Sepsis Alliance Symposium: Precision Sepsis Care (Enduring Course)

Sepsis Alliance Symposium: Precision Sepsis Care (Enduring Course)

4.67 (9 votes)

Recorded On: 06/22/2023

Description: 

The clinical complexity and heterogeneity following infection and sepsis is a well-recognized challenge to effective patient management. Traditional pathogen-only targeted treatment currently remains the standard of care in diagnosis and treatment. Precision medicine, a concept that has been around for many years, applies host-directed diagnostics and therapeutics to use a person’s own genes or proteins as a potential way to yield more precise diagnoses, predict disease risk before symptoms occur, and design customized treatment plans that maximize safety and efficiency. For the medical community, precision medicine holds a lot of promise and hope for improved, personalized care and outcomes in infectious diseases and sepsis. 

This Sepsis Alliance Symposium, focused on precision medicine in sepsis care and examining host-directed diagnosis and treatment for infectious diseases and sepsis, will allow learners to better understand the host response and how precision medicine might be applied. Presenters will also review host-based diagnostics across the continuum and explore the role of data and machine learning in host-based diagnostics and therapeutics.

Learning Objectives: 

At the end of the activity, the learner should be able to:

  • Identify the immune activation to immune suppression;
  • Review current host-directed diagnostics and phenotyping being researched, translated, and used in infection and sepsis care;
  • List possible approaches to host-directed therapeutics in infection and sepsis care;
  • Describe the role of data and machine learning in precision medicine.

Target Audience: 

Nurses, advanced practice providers, physicians, emergency responders, pharmacists, medical technologists, respiratory therapists, physical/occupational therapists, infection prevention specialists, data/quality specialists, and more.

Session 1: Immunotherapy of Sepsis: The Right Patient at the Right Time with the Right Drug

Speaker: Richard Hotchkiss, MD

Description: The evolving nature of sepsis highlights the crucial role of immunotherapy in its management. This session will delve into the transition of sepsis from a hyper-inflammatory phase to a prolonged immunosuppressive phase, shedding light on the underlying mechanisms and implications for patient outcomes. The critical phase in which the majority of sepsis-related deaths occur will be discussed, along with how to prioritize interventions to improve sepsis survival rates. Emerging immune adjuvant therapy options that can enhance patients’ ability to effectively combat invading pathogens, providing potential breakthroughs in sepsis treatment will also be explored. Learners can expect to become equipped with valuable knowledge to identify the right patients, determine optimal timing, and select the appropriate immunotherapy for sepsis management, ultimately improving patient outcomes.

Session Objectives: At the end of this session, the learner should be able to: 

  • Describe how sepsis can evolve from a hyper-inflammatory phase to a more prolonged immunosuppressive phase; 
  • Identify the phase in which most deaths in sepsis occur; 
  • List emerging immune adjuvant therapy options to boost patients’ ability to contain and eliminate invading pathogens. 

Session 2: Phenotypes in Pediatric Sepsis and the Importance of Personalized Care

Speaker: L. Nelson Sanchez-Pinto, MD, MBI, FAMIA

Description: Pediatric sepsis is a heterogenous disease: not every child with sepsis has the same type of response to infection or presents with the same clinical picture. These differences can make some children more likely to respond to, or be harmed by, specific therapies. Different children may require very different clinical trajectories. In this presentation, learners will review the importance of identifying and studying phenotypes of pediatric sepsis to advance the science of this potentially devastating syndrome, and how to provide more personalized care to the children affected by it.

Session Objectives: At the end of this session, the learner should be able to: 

  • Restate the importance of phenotypes and personalized care in pediatric sepsis;
  • List some key examples of pediatric sepsis phenotypes described in the literature; 
  • Describe the concepts of predictive and prognostic enrichment and how they relate to phenotypes and personalized care in pediatric sepsis.

Session 3: Shaping the Future of Sepsis Care: The Role of Phenotyping in Prognosis

Speaker: Azra Bihorac, MD, MS, FCCM, FASN

Description: To use precision medicine for providing sepsis patients with the best available care, we need to understand sepsis subclasses and their biological basis. Current phenotypes of acute kidney injury (AKI), however, are not consistent and are classified by different criteria such as timeline or acuity. Confusion can result from the existing efforts to define sepsis subclasses, where researchers may have used different approaches to classification (empirical, hypothesis-based, or agnostic) and may have used interchangeable terms (such as subgroup, sub-phenotype, or endotype) that were not reconciled with terminology from previously published studies. This presentation will discuss current efforts to establish data-driven phenotypes and how these efforts could be converted into clinical impact in the future.

