Sepsis Is a Serial Killer

An estimated 770 serial killers operated in the U.S. throughout the 1980s...

Many of us remember when the headlines were dominated by stories of serial killers such as Ted Bundy and Jeffrey Dahmer. An estimated 770 serial killers operated in the U.S. throughout the 1980s but in this past decade, their numbers have plummeted to just over 100.¹ The prevailing theory for this decline is that DNA and forensic evidence are now readily available, therefore the thrill is more short-lived. Others contend that there are less readily available victims and they have also been replaced by mass shooters.²

Serial killer Jeffrey Dahmer, 1991. (Milwaukee County Sheriff’s Department)

Well, onward to a second morbid subject which has not experienced such a decline—sepsis. It remains a leading cause of death in the U.S. Despite overall mortality rates being more stable, rates secondary to pulmonary, abdominal, and genitourinary sepsis are increasing in both sexes and in all age groups. There is also significant racial variation in mortality rates/trends.³

In 2015, The Centers for Medicare and Medicaid Services (CMS) introduced the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) as a national quality measure. One cohort study showed that when SEP-1 was implemented, there was an immediate increase in lactate testing rates, no change in rates of broad-spectrum antibiotics, and no change in short-term mortality rates for patients with suspected sepsis.⁴ Wide variability in sepsis mortality rates continue despite standardization in care.⁵ This leads many who study such trends believing such gaps exist due to healthcare disparities.⁶

The reason sepsis results in death is ultimately organ failure.⁷ So we know the serial killer, we just haven’t figured out how to stop it from killing again.

Here is a CDC map that may interest you which depicts sepsis mortality by state.

1. https://www.discovermagazine.com/the-sciences/what-explains-the-decline-of-serial-killers. Accessed 4 November 2022.

2. https://www.biometrica.com/what-happened-to-the-serial-killer-phenomenon-that-terrorized-and-captivated-an-entire-generation/. Accessed 4 November 2022.

3. Prest J, Nguyen T, Rajah T, et al. Sepsis-Related Mortality Rates and Trends Based on Site of Infection. Crit Care Explor. 2022 Oct 10;4(10):e0775.

4. Boccio E, Haimovich A, Jacob V, et al. Establishment of SEP-1 national practice guidelines does not impact fluid administration for septic shock patients. Am J Emerg Med. 2022 Oct 1;62:19-24.

5. Andaluz D, Ferrer R. SIRS, qSOFA, and organ failure for assessing sepsis at the emergency department. J Thorac Dis. 2017;9(6):1459–62.

6. DiMeglio M, Dubensky J, Schadt S, et al. Factors Underlying Racial Disparities in Sepsis Management. Healthcare (Basel). 2018 Nov 19;6(4):133.

7. https://nigms.nih.gov/education/fact-sheets/Pages/sepsis.aspx. Accessed 4 November 2022.