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By Helle Sorensen, Communications Officer, Intensive Care Society

Major award goes to director of research at the Intensive Care Foundation. On 27 June 2016 a National Institute for Health Research (NIHR) Research Professorship was awarded to an Intensive Care Medicine professional for only the second time since its launch in 2011. The award was given to one of the leading researchers in sepsis treatment, Professor Anthony Gordon.

Sepsis can be difficult to diagnose initially and can progress to a critical illness very quickly. Patients are very ill once they reach the ICU, but current practice is to treat all patients with a similar regime (antibiotics, intravenous fluid resuscitation and powerful adrenaline-like drugs to support the heart and blood pressure).

A drug problem

However, there are problems with these treatments. If antibiotics are delayed or the wrong antibiotics are given while laboratory tests are carried out, then death rates are higher. If doctors use very powerful antibiotics too often, bacteria become resistant to them, and there is a serious concern that soon we will have infections that will become resistant to all antibiotics. The adrenaline-like drugs are very effective at supporting the heart and blood pressure but are known to have serious side-effects in some patients.

The overall aim of Professor Gordon’s research programme is to develop a personalised medicine strategy for patients with sepsis to allow clinicians to treat patients as individuals, selecting the most appropriate treatments for them and improve their outcome. It is Professor Gordon’s aspiration that this will lead to significantly fewer deaths and a shorter recovery period for patients both in the hospital and after discharge: “If we make treatment more efficient, we can discharge patients sooner or even avoid admission altogether in some cases”, he says.

Use of modern technology

Prof Gordon’s research draws upon the use of modern technology. He will test if the known differences in our genetic make-up mean patients respond differently to the adrenaline-like drugs used to treat sepsis. The study will test this in 4500 DNA samples, already collected from patients with sepsis from international sepsis studies and trials: “I will test if, based on these genetic variations, some patients require alternative drugs or different doses of the drugs to support the heart and blood pressure, and if this treatment effects their survival and causes less problems for them”. In the samples from the previous drug trials they will be able to test if patients respond differently to these treatments based on their DNA variations.

Further, he will identify different groups of sepsis patients based on known patterns of gene expression (the type and amount of “message” that comes from the gene and determines what and how much protein is made), protein levels and chemicals in the blood, and test if these groups respond differently to treatments. This will require the use 700 blood samples that is already collected. Professor Gordon and his team will examine how these patients respond differently to sepsis and if they respond differently to different treatments.

Professor Gordon’s research will also assess new technology in tests, which can be done rapidly in the ICU, to identify the cause of infection more quickly and therefore target it with the most effective antibiotic: “In 500 patients I will compare these new results to current tests, (which usually take 48 hours to be ready) checking the accuracy and speed of the result as well as the potential to improve patient care. I will also explore the best way to use this new test within the NHS”.

Enthusiasm in the UK in general

In general, Professor Gordon is positive about the improvement seen in sepsis research in the UK over the last few years: “With financial help and support from both NIHR and the Intensive Care Foundation we have managed to create a community and a sense of ownership around intensive care research in the UK. The system and staff members now feel confident conducting trials and it has become a more normal practice. I see enthusiasm in the UK in general”.

His research has also been discussed with ICUsteps (the ICU patient and relative support charity), a former sepsis patient and a relative of a patient who had sepsis, and they have confirmed the importance of targeted treatments for sepsis. As in his other trials, involving patients and relatives will be an integral part of his work: “I will invite two representatives with experience of sepsis to be on the steering group, and will also approach charities such as ICUsteps and the UK Sepsis Trust for opinions on specific issues”, he says.

Treatment of sepsis is very costly for the health service and is the leading cause for admission to an intensive care unit in the UK accounting for about 30% of all admissions. It is estimated that £170 million could be saved every year in the UK through better diagnosis and treatment of sepsis[2]: “With better care we can improve the long term recovery, and this will significantly reduce the costs related to patients’ aftercare, such as taking time off work, which is beneficial both for the individual families and the UK society as a whole”, says Professor Gordon.

About Professor Anthony Gordon

  • Professor Anthony Gordon is the Chair in Anaesthesia and Critical Care at Imperial College London and is a Consultant in Intensive Care Medicine based at Charing Cross Hospital.
  • He is combining pharmacogenetic, gene expression and metabolic profiling with rapid point-of-care diagnostic tests to select the most appropriate treatments for patients and improve their outcome.

Sources

[1] Sepsis Action Plan (NHS England, 2015): https://www.england.nhs.uk/wp-content/uploads/2015/08/Sepsis-Action-Plan-23.12.15-v1.pdf

[2] Improvement in sepsis will result in a cost saving of £170 million to the NHS based upon studies by the European SOAP study (Vincent et al 2006) by identifying that patients treated earlier spend on average 3-4 fewer days in hospital, and critically fewer days in costly Intensive Care beds.

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