University of Nebraska Medical Center researchers are part of an international team that demonstrated how sepsis infections can be recognized before they become lethal in resource-limited environments.
The international team is known as the Sepsis Assessment and Identification in Low Resource Settings (SAILORS).
Sepsis occurs when the body’s response to infection becomes excessive and causes injury to vital organs, said Andrew Patterson, M.D., Ph.D., a critical care medicine physician and executive vice chair of the UNMC Department of Anesthesiology, who was involved in the research.
"Intensive medical management can be lifesaving if patients with sepsis are identified early enough," Dr. Patterson said. "Unfortunately, predicting which patients with infection will develop sepsis is difficult, particularly in resource-limited environments where laboratory data and sophisticated monitoring are not available."
Dr. Patterson cited the quick Sequential Organ Failure Assessment (qSOFA) as a simple tool which allows clinicians to use three bedside assessments to predict whether a patient is developing sepsis: mental status, respiratory rate, and blood pressure.
In the May issue of the Journal of the American Medical Association (JAMA), Dr. Patterson and his UNMC colleagues and members of the SAILORS team, provide evidence that qSOFA is effective in resource-limited environments to ascertain whether a person has sepsis compared to the traditionally used systemic inflammatory response syndrome (SIRS).
"This work represents a collaboration between researchers from around the world," said Dr. Patterson, who’s worked in the rural village of Gitwe, Rwanda for more than a decade. "For the SAILORS study, we worked with investigators from Bangladesh, Haiti, India, Indonesia, Sri Lanka, Thailand, Vietnam, Sierra Leone, Rwanda, and Myanmar."
Dr. Patterson said the SAILORS project highlights the remarkable work of health professionals including Urayeneza Olivier, M.D. and Urayeneza Gerard in Gitwe, Rwanda as well as numerous others in Africa and Asia who dedicate their lives to the care of others in resource-limited environments.
He said UNMC’s earlier study in Gitwe, Rwanda was among the largest included in the SAILORS analysis. The UNMC team, together with individuals from Rwanda and Austria conducted, the yearlong study of sepsis in Gitwe that included more than 1,500 patients.
"We are grateful for the opportunity to learn from them and with them," Dr. Patterson said. "And, we are indebted to the patients who participated in the SAILORS studies. They provided the information that made this work possible."
UNMC and Nebraska Medicine health professionals and medical students participate in education, research and clinical care in Gitwe.
The study was led by Kristina Rudd, M.D., of the University of Washington, and Derek Angus, M.D., of the University of Pittsburgh. In addition to Dr. Patterson, the UNMC team included Danstan Bagenda, Ph.D., Julia Hoffman, and Austin Porter, UNMC Department of Anesthesiology; Monirul Islam, M.B.B.S., Ph.D., UNMC College of Public Health; Ashok Mudgapalli, Ph.D., UNMC Department of Genetics, Cell Biology and Anatomy.
The research analyzed data from nine studies in countries designated as low or moderate income, and evaluated which technique - quick Sequential Organ Failure Assessment (qSOFA) or systemic inflammatory response syndrome (SIRS) - was the most accurate and useful in predicting the development of sepsis.
After looking at 6,569 records from 17 sites - ranging across sub-Saharan African, Asia and the Americas - the team concluded that qSOFA provided a more accurate and practical way for caregivers to assess how likely it was that a patient was developing sepsis.
qSOFA only requires a clinician to go through a list of clinical observations - blood pressure, mental status and respiratory rate - while the patients are at the clinic or hospital.
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