Session Objectives: At the end of this session, the learner should be able to: 

  • Discuss and analyze the heterogeneous approaches to defining sepsis phenotypes;
  • Examine the challenges of and potential next steps toward making a clinical impact with sepsis phenotypes.

Session 4: A Sepsis Innovation Collaborative (SIC) Roundtable: Challenges and Opportunities in Precision Sepsis Diagnosis

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Speakers: Steven Q. Simpson, MD; Tim Sweeney, MD, PhD; Debra M. Foster, BSc; Bobby Reddy Jr., PhD; Vincent Liu, MD, MS

Description: Sepsis Innovation Collaborative (SIC) is a multi-stakeholder collaborative that brings together academic, clinical, industry, patient advocacy, and other stakeholders. This roundtable with SIC members will dive into the common challenges and unmet needs related to sepsis and the opportunities precision medicine provides for addressing these issues. In this roundtable session, panelists will address the latest research, technological breakthroughs, and emerging trends, offering participants a unique opportunity to learn about the ongoing development of precision medicine strategies in sepsis management. Panelists will also share how SIC is working to improve patient outcomes and enhance sepsis diagnosis and management through precision medicine.

Session 5: Human Genomics of Infectious Diseases & Sepsis

Speaker: Samira Asgari, PhD

Description: Understanding how human genetic diversity translates to phenotypic diversity in the immune system and how this phenotypic diversity affects the clinical outcome of infectious diseases is critical for developing better preventative and therapeutic measures to fight infections and sepsis. These human genetic differences may be the key to understanding the interindividual variability for infectious disease outcomes. This presentation will provide an overview of the outcomes of any infection and sepsis and the complex interplay between host, pathogen, and the environment. Future applications of precision medicine and host genetics to help patients and decrease health inequities will also be discussed.

Session Objectives: At the end of this session, the learner should be able to:

  • Summarize the spectrum of genetic architectures in diseases;
  • Evaluate methods and approaches used to study human genomics of infectious diseases.

Session 6: Strategies for Building a Better Approach to Host-Targeted Therapeutics in Sepsis Care

Speaker: Timothy G. Buchman, Ph.D., M.D., FACS, FCCP, MCCM

Description: The frustration experienced by the healthcare community when encountering situations where two patients with similar characteristics receive identical treatment, but one survives while the other succumbs to multiple organ system failure, is a common sentiment. This discrepancy in outcomes may potentially be attributed to variations in host-response. Understanding the impact of individual host-response to infection is crucial in advancing our knowledge of sepsis and improving personalized patient care.  

In this session, host response to infection will be highlighted, along with the dysregulated host responses which characterize sepsis. Lessons and insights learned from the COVID-19 pandemic will be used to provide an in-depth analysis of the current state of host-targeted therapies with steps that can be taken to provide a more personalized approach to sepsis assessment and care.

Session Objectives: At the end of this session, the learner should be able to: 

  • Describe the host response to infection; 
  • Identify the dysregulated host responses that characterize sepsis;  
  • Describe the current state of host-targeted therapies that are widely used, including a review of the COVID-19 experience; 
  • Recognize the need and promise for personalized assessment and care; 
  • Explain immediate and intermediate “next steps” to improve the approach to personalized assessment and care.

Session 7: Resuscitation and Management: Knowns, Unknowns, and the Role for Big Data

Speaker: Andre L. Holder, MD, MS

Description: Big data and artificial intelligence (AI) have the potential to improve sepsis care in a number of ways. For example, big data can be used to identify patients at risk for sepsis, to develop personalized treatment plans, and to monitor patient outcomes. AI can be used to develop algorithms that can predict sepsis, to identify patients who are not responding to treatment, and to recommend interventions that are most likely to be successful. This presentation will discuss the current state of knowledge on sepsis resuscitation and management, as well as the areas where there is still uncertainty or controversy. The presentation will also discuss the potential role of big data and artificial intelligence (AI) in improving sepsis care.

Session Objectives: At the end of this session, the learner should be able to:

  • Summarize topics in which the Surviving Sepsis Campaign provides insufficient guidance or management is controversial:  
  • Restate proper fluid resuscitation techniques in patients with heart failure or ESRD; 
  • Overview timing and patient selection for steroids and other immunosuppressants; 
  • Outline pre-clinical” detection of sepsis or its sequelae;  
  • Restate potential approaches in which Artificial Intelligence (AI) can provide guidance in these three areas.  


