Sepsis, A Wily Killer, Stymies Doctors' Efforts To Tame It

May 4, 2015
Originally published on May 5, 2015 12:48 pm

If you ran down the list of ailments that most commonly kill Americans, chances are you wouldn't think to name sepsis. But this condition, sometimes called blood poisoning, is in fact one of the most common causes of death in the hospital, killing more people than breast cancer and prostate cancer combined.

Jennifer Rodgers learned about sepsis the way many people do — through personal experience.

In the summer of 2012, Rodgers and her extended family took their annual trip to the Jersey Shore. But that trip came to an abrupt halt after her 62-year-old father, Bob Skierski, developed a serious medical condition: a blocked artery in his abdomen.

"He was not getting any blood flow to his legs, basically as a side effect of smoking," Rodgers says during an interview in her home in Haddon Heights, N.J.

Doctors in Philadelphia replaced the damaged blood vessel, but a year later it failed again, and Skierski was back in the operating room.

"There were several complications with that surgery; basically it ended up being a 9- or 10-hour surgery," Rodgers says. The blood flow to part of her father's intestines had stopped, so the doctors removed a section of his colon.

Skierski would need another operation, but first he would have to wait in a long-term acute-care hospital while his abdomen healed. He was hospitalized for more than six months. And just a few weeks before his next surgery was scheduled, there was more trouble.

"He got very confused, he was very sweaty, incoherent at times," Rodgers says. "His blood pressure and heart rate became unstable. His body temperature, his white blood cell count had gone up. And those are all warning signs of sepsis."

Indeed, an infection had suddenly turned into the life-threatening condition called septic shock. A team of doctors swarmed Skierski, pumping him full of antibiotics and doing what they could to prevent a common consequence of sepsis: a drop in blood pressure and multiple organ failure.

"I had never seen anyone that sick before in my life," Rodgers says, noting her father was on so many drugs he had two IV poles — one on each side of his bed.

Bob Skierski survived this bout of sepsis, though in a weakened state. A few weeks later, the doctors decided to go ahead with the scheduled surgery, hoping to end his months-long sojourn in the hospital.

"His whole team of doctors was pleased with the surgery; it went well. He truly was really filled with joy that he got through the surgery, and at that point we were all very hopeful" that he could finally go home, she said. "Unfortunately that didn't happen."

Instead, Skierski got a second bout of sepsis, and this time the doctors couldn't bring it under control. It rapidly took his life.

Most vexing is that doctors can only treat the symptoms. They don't have an effective treatment for the underlying condition.

"So I guess that actually raises several questions," says Dr. Edward Sherwood, a professor of anesthesiology at the Vanderbilt University Medical Center. "Do we truly understand what causes sepsis and are we attacking the right target?"

For example, it's not clear whether boosting the immune system or turning it down is actually more helpful. It may in fact be different, case by case.

Dozens of drugs have been developed in mice for sepsis, but every one of those has been a bust in people.

"There have been many billions spent in many different categories, and none have been actually useful," says Dr. Ronald Tompkins, a surgeon at Massachusetts General Hospital. He says that's because "there's a tacit understanding the system would behave similarly in people as it does in mice."

But Tompkins and colleagues have found that mouse immune systems are very different from human immune systems, so the rodents are a questionable stand-in.

"And even worse, the studies that we do in young adolescent mice are in laboratories, never exposed to the wild world," Tompkins says. "And that's not people."

Human immune systems are constantly challenged by germs and shaped by the real-world environment. Tompkins says mouse studies have been so disappointing that he's looking for novel ways to study sepsis, if he can get funding to pursue them.

Sherwood still believes mice can be useful for studying sepsis. But he does agree that you can't use mice as a stand-in for a hospitalized patient.

"You can't really support a mouse for days on end as you would in an ICU for a person, and because of that I think we don't really have an accurate model of what happens clinically," Sherwood says.

As a result, researchers have simply used trial and error as they struggle to treat the symptoms.

One thing that can help is prompt medical attention — especially when an infection is accompanied with some of the symptoms of sepsis, such as confusion, rapid heartbeat, shaking and skin rash. Doctors can more quickly start antibiotics and other needed treatments.

After her father died, Jennifer Rodgers decided to do what she could to raise public awareness of sepsis, through art. She's an artist and high-school art teacher. She has already produced a number of pieces that capture her feelings about her father's long hospital stay and ultimate death from sepsis.

"I hope to eventually make a series specifically about sepsis, as a way to educate people so they're aware," Rodgers says. "Watching what sepsis does is just devastating. I know it can strike anybody at any time. And having seen it myself, it's horrible. It's truly horrible."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.

Transcript

STEVE INSKEEP, HOST:

Let's report now on one of the most common causes of death in the hospital - it's called sepsis. It doesn't get a lot of attention, but there it is, a vexing combination of infection and inflammation, sometimes called blood poisoning. Doctors can treat the symptoms, but nobody has found a drug to treat the disorder itself. And today in Your Health, NPR's Richard Harris looks at this disease that strikes more than a million Americans per year and kills more than prostate cancer and breast cancer combined.

RICHARD HARRIS, BYLINE: Sepsis can kill young and old alike. This particular story is of a man who was closing in on retirement age. Bob Skierski had lived for many years in a vintage suburban home in Haddon Heights, N.J., which he'd sold a few years ago to his daughter Jennifer Rodgers.

