Abstract
As prevalent as sepsis is, it is also largely invisible, and its toll is exacted with an uncomfortable sense of fatalism. Nearly 90% of people in North America are unfamiliar with the word “sepsis,” and of those who are, a minority recognizes sepsis as a leading cause of death [2]. All too commonly, patients dying of sepsis are described as succumbing “to complications of cancer” or “following a brief illness.” Death from pneumonia is deemed an irremediable consequence of antibiotic failure; death from peritonitis is considered a failure of surgical intervention. Whereas charitable and public advocacy groups rally patients and the society at large to find a cure for breast cancer, human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS), multiple sclerosis, and a host of less common illnesses, no such campaigns exist to advance the care of patients with sepsis.
Over the past quarter century, there has been a revolution in our understanding of the mechanisms through which microorganisms cause morbidity and death. For example, we have learned that they kill the host indirectly, through the activation of innate immune responses that cause bystander tissue injury [3] and suppress adaptive immunity [4]. Many of the putative biochemical mediators of this process have been identified and are beginning to undergo evaluation as novel therapeutics or targets for interdiction. We have learned also that genetic factors play a crucial role in defining the course and outcome of sepsis, and to a much greater extent than they do that of cancer [5]. Specific genetic risk factors are being identified and point to new approaches to patient stratification and treatment [6]. Most importantly, we have learned through the Surviving Sepsis Campaign that survival can be increased by systematic application of evidence-based clinical practice guidelines [7], a process that has been supported enthusiastically since its inception by the Surgical Infection Society (SIS) and in the pages of this journal [8,9].
The disconnect between the promise inherent in a rapidly evolving body of scientific knowledge and the absence of a broad awareness of the problem of sepsis was a driving force behind the development of the Global Sepsis Alliance (GSA), inaugurated in September 2010 at the Merinoff Symposium of the Feinstein Institute for Medical Research on Long Island. The GSA brings together a large number of professional and voluntary organizations whose focus is sepsis and the optimal care of critically ill patients. It was founded by four organizations—the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS), the Sepsis Alliance (SA), and the International Sepsis Forum (ISF); and its current membership includes another 20 organizations (Table 1), including the SIS. The GSA is chaired by Professor Konrad Reinhart (Jena, Germany). Its mission is to promote collaboration in advancing sepsis understanding and clinical care and, in particular, to increase the public profile of sepsis and ensure a commensurate increase in awareness and in funding for research and education.
An inaugural activity of the GSA was the development of a definition of sepsis that would facilitate communications with the lay public:
Sepsis is a life-threatening condition that arises when the body's response to an infection injures its own tissues and organs. Sepsis may lead to shock, multiple organ failure, and death, especially if not recognized early and treated promptly. Sepsis remains the primary cause of death from infection despite advances in modern medicine, including vaccines, antibiotics, and acute care. Millions of people die of sepsis every year worldwide.
Current activities of the GSA aim to urge the medical community to recognize sepsis as a medical emergency requiring the administration of fluids, antibiotics, and appropriate anti-infectives within one hour of suspicion of sepsis. Future activities will be developed by its partner members and focus on a greater understanding of the epidemiology of sepsis and educational programs to increase awareness and better management. More about these goals is available on the GSA website at www.globalsepsisalliance.org.