NETIMIS was developed to model point of care testing (POCT) interventions to help reduce the risk of sepsis.
Sepsis is a life-threatening condition which is triggered by the invasion of germs such as bacteria, fungi, viruses or parasites into the blood stream of the body1. To defend the body against these invaders, the body stimulates an immune response, which may attack the body’s own tissue. Hence, to confirm the diagnosis of sepsis, clinicians look for history of infection in a patient together with two or more of the following conditions:
- Temperature: greater than 38°C or less than 36°C
- Heart rate: greater than 90 beats per minute
- Respiratory rate: greater than 20 breaths per minute or hyperventilation, indicated by PaCO2 less than 32 mm HG
- White Cell Count: greater than 12,000/cu mm, or less than 4,000/cu mm or the presence of more than 10% immature (band) cells
Type of sepsis
Mild form of sepsis can be treated with antibiotics and may not need hospitalization. However, sepsis may be complicated by remote organ dysfunction (severe sepsis) or arterial hypotension (septic shock) or death especially if not recognised early and treated promptly. Severe sepsis and septic shock patients require straight away admission into hospitals for their organs support while the infection is treated.
Severe sepsis is clinically defined as sepsis associated with organ dysfunction, hypo perfusion or hypotension. Hypo perfusion and perfusion abnormalities may include, but are not limited to: lactic acidosis, reduced urination, or an acute alteration in mental status.
Septic shock is the sepsis induced hypotension despite adequate fluid resuscitation along with severe sepsis.
INCIDENCE OF SEPSIS
- World-wide, incidence of sepsis is 1.8 million cases annually, although actual figure can be much higher2.
- In the European Union, incidence of severe sepsis (sepsis-induced organ dysfunction) has been estimated at 90.4 cases per 100 000 population, as opposed to 58 per 100 000 for breast cancer3.
- In the UK, more than 100,000 people per year are admitted to hospital because of sepsis. Of these 100,000 cases, sepsis claim approximately 37,000 lives.
An interrogation of a high quality database, Intensive Care National Audit & Research Centre (ICNARC), revealed that between December 1995 and January 2005 there were 343,860 admissions into critical care units (ICUS and combined ICU/high dependency units) across England, Wales and Northern Ireland4.
This data revealed that hospital mortality due to severe sepsis in these critical care units was about 45%.
ECONOMIC IMPACT OF SEPSIS
Sepsis is a deadly condition where the condition of patients can deteriorate into serious life threatening state if the treatment does not start within an appropriate time frame. The economic impact of sepsis on healthcare is huge because most patients tend to be admitted into critical care. If recognised early, sepsis can be treated more cheaply with anti-infectious therapy such as administration of antimicrobial therapy or initiation of surgical source control. According to World Sepsis Day, between 2000 and 2008, hospitalization has more than doubled. The UK sepsis Trust estimates the cost of managing sepsis to NHS England is about 2.5 billion per year.
An independent report published by Parliamentary and Health Services Ombudsman reported that each year in UK, there are approximately 100,000 hospital admissions occur due to sepsis, with an average cost of care about £20,000 per patient. It also stated that just by following basic principles of sepsis management, approximately £4,000 can be saved per episode.
DIAGNOSIS OF SEPSIS
Any suspected sepsis needs immediate attention to start the appropriate treatment. Although fast and appropriate therapy is the cornerstone in the treatment, the discrimination of sepsis from non-infectious causes of inflammation may be difficult.
Conventional diagnosis often relies on patient’s history, clinical symptoms, measurement of vital signs such as temperature, respiratory rate and heart rate and results of routine blood and urine test. However, confirming infection as an initiator of severe inflammatory response remains the challenging factor.
Several biomarkers and point of care testing device are currently under research for rapid diagnosis of sepsis. These include C-reactive protein, Procalcitonin, Interleukin-6, Strem-1, Liposaccharide-binding protein, suPAR. Apart from clinical advantages such as rapid turnaround time, rapid clinical decision making, easy interpretation of test result, portability of testing, low maintenance and minimal use of blood, many economic benefits of POCT such as; reduced number of clinic visits, reduced length of hospital stay, inappropriate use of drugs etc. have been anticipated in literatures. Nonetheless, determination of cost effectiveness of POCT device with changes to healthcare delivery system has been proven as quite a challenging task.
The role of the NETIMIS tool is, to address this challenge by using modelling and simulation, to inform decision makers in healthcare practice. The tool is designed in partnership with clinicians and industry leaders to allow the decision makers to model the existing healthcare patient pathways and to experiment changes with minimal financial investment. The tool’s highly user friendly ability enables users to model patient pathways with very little training or supervision.
1Bone, Roger C., et al. "Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine." Chest Journal 101.6 (1992): 1644-1655.
2Daniels, Ron. "Surviving the first hours in sepsis: getting the basics right (an intensivist's perspective)." Journal of antimicrobial chemotherapy 66.suppl 2 (2011): ii11-ii23
3Davies, A., et al. "Severe sepsis: A European estimate of the burden of disease in ICU." Intensive Care Medicine. Vol. 27. 175 FIFTH AVE, NEW YORK, NY 10010 USA: SPRINGER-VERLAG, 2001.
4Harrison, David A., Catherine A. Welch, and Jane M. Eddleston. "The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996 to 2004: secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database." Crit Care 10.2 (2006): R42