JENNIFER RODGERS: Hi. Come on in. I'm Jennifer.

HARRIS: Hi, Jennifer, hi. I'm Richard, so nice to meet you.

RODGERS: Hi, Richard. Come on in.

HARRIS: We settle around the kitchen table and Rodgers tells the story of her dad. Disease first struck in 2012 during a family vacation to the Jersey Shore. Dad was rushed to the hospital with a serious problem in his abdomen - a blocked artery.

RODGERS: And he was not getting any blood flow to his legs, basically as a side effect of smoking. He had pretty much smoked his whole life.

HARRIS: Doctors in Philadelphia replaced the damaged blood vessel, but a year later, it failed again, and he was back in the operating room.

RODGERS: There were several complications with that surgery; basically ended up being, I think, a nine to 10 hour surgery. He ended up having part - part of the blood flow to his intestines had stopped. So they had to go in and remove part of that, had to give him a colostomy. At one point, our doctors told us he was the sickest person in the ICU.

HARRIS: He would need another operation, but first, he would have to wait for his abdomen to heal in a long-term, acute-care hospital. He was hospitalized for more than six months, and just a few weeks before his next surgery was scheduled, there was more trouble.

RODGERS: He got very confused. He was very sweaty, incoherent at times. His blood pressure and heart rate became unstable. His body temperature, his white blood cell count had gone up. And those are all warning signs of sepsis.

HARRIS: Indeed, an infection had suddenly turned into this deadly condition septic shock. A team of doctors swarmed him, pumping him full of antibiotics and doing what they could to prevent a common consequence of sepsis - multiple organ failure. Rodgers is an artist and a high school art teacher. She kept copious notes and drawings to capture these frightening moments with her dad.

RODGERS: I had never seen anyone that sick before in my life. He was on so many medicines. I took a picture and did some drawings of the IV pole. In fact, there were two on both sides of his bed.

HARRIS: Bob Skierski survived this bout of sepsis, though in a weakened state. A few weeks later, the doctors decided to go ahead with the scheduled surgery, hoping to end his months-long sojourn in the hospital.

RODGERS: So they did proceed with surgery. His whole team of doctors were very pleased with the surgery. It went well. He truly was really filled with joy that he got through the surgery, and at that point, we were all very hopeful. We're like, now you can just heal and come home. And unfortunately, that didn't happen.

HARRIS: So what did happen?

RODGERS: Sepsis, again.

HARRIS: And this time, the doctors couldn't bring it under control. Skierski died last year at the age of 64. His story is more drawn out than many. Even a seemingly simple bladder infection can lead to sepsis. And the most vexing part is that doctors can really only react to and treat the symptoms.

ED SHERWOOD: But as far as attacking the underlying cause of sepsis, we have not been very successful.

HARRIS: Dr. Ed Sherwood is a professor of anesthesiology at the Vanderbilt University Medical Center.

SHERWOOD: So I guess that actually raises several questions. One, do we truly understand what causes sepsis, and are we attacking, you know, the right target?

HARRIS: They're not really sure what they're dealing with. For example, it's not clear whether boosting the immune system or turning it down is actually more helpful. Dozens of drugs have been developed in mice for sepsis, but every one of those has been a bust in people, says Ron Tompkins, a surgeon at Massachusetts General Hospital.

RON TOMPKINS: There have been many billions spent in many different categories, and none have been actually useful.

HARRIS: Essentially, all of these trials have failed.

TOMPKINS: They have in the past because there's a tacit understanding that the system was going to behave similarly in people as it does in mice.

HARRIS: Tompkins and colleagues have found that mouse immune systems are very different from human immune systems. So the rodents are a questionable stand-in.

TOMPKINS: And even worse, the studies that we do are in young adolescent mice that are in laboratories, never exposed, really, to the wild world. And that's not people.

HARRIS: Human immune systems are constantly challenged by germs and shaped by the real-world environment. Tompkins is looking for ways to study sepsis without mice. Ed Sherwood says mice can still be useful in studying sepsis, but he does agree that you can't really treat the animals the way people are treated in the hospital, say, by giving them a breathing tube.

SHERWOOD: You can't really support a mouse for days on end kind of like you would in an ICU for a person, and because of that I think we don't really have an accurate model of what happens clinically.

HARRIS: So researchers have simply used trial and error as they struggle to treat the symptoms. One thing that can sometimes help is prompt medical attention. So after her father died, Jennifer Rodgers decided to do what she could to raise public awareness of sepsis through her art.

RODGERS: So these are my sketchbooks - yeah, here they are. Everything in here represents something about him or his experience in the hospital.

HARRIS: And I see that you've not only dated it, but you've dated it day 181.

RODGERS: Yeah, I kept count the whole time.

HARRIS: Significant numbers crop up in her work, along with gauze and threads of gold, which evoke the hospital for her.

RODGERS: I hope to eventually make a series specifically about sepsis as a way to just educate people so they're aware. Watching what sepsis does is just devastating. I know it can strike anybody at any time, and having seen it myself, it's horrible. It's truly horrible.

HARRIS: Her art is also helping her come to terms with her father's ordeal. Richard Harris, NPR News. Transcript provided by NPR, Copyright NPR.