Earlier Warning for Septic Shock

Winter 2021

Sepsis and septic shock are the leading causes of in-hospital deaths. But earlier identification of this deadly condition could soon get easier, thanks to recent findings from a team of Johns Hopkins biomedical engineers.

The researchers have shown that hospitals can more accurately classify patients with sepsis into four distinct categories that prioritize early interventions for those who are closest to the rapid period of septic shock when infection overwhelms the immune systems, leading to organ failure and death.

“We were able to reliably assign patients to these risk categories based on their risk score trajectories,” says Ran Liu, a doctoral student in biomedical engineering and lead author for the study.

Rai Winslow
Raimond Winslow

The research, published in the eLife online journal, was supervised by Liu’s adviser, Raimond L. Winslow, the Raj and Neera Singh Professor of Biomedical Engineering and director of the Institute for Computational Medicine. The research utilized more than two dozen physiological indicators from more than 200,000 individual admissions at 208 U.S. hospitals. While the discovery of an “algorithmic definition” of septic shock requires more study, the findings will help clarify the current ambiguous guidance in the field, the researchers believe.

The new research indicates that septic shock likely begins much earlier than when the final stage of the deadly condition is currently understood to start.

“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 to 60 minutes immediately preceding time of early warning,” the study states.

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 researchers note. 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.”

The team members recommend that more hospitals 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, they say, and eliminate disagreements among medical staff about onset.