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Sepsis risk four times higher in people with a learning disability

Socioeconomic deprivation, comorbidity and learning disabilities are associated with an increased risk of developing non-Covid-19 related sepsis, according to new research.

Socioeconomic deprivation, comorbidity and learning disabilities are associated with an increased risk of developing non-Covid-19 related sepsis and 30-day mortality in England, according to new research.

The study, published in  eClinicalMedicine, analysed 248,767 cases of non-Covid-19 sepsis from January 2019 to June 2022 and matched them with 1,346,166 controls. It found that cancer, neurological disease, immunosuppressive conditions, and having multiple prior courses of antibiotics were associated with developing non-Covid-19 sepsis.

People with a learning disability had a four-fold increased risk and people with chronic liver disease were just over three times as likely, and stage five chronic kidney disease over six times more likely to develop non-Covid-19 sepsis.

Co-author Professor Tjeerd van Staa from The University of Manchester said: “We think the research provides comprehensive data and findings of relevance to healthcare systems worldwide. It underscores the urgent need for sepsis risk prediction models to account for chronic disease status, deprivation status, and learning disabilities, along with infection severity.

“Sepsis remains a global issue of significant concern so understanding its clinical and health inequality risk factors is essential to understanding at-risk cohorts and effective public health mitigations. There is an urgent need to improve the prevention of sepsis, including more precise targeting of antimicrobials to higher-risk patients.”

Sepsis risk during the pandemic

Sepsis develops when the body’s immune system overreacts to an infection and starts attacking its own tissues and organs. It accounts for a significant proportion of global mortality each year. Symptoms can be similar to those of flu and include severe breathlessness and a high fever. Around 80% of cases are believed to develop outside hospital in the UK.

The study was the first to analyse fluctuations in the incidence of non-Covid-19 sepsis before, during, and after the Covid-19 pandemic within a large population.

It found that the incidence rate of non-Covid-19 sepsis decreased during the Covid-19 pandemic which could be attributable to lower risks of non-Covid-19 infections due reduced social mixing, and changes in healthcare delivery.

The figures, however, rebounded to pre-pandemic levels in April 2021 after national lockdowns had been lifted.

UKST Founder and Joint CEO Dr Ron Daniels said: “As an intensive care doctor in inner-city Birmingham, I frequently see patients from underrepresented communities presenting late with sepsis. This important study reminds us that socioeconomic status and the presence of underlying illness – which are themselves often interlinked and additionally linked to ethnicity – are at play in determining inequality in the risk of developing non-Covid sepsis. Healthcare has a duty to reduce this inequality and improve access for all.

“This study therefore highlights the need for targeted education among members of the public in at-risk communities and for the health professionals that serve them, which is why advocacy organisations like the UK Sepsis Trust are working to develop resources in multiple languages, that are inclusive of different skin tones. However, we must remember that whilst the risk factors highlighted in this study are important, sepsis can still strike indiscriminately.”

The study is funded by UK Health Security Agency, Health Data Research UK and the National Institute for Health and Care Research Manchester Biomedical Research Centre.

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