Sepsis

Double jeopardy: Escalating mortality trends and disparities in lung cancer patients with sepsis - A retrospective epidemiological study (2025)

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Type of publication:

Conference abstract

Author(s):

Hemida M.F.; Sarfraz M.R.; Khan T.; Mushtaq I.; Ibrahim A.A.; Chandak V.; Al-Saadi M.; Sharhiar Z.; *Ali A.

Citation:

Thorax. Conference: British Thoracic Society Winter Meeting 2025. Westminster . 80(Supplement 2) (pp A249-A250), 2025. Date of Publication: 01 Nov 2025

Abstract:

Background Lung cancer (LC) remains the leading cause of cancer-related mortality globally. Studies indicate LC patients with sepsis have significantly lower survival rates, yet the temporal trends and disparities in mortality remain unexplored. We examined mortality trends and disparities of LC complicated by sepsis across different sociodemographic strata. Methods This retrospective study analysed death certificate data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database from 1999-2023, for individuals >=25 years with multiple causes of death listed as lung/bronchus cancer (ICD-10: C34) with sepsis. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by sex, race/ethnicity, and geographic region, with Joinpoint regression analysis to determine the change in mortality trends. Results From 1999-2023, 103,907 deaths were attributed to LC with co-existing sepsis, demonstrating increasing mortality trends throughout the study period. AAMRs rose significantly from 1.61 in 1999 to 2.07 in 2023 (AAPC: 1.32%; p<0.000001). Sex-stratified analysis revealed men had consistently higher overall AAMRs (2.32/100,000) with an AAPC of 0.49% (95% CI: -0.12 to 1.12; p=0.12) compared to women (1.37/100,000) with an AAPC of 1.94% (95% CI: 1.74 to 2.14; p<0.000001). Patients aged >=65 years exhibited the highest mortality rates (6.59%). Racially, non-Hispanic (NH) Black individuals had the highest overall AAMRs with increasing mortality patterns (AAMRs: 2.57/100,000; AAPC: 0.32%; 95% CI: 0.045 to 0.599; p=0.02), while Hispanic populations recorded the lowest AAMR (1.01/100,000; AAPC: 0.61%; 95% CI: 0.156 to 1.068; p=0.01). Regionally, the South demonstrated the highest mortality (AAMRs: 2.04), followed by the Northeast (AAMRs: 1.78), Midwest (AAMRs: 1.75), and West (AAMRs: 1.42). Most deaths occurred in inpatient medical facilities (90,425 deaths; 87%). Conclusion Mortality rates increased significantly over the study period with a significant increase during recent years. Notable disparities across sex, race/ethnicity, and geographic regions were observed, with NH Black populations and Southern states showed highest mortality rates. These findings highlight the urgent need for targeted sepsis prevention protocols in LC patients, enhanced surveillance systems for high-risk demographics, and comprehensive region-specific interventions to address underlying healthcare disparities and improve clinical outcomes across all populations.

DOI: 10.1136/thorax-2025-BTSabstracts.358

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The spiked helmet sign in severe sepsis: an unusual electrocardiographic finding in a critically ill patient (2025)

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Type of publication:

Journal article

Author(s):

Manea, Hashim; Alhatemi, Ahmed Qasim Mohammed; Al-Ghuraibawi, Mohammedbaqer Ali; *Alhumairi, Ghaith Asaad; Al-Shammari, Ali Saad; Al-Ibraheem, Abdullah Muataz Taha; Ahmad, Ibrar; Abdulammer, Hussein Safaa.

Citation:

Oxford Medical Case Reports. 2025(11):omaf232, 2025 Nov.

Abstract:

Background: The 'spiked helmet' sign is a rare electrocardiographic (ECG) phenomenon characterized by transient ST-segment elevations mimicking an acute coronary syndrome, typically seen in critically ill patients. While often associated with severe physiological stress, its presence in sepsis is particularly uncommon.

Case Presentation: A 68-year-old male with a history of hypertension and diabetes mellitus presented to the emergency department with fever, altered mental status, and hypotension. Initial workup revealed severe sepsis secondary to pneumonia. His ECG showed pronounced ST-segment elevations in leads II, III, and aVF, with a distinctive 'spiked helmet' pattern. Troponin levels were mildly elevated, raising concerns for concurrent myocardial ischemia. However, the patient denied chest pain, and further cardiac evaluation, including echocardiography, showed no evidence of ischemia or infarction. Intensive care management included broad-spectrum antibiotics, intravenous fluids, and vasopressors. Despite the severity of his illness, the patient's condition gradually improved, and repeat ECGs showed resolution of the ST-segment elevations. The 'spiked helmet' sign was attributed to severe sepsis-induced autonomic dysfunction rather than primary cardiac pathology.

Conclusion: This case highlights the importance of recognizing the 'spiked helmet' sign as a marker of severe stress in critically ill patients, which may mimic myocardial ischemia on ECG. Prompt differentiation between this sign and true ischemia is crucial to avoid unnecessary interventions and focus on managing the underlying critical illness.

DOI: 10.1093/omcr/omaf232

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The FAST-M complex intervention for the detection and management of maternal sepsis in low-resource settings: a multi-site evaluation (2021)

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Type of publication:
Journal article

Author(s):
Cheshire, James; Jones, Laura; Munthali, Laura; Kamphinga, Christopher; Liyaya, Harry; Phiri, Tarcizius; *Parry-Smith, William; Dunlop, Catherine; Makwenda, Charles; Devall, Adam James; Tobias, Aurelio; Nambiar, Bejoy; Merriel, Abi; Williams, Helen Marie; Gallos, Ioannis; Wilson, Amie; Coomarasamy, Arri; Lissauer, David

Citation:
BJOG : an international journal of obstetrics and gynaecology; Jul;128(8):1324-1333

Abstract:
OBJECTIVE To evaluate whether the implementation of the FAST-M complex intervention was feasible and improved the recognition and management of maternal sepsis in a low-resource setting.DESIGNA before and after design.SETTINGFifteen government healthcare facilities in Malawi.POPULATION Women suspected of having maternal sepsis.METHODS The FAST-M complex intervention consisted of the following components: i) the FAST-M maternal sepsis treatment bundle and ii) the FAST-M implementation programme. Performance of selected process outcomes were compared between a two month baseline phase and six month intervention phase with compliance used as a proxy measure of feasibility.MAIN OUTCOME RESULT Compliance with vital sign recording and use of the FAST-M maternal sepsis bundle.RESULTS Following implementation of the FAST-M intervention, women were more likely to have a complete set of vital signs taken on admission to the wards (0/163 (0%) vs. 169/252 (67.1%), p<0.001). Recognition of suspected maternal sepsis improved with more cases identified following the intervention (12/106 (11.3%) vs. 107/166 (64.5%), p<0.001). Sepsis management improved, with women more likely to receive all components of the FAST-M treatment bundle within one hour of recognition (0/12 (0%) vs. 21/107 (19.6%), p=0.091). In particular women were more likely to receive antibiotics (3/12 (25.0%) vs. 72/107 (67.3%), p=0.004) within one hour of recognition of suspected sepsis.CONCLUSION Implementation of the FAST-M complex intervention was feasible and led to the improved recognition and management of suspected maternal sepsis in a low-resource setting such as Malawi.

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