TMC PULSE

29 T M C » P U L S E | A U G U S T 2 0 1 8 New Ways to Identify and Treat Sepsis The illness is difficult to diagnose and often fatal B y C h r i s t i n e H a l l H uman bodies can be fickle. While some work to fight germs and prevent infection, others turn on themselves and stop attacking the bacte- ria or viruses that keep infection at bay. When the body has an overactive, outsized response to an infection, this is the start of sepsis. "An easy way to think about it is being poked by a sharp object and the body's response to it being totally disproportionate to the pain," said Sarma Velamuri, M.D. If not treated quickly, sepsis can cause tissue damage and organ failure, and could lead to death—sometimes in a matter of hours. In the United States, someone dies from sepsis every two minutes, according to the Sepsis Alliance, a sepsis advocacy organization. Velamuri, the founder and CEO of health care startup Luminare, is working to help hospitals better diagnose the illness so treatment can be given more quickly. He and his team are devel- oping a sepsis process improvement software for hospitals that analyzes vital signs and laboratory work-ups of patients for evidence of sepsis in a matter of minutes. Luminare recently completed the Texas Medical Center's TMCx accelerator pro- gram, which helps health care startups take their products from idea to commercialization. While on rounds, Velamuri would walk into patients' rooms and it would be obvious to him that some had sepsis. So he came up with a stan- dard of care that could be applied to every patient. He found there was a disconnect in infor- mation, especially during shift changes, when nurses needed to be brought up to speed on the patients who would be in their care. For every hour of information processing, mortality by sepsis increases by 8 percent, he said. Although patient information is available, it is often unclear what the information means. Luminare's digital application processes some 30 different variables simultaneously and helps nurses do the critical thinking. They can see who has been evaluated, what the assessment was, any treatment that was prescribed, where the patient is in the treatment process and whether or not the patient is progressing. If there is a probability of sepsis, the software notifies the nurse immediately and explains what to do next. For example, the software might recommend sending out for certain labs or calling the doctor to prescribe antibiotics. The system also builds a network of people to treat the patient—from the nurse to the supervisor to the rapid response team—instead of relying on the nurse to run around and gather all the players, Velamuri said. "I had a friend whose daughter passed away from sepsis, and that motivated me to invest everything I had in the company four years ago," he said. "We believe we are producing something that is reproducible at every hospital and will systematically drop the amount of deaths and bad outcomes from sepsis." Diagnosing sepsis The most common ways to get sepsis are urinary tract infections and pneumonia, followed by Foley catheters (used to drain urine) and central lines, which are catheters inserted into a vein in the arm. "Sepsis is the No. 1 cause of death from infec- tions and it is preventable," said Imrana Malik, M.D., associate professor in the Department of Critical Care and Respiratory Care at The University of Texas MD Anderson Cancer Center. "We see it in all ages, genders. It hits everyone, and the difficult thing is there is little in the armory to fix it." Sepsis is not a disease that needs a certain environment to occur, Velamuri said. Anyone can get it. In addition, sepsis is not the product of one symptom, according to the U.S. Centers for Disease Control and Prevention, but could be a combination of any of the following: Confusion or disorientation, shortness of breath, high heart rate, fever or shivering, extreme pain or discom- fort or clammy, sweaty skin. Sepsis is often difficult to diagnose, Malik said. Someone could come to the hospital clutching his or her chest, but that could be because of several sepsis symptoms that the doctor would have to put together. Sepsis in cancer patients Chemotherapy or central transplants put some cancer patients at a higher risk of sepsis, Malik said. (continued) Sarma Velamuri, M.D., is CEO of Luminare. SYMPTOMS OF SEPSIS S Shivering, fever or very cold E Extreme pain or general discomfort P Pale or discolored skin S Sleepy, difficult to rouse, confused I "I feel like I might die" S Short of breath Source: Sepsis Alliance (sepsis.org)

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