Steven Q. Simpson, MD (Moderator)

Professor of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine

University of Kansas

Steven Q. Simpson, MD is Professor of Medicine at the University of Kansas in the Division of Pulmonary, Critical Care, and Sleep Medicine, where he previously served as Division Director, Director of three ICUs, Chair of the Sepsis Team, and Chair of Multidisciplinary Critical Care. He has done research in all areas of severe sepsis from molecular and cellular mechanisms, to translational studies, to quality improvement studies.

He was a founder, in 2005, of the Midwest Critical Care Collaborative, a multidisciplinary and interprofessional collaborative effort to improve the quality of critical care services throughout the Midwest. In 2007, he initiated the Kansas Sepsis Project, a statewide program to improve severe sepsis care and outcomes throughout the state via continuing education both in sepsis and in quality improvement principles, and via inter-professional collaboration. He is currently heading a BCBS-sponsored sepsis collaborative among Kansas City metro area hospitals and is a contributing faculty member of the ongoing Surviving Sepsis Campaign collaboratives, leading the effort in the Midwest. He is a participant in the 2016 review and update of the Surviving Sepsis Campaign Guidelines.

Dr. Simpson was the North American co-chair of the International Single Day Point Prevalence Study for Severe Sepsis and Septic Shock (IMPRESS) in the fall of 2013. During his tenure at the University of New Mexico, he contributed to the discovery of a particular form of sepsis, the Hantavirus Pulmonary Syndrome, and published numerous papers on the clinical description, the hemodynamic description, and the approach to supportive care for patients with the syndrome, including extracorporeal hemodynamic and oxygenation support.

Dr. Simpson received his M.D. degree from the University of Kansas in 1983. He completed residency training in Internal Medicine at KU in 1986 and fellowship training in Pulmonary Diseases at Rush Medical College in 1989. He has been a faculty member at Rush Medical College, the University of New Mexico, and the University of Kansas. He is a regular reviewer for the journals Critical Care Medicine and CHEST, and he reviews on an ad hoc basis for Shock, the Journal of Intensive Care, JAMA, Virology, and Antiviral Therapy. He is the author of over 70 peer reviewed and invited manuscripts, book chapters, and web-based articles and presentations.

Dr. Simpson was the Third Eli Lilly and Company Distinguished Scholar in Critical Care Medicine, sponsored by the American College of Chest Physicians and the Chest Foundation for his work in reducing geographic disparities for severe sepsis care (the Kansas Sepsis Project). In 2013 he delivered the Roger C. Bone Memorial Lecture at the annual international meeting of the American College of Chest Physicians, describing the Kansas Sepsis Project. Dr. Bone was Dr. Simpson’s early career mentor and was the progenitor of the criteria used throughout the world to recognize severe sepsis.

No relevant financial relationships to disclose.

Richard Hotchkiss, MD

Professor of Anesthesiology, Medicine, Surgery, and Developmental Biology

Washington University School of Medicine

Richard Hotchkiss, MD, studied at the University of Virginia where he received both his undergraduate and medical degrees and was inducted into the Phi Beta Kappa and Alpha Omega Alpha Honor Societies. He trained in two specialties, first in Internal Medicine at Emory University School of Medicine (where he was also Chief Resident), and then in Anesthesia at the Massachusetts General Hospital. Dr. Hotchkiss pursued his interest in critical care as a Fellow at the University of Virginia and then as a Senior Fellow in the Respiratory Intensive Care Unit. In 1987, Dr. Hotchkiss moved to the Department of Anesthesiology at Washington University in St. Louis where he has remained, climbing the ranks to Professor in the Departments of Anesthesiology, Medicine, Surgery, and Molecular Biology & Pharmacology. 

Dr. Hotchkiss has had a long, successful career as an investigator studying the pathophysiology of sepsis. His many contributions are documented in over 200 publications. A seminal observation from his laboratory was the identification of extensive apoptotic death of immune effector cells in patients dying of sepsis. This discovery led to the concept that apoptosis-induced immunosuppression is an important pathogenic mechanism in sepsis, a finding that has changed the paradigm in search of new therapeutic approaches to this major threat to public health. A review article on sepsis by Drs. Hotchkiss and Irene Karl helped define and promulgate this concept and is now the sixth most cited review article in the New England Journal of Medicine in the last decade. 

Dr. Hotchkiss has been continuously funded by the National Institutes of Health for approximately 20 years and is the recipient of a number of prestigious awards, including the NIH Research Career Development Award (1995) and the NIGMS Merit Award (2003). Additional honors include serving as President of the Shock Society for which he received the Distinguished Service Award of the Society in 2007. Washington University in St. Louis honored him with its Distinguished Investigator Award in 2008. 

