Recent research shows that genetic factors play a greater role in the risk of early death from an infection than early death from other diseases such as cancer or heart disease. In 2012-2013, we analysed the genes (GWAS genotyping) of 1700 patients in the BSI registry who have participated in the Nord-Trøndelag Health Study (HUNT). Since then, all the participants in HUNT have been genotyped, so that we have now genotyped 2700 patients with sepsis and 65,000 controls in total. The genes of the frozen bacteria isolated from the patients’ blood will also be analysed. 

We believe that information about the interaction between patients’ genetics, the clinical course of the disease and the genetics of the bacteria can identify new markers for development of serious disease and new treatment targets. Personalized treatment may soon enable more effective sepsis care. Read more about this in the PEST project.   

We also have a large innovation project in progress, called SepCease, in which we will be working on developing a new type of ultrasound technology for early detection of changes in blood circulation in sepsis. Our clinical projects are observational studies of sepsis patients, as well as a large intervention study, “Stop Sepsis, Nurse”, which reduced sepsis mortality by 40% through close monitoring of patients with infections in an ordinary ward. 

We have published several epidemiological studies where we have combined data from HUNT and the BSI registry, and identified several risk factors both for developing sepsis and for dying of it. Long-term effects for sepsis survivors are another area we are focusing on. 

We carry out educational activities and information campaigns about sepsis, and we have created both e-learning programmes and information videos. If you need someone to talk about sepsis, you are welcome to contact us.

PErsonalized Sepsis diagnostics and Treatment PEST

Integrating genetic, microbial and clinical information to identify individual risk of death and severe disease.

Infections have been continuous and prominent threats to survival during human evolution, making innate response genes highly polymorphic. Probably surprising to many, genetic factors play a much more important role in the risk of death from infection than they do in the risk of death from cancer or heart disease. However, genetic risk factors for the latter have received much more attention than those for infectious diseases. 

The primary objective of this project is to develop novel and personal diagnostics and treatment strategies for sepsis tailored to the specific biological and clinical characteristics of the individual patient. 

By using unique Norwegian population-based follow-up studies, we propose to include detailed information on 78 000 participants that are all genotyped in HUNT-MI (70k in the HUNT study and 8k in the Tromsø survey). We have already identified >2000 with sepsis, all included in our existing sepsis registry, one of the world’s biggest sepsis cohorts with clinical and genetic information and the bacterial isolate. Since the microbe is isolated in only 30% of patients with sepsis, we estimate that the real number of sepsis cases among the 78 000 totals >7000 patients. Since ethical committee permission has been granted to abstract detailed information from EHR in all 78000, the PEST-project will be able to extract details of sepsis phenotype (early signs, clinical course, focus of infection, antibiotic use, treatment response, etc.), from community health through hospital and back. We have joined a unique multidisciplinary team of experts in medicine, computational science, and language science, -with collaborators as HEMIT, IBM and BigMed, which will make this feasible. This potentially very large cohort with phenotype, genotype and microbe will reveal possible novel personalized treatment-strategies for sepsis. 

Nurses’ observation increases sepsis survival

Ward nurses have had little knowledge of how important systematic observation of the patient’s vital signs is for identifying sepsis. A project named “Stopp Sepsis Sykepleier” (“Stop Sepsis, Nurse”), launched in 2010, aimed to equip ward nurses with triage tools so that they could make effective observations to detect sepsis early and objectively communicate the level of urgency to the doctor. The project has resulted in better observation of sepsis patients, halving the length of stay in intensive care, reducing organ damage in sepsis survivors and reducing mortality by 43% at Levanger Hospital. The project won the improvement prize awarded by the Norwegian Patient Safety Conference in 2016 and the Norwegian Quality Prize for the health service in 2017.

Published in Critical Care 2016: https://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1423-1

“Peripheral Intravenous Catheters (PIVC), sepsis and blood stream infections (BSI) - Improving patient safety by raised knowledge and quality of care”

 Almost all patients have a peripheral intravenous catheter inserted when they are admitted to hospital. This device makes it easy to administer medication or fluids right into the bloodstream. Although these devices are simple and in everyday use, they must be inserted, observed and handled according to procedures so that they do not present an infection risk for patients. There are strong indications that poor quality in PIVC handling can lead to sepsis. In this project, we will test whether a new assessment tool is valid for assessing the quality of PIVC handling. We will use the tool together with training of nurses to improve PIVC handling procedures and we will investigate the relationship between various types of sepsis and PIVC quality. This is Lise Hovik’s PhD project.

qSOFA performs poorly as a screening tool in predicting severe sepsis and mortality.

A new definition of sepsis was published in 2016. A screening tool named qSOFA was also developed, with three criteria: respiratory rate ≥22 breaths per minute, systolic blood pressure ≤100 and altered mental status. If patients meet at least two of these criteria, mortality is at least 10% and these patients need urgent treatment. We evaluated qSOFA compared with other screening tools such as SIRS and RETTS (the Rapid Emergency Triage and Treatment System). Our study showed that the sensitivity of qSOFA is significantly lower than that of RETTS triage. Our recommendation is therefore that screening should not be based on qSOFA alone, because this tool identifies too few patients who are seriously ill. The findings from this study are important for clinical practice at all hospitals in Norway and the rest of the world.

Link to article: https://sjtrem.biomedcentral.com/articles/10.1186/s13049-017-0399-4

Epidemiological studies

We also conduct epidemiological studies in which we combine data from HUNT and the BSI registry to study risk factors both for developing sepsis and for dying of it. Among other factors, we have shown that obesity, smoking and physical inactivity are linked with a significantly higher risk of sepsis and higher sepsis mortality rates. We are also exploring the possible effects of genetic variants on the risk of developing sepsis. We have looked at how the occurrence, mortality, microbe spectrum and resistance patterns have changed in our region over time, and investigated how well the standard antibiotic treatment covers sepsis in community- and hospital-acquired infections. Long-term effects for sepsis survivors are another area we are focusing on.