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Severe sepsis is a syndrome characterised by systemic inflammation, coagulopathy and acute organ dysfunction in response to an infection.1 Worldwide, 18 million cases of severe sepsis occur each year. It is estimated that, worldwide, 1400 people die each day from sepsis, with up to 30% dying within 1 month of diagnosis. Comparatively, more people die from sepsis than from breast or colon cancer. Severe sepsis is a major cause of in-hospital mortality with reported mortality rates of 23–46%.2 Recent trials involving new therapeutic interventions have shown, for the first time in 20 years, improved survival in patients with severe sepsis and septic shock. However, despite these advances, a recent meta-analysis revealed only a modest decrease in septic shock-induced mortality over the last 30 years.3 The current 28-day mortality for sepsis is comparable to the hospital mortality of patients presenting to hospital in the 1960s with an acute myocardial infarction (AMI) (ie, 30%).4 The current in-hospital mortality of AMI ranges from 2.7% to 9.6%. This reduction in mortality was achieved by the development and implementation of life-saving interventions such as aspirin and fibrinolytics which are now part of routine practice within emergency departments nationwide. As a result of its high mortality rates and healthcare costs, AMI has been the focus of media and public attention with considerable research and resources being directed towards its prevention. This has resulted in steady improvements in the management of AMI and a subsequent reduction in its mortality. These same lessons should be applied to the management of sepsis. As with AMI, the speed and appropriateness of treatment administered to a patient with sepsis in the initial hours is likely to influence the outcome. These crucial initial hours …
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