Lazaro Nelson Sanchez-Pinto, MD, MBI

Assistant Professor of Pediatrics (Critical Care)

Northwestern University Feinberg School of Medicine

Nelson Sanchez-Pinto is an Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine, biomedical informatics specialist, and clinical data scientist. His clinical and academic interests focus on patients with a host of critical conditions, including sepsis. 

Azra Bihorac, MD, MS, FCCM, FASN

Senior Associate Dean for Research

University of Florida College of Medicine

Azra Bihorac, MD, MS, FCCM, FASN, is the Senior Associate Dean for Research at the University of Florida College of Medicine. She is the R. Glenn Davis Professor of Medicine, Surgery, Anesthesiology, and Physiology and Functional Genomics; the Lab Director of the Precision and Intelligent Systems in Medicine Research Partnership (PRISMA); and Co-Director of the Intelligent Critical Care Center (IC), a multi-disciplinary center focused on providing sustainable support and leadership for transformative medical AI research, education, and clinical applications to advance patients’ health in critical and acute care medicine.

Through her research, Dr. Bihorac is addressing an unprecedented opportunity for world-leading ambient, immersive, and AI innovation to transform the diagnosis, monitoring, and treatment for critically and acutely ill patients. Dr. Bihorac’s vision is to develop tools for intelligent human-centered health care that is tailored to a patient’s “personal clinical profile” using digital data. She is a nationally and internationally recognized expert in medical AI, data science, informatics, and translational research. Since 2010, she has had continuous NIH funding and 185 peer-reviewed publications with more than 10,000 citations.

Dr. Bihorac is currently a PI for multiple NIH-funded programs, including a $23.5 million, multicenter Bridge2AI project called “A Patient-Focused CHoRUS for Equitable AI,” which seeks to develop a 100,000-patient dataset for AI research in critical care along with AI workforce training events and a set of standards for the ethical use of AI in critical care.

Tim Sweeney, MD, PhD

Co-Founder and Chief Executive Officer

Inflammatix

Tim Sweeney, MD, PhD, helped invent the core Inflammatix technology and is a licensed physician and data scientist. He completed his MD/PhD at Duke University and then spent time training in the general surgery residency program at Stanford University. While training as a surgeon, he became frustrated with the current diagnostic tools for infection. During his residency research years, he completed a postdoc MS in Biomedical Informatics, during which he worked with Dr. Khatri to identify a new way to diagnose infections based on ‘reading’ the immune system. Their work designing custom informatics algorithms for sifting through heterogeneous large datasets led to the core technology on which Inflammatix is based.

Debra Foster, BSc

Clinical Consultant

Spectral Medical

Debra Foster, BSc, began her professional career as a registered nurse, specializing in the adult critical care area. Shortly thereafter, Debra joined the critical care clinical research team at Toronto General Hospital. While there, Debra was the project lead for a multi-national, multi-center clinical trial, the MEDIC study. The data was used for a successful 510k de novo submission to the FDA for the Endotoxin Activity Assay (EAA). It was the first in vitro disagnostic (IVD) in the field of sepsis. Debra followed the device to its commercial partner, becoming an employee of Spectral Medical. She was appointed Vice President of Clinical Development in 2011. Debra has led many clinical research projects, including the EUPHRATES and TIGRIS clinical trials for a device to treat patients with endotoxemic septic shock. In December 2021, Debra opted for partial retirement and remains a clinical consultant for Spectral Medical.

Debra has lectured many times to medical professionals on the topics of sepsis and clinical trials for sepsis. She has co-authored more than 50 articles in peer-reviewed journals and lectured for academic and industry audiences. 

Session Title: Spectral Medical Sponsored Session: What is Endotoxin and Why is it Important?

Session Day/Time: Wednesday, September 27, 2023, 1:40 - 2:10 PM EST

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Bobby Reddy Jr., PhD

CEO & Co-Founder

Prenosis

Bobby Reddy, Jr., Ph.D., is an engineer turned entrepreneur who has focused on the development and commercialization of precision medicine products for over 14 years. He co-founded Prenosis, Inc. in 2014 and serves as its CEO. In this role, he has raised capital from investors, been awarded numerous research grants, recruited a dynamic and multi-disciplinary team, and executed various strategic partnerships with huge diagnostic companies, hospitals, manufacturers, technology partners, and others. He is passionate about the problem of the deconvoluting heterogeneity of immune system dysregulation and its relevance in sepsis and other diseases. Dr. Reddy received his Ph.D. in electrical engineering from University of Illinois Urbana-Champaign (UIUC) in 2012 with a focus on biotech devices and algorithms.

