing automated early warning technology. Systems capable of assigning distinct risk categories determined by data would provide a “clear and objective definition” of septic shock and eliminate common disagreements among medical staff about onset.

The paper also supported existing research that calls for more frequent lactate measurements to better classify patients. “The median time between observations of lactate, the most important feature in our risk model, is 11.2 hours,” the paper states. Prior studies recommended measurements every 1 to 2 hours.

Reporters who want to interview Ran Liu can contact Doug Donovan at 443-462-2947 or at dougdonovan@jhu.edu.

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