SPOTLIGHT: Sepsis

Sepsis. It's not a commonly used term in the insurance lexicon - more of a potentially deadly outcome of a condition. Reports suggest that sepsis has become more common than heart attacks in the UK. Unlike heart attacks, sepsis can affect all ages; parents need to be as vigilant for sepsis as they are for meningitis, meaning that the condition has now been thrown under the spotlight.

Hospital admissions in England for sepsis have more than doubled in three years, according to NHS Digital data. The rises are consistent across all age groups, including the very young.

Why the rise? This is due to the combined factors of increasing antibiotic resistance in the population and growing awareness of sepsis, according to the UK Sepsis Trust. Invasive healthcare treatments - such as those for cancer - and any under-treated infection increases the risk of sepsis developing.

Hospital admissions in England for sepsis have more than doubled in three years

What is sepsis?

Sepsis is a life-threatening condition caused by the body's immune system working overtime to fight infection. It's also known as septicaemia or blood poisoning. Bacterial infections (such as MRSA) are most often to blame, although it can be caused by other types of infection such as those from viruses, fungi or parasites. Sepsis can begin at any site where bacteria or viruses enter the body, even by something as seemingly trivial as a grazed knee or elbow.

Most prone to sepsis are those being treated with immunosuppressive drugs for autoimmune conditions such as Type 1 diabetes or multiple sclerosis. Cancer patients treated with chemotherapy are also at particular risk, as both the cancer and the chemotherapy taken can weaken one's immune system

Diagnosis

In the past, sepsis was screened for according to the SIRS (systematic inflammatory response syndrome) criteria. If the SIRS criteria were negative, it was thought very unlikely that the person had sepsis. Under SIRS there were different severity categories: sepsis, severe sepsis, and septic shock.

• Sepsis is defined as SIRS in response to an infectious process.
• Severe sepsis is defined as sepsis with sepsis-induced organ dysfunction or tissue hypoperfusion (reduced blood flow). Severe sepsis is associated with multiple organ dysfunction syndrome even with the use of intravenous fluids. In 2016, the SIRS criteria for screening was augmented with qSOFA (quick sepsis related organ failure assessment).

However, both SIRS and qSOFA have their limitations.

There are concerns that qSOFA criteria may delay the diagnosis of serious infection, leading to delayed treatment and poorer outcomes. SIRS, on the other hand, is sometimes criticised for being too sensitive and not specific enough in identifying sepsis. Consensus seems to be that qSOFA is better in assessing the risk of death and SIRS criteria better for screening.

Signs & Symptoms

Sepsis often begins with a feeling of being generally unwell as though you are starting to get the ‘flu'. It affects everyone differently but there are some things that happen to most people and these include:

• Increased temperature and fever.
• A drop in blood pressure, causing light headedness.
• Palpitations as the heart beats faster to get the blood pressure back up again
• Swelling of the arms and legs as blood vessels leak into tissue
• Breathing difficulties

Treatment involves management of the underlying condition as well as the use of intravenous fluids and antibiotics.

Prevalence

There are more than 30 million cases globally, of which at least 250,000 occur in the UK each year. This means that sepsis has become more common than heart attacks. 25,000 children are affected by sepsis each year in the UK and sepsis now kills as many people as breast, bowel and prostate cancer combined.

About 40% of all survivors also have either physical or psychological after-effects, such as cognitive impairment or a disability of some type. A quarter of all sepsis survivors suffer permanent, life-changing after effects. More on that below.

Longer term impact

After discharge, sepsis still carries an increased risk of death as well as an increased risk of recurrence. Some sepsis survivors experience a variety of physical, psychological and emotional problems while recovering. This is known as post sepsis syndrome (PSS) and can last 18 months or more.

During this prolonged recovery period, sufferers and their family may also suffer financial hardship as residual weakness may prevent an early return to work.

A previous diagnosis of sepsis is also a leading cause of readmissions when compared with other conditions such as a heart attack or respiratory disease.

Sepsis survivors are also at higher risk of major events such as stroke, when compared with patients hospitalised because of a non-sepsis diagnosis.

Deaths from sepsis usually occur within the first six months of diagnosis but the risk still remains higher for up to two years later.

Underwriting considerations

Sepsis on its own doesn't really present much in the way of a challenge for underwriters, it's really what caused it that is of concern. As far as the sepsis itself is concerned, underwriters will want to know how long it's been since recovery and whether there are any residual effects such as organ damage or disability.

Where sepsis is covered by serious illness cover (SIC) and the individual is suffering from both sepsis and, say, cancer, the more severe of the conditions will be taken into account for claim purposes. So, in this hypothetical scenario, the individual would most likely receive a pay-out on cancer, but not both. It may be possible for that person to receive a future pay-out on sepsis if they suffered a recurrence.

Considering the prevalence of sepsis, it's worth checking whether it's covered when considering life and SIC on behalf of clients. The same goes for children's cover: it's included in some provider policies but not all.

John Downes is underwriting & claims director of VitalityLife

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