Sepsis: A Clinical Update

T he burden of sepsis on our health care system is signif-icant, with approximately 750,000 cases per year in theUnited States, 215,000 resultant deaths, and annual costs of $16.7 billion nationally (1). Organ failure is a significant contributor to mortality, with renal failure occurring in approx-imately 15 % of patients (2). In a large registry of critically ill patients with acute renal failure, in 19 % of whom was sepsis identified as the presumed cause, in-hospital mortality was 37 % with a combined outcome of death or dialysis dependence in 50 % (3). Clinicians are challenged to manage this disease in an aging population with multiple comorbidities, immunosup-pression, and a changing pattern of causative microorganisms (2,4). The increasing incidence of sepsis and the unacceptably high mortality rates associated with the disease have led to global efforts to understand pathophysiology, improve early diagno-sis, and standardize management (5). Understanding the spec