Vincent Liu, MD, MS

Research Scientist

Kaiser Permanente Division of Research

Vincent Liu, MD, MS, is a research scientist at the Kaiser Permanente Northern California Division of Research. His work focuses on the intersection of sepsis, acute severe illness, informatics, and health care delivery with a goal of building a learning hospital system. Dr. Liu is board certified in Internal Medicine, Pulmonary Disease, Critical Care Medicine, and Clinical Informatics. He received his undergraduate degree from the University of Pennsylvania and his medical degree from New York University. He completed his residency training at New York University Hospitals (Bellevue) and a chief residency at Memorial Sloan-Kettering Cancer Center. He also completed a pulmonary and critical care medicine fellowship and has masters degrees in Health Services Research and Biomedical Informatics, both from Stanford University. In addition to his clinical practice and research, Dr. Liu is also the Regional Director of Hospital Advanced Analytics at Kaiser Permanente Northern California, a role in which he leads the development, implementation, deployment, and evaluation of real-time EHR-based risk prediction models across Kaiser Permanente’s 21 hospitals.

Samira Asgari, PhD

Assistant Professor, Institute for Genomic Health, Department of Genetics and Genomic Sciences

Icahn School of Medicine at Mount Sinai

Samira Asgari, Ph.D. was born and raised in Iran. She obtained her Ph.D. in human genomics of infectious disease from École Polytechnique Fédérale de Lausanne (EPFL) in 2012. In 2017, she moved to Boston for her postdoctoral training in human statistical and population genomics at the Brigham and Women’s Hospital. She started her research group at Icahn School of medicine at Mount Sinai in New York City in 2022. Her research focuses on understanding the human genetic basis of infection and immunity. Some of the questions the Dr. Asgari lab asks include:

- What are the human genetic variants underlying susceptibility and resistance to specific pathogens?

- What are the molecular mechanisms connecting these variants to cellular functions and immune responses? and

- How do differences in population history and demography play into susceptibility and resistance to specific pathogens?

To answer these questions, they use a combination of statistical, functional, and population genomics methods. 

Timothy G. Buchman PhD, MD, FACS, FCCP, MCCM

Professor of Surgery, Professor of Anesthesiology, Professor of Biomedical Informatics

Emory University School of Medicine

Timothy G. Buchman, PhD, MD, FACS, FCCP, MCCM has four decades of bedside experience caring for septic patients. A general surgeon, intensive care doctor and virologist, he is currently Senior Advisor, IPA to the Division of Research, Innovation, and Ventures (DRIVe), Biomedical Advanced Research and Development Authority (BARDA), Office of Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (HHS). Dr. Buchman’s other current roles include Professor of Surgery, Anesthesiology, and Biomedical Informatics at Emory University, where he founded the Emory Critical Care Center. Dr. Buchman is past president of the Shock Society, of the Society for Complex Acute Illness and of the Society of Critical Care Medicine, the latter being the largest organization of critical care professionals in the world. He is Editor-in-Chief of Critical Care Medicine (www.ccmjournal.org) and Critical Care Explorations (www.ccejournal.org). He is a member of the External Faculty of the Santa Fe Institute. He also serves as site director of the military-civilian partnership, Surgical Critical Care Institute (www.sc2i.org).

No financial relationships to disclose.

Andre Holder, MD, MSc

Assistant Professor, Division of Pulmonary Allergy, Critical Care, & Sleep Medicine

Emory University School of Medicine

Dr. Holder is an NIH-funded clinician scientist with board certification in emergency medicine, internal medicine and critical care medicine. He is an assistant professor in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at Emory University. His primary area of research focus is the appropriate timing and use of interventions to prevent or mitigate syndromes of critical illness (e.g. sepsis) by forecasting the evolution of patient decompensation and organ failure. Through collaborations with colleagues in Emory’s Department of Biomedical Informatics, he creates and tests data-driven, machine learning algorithms to predict clinical decompensation from sepsis. Other areas of research interest include early sepsis resuscitation and hemodynamic monitoring, cardiopulmonary resuscitation, & novel sepsis biomarkers. He is a practicing intensivist in the medical ICU at Grady Memorial Hospital and the medical/surgical ICU at Emory Midtown Hospital, both in Atlanta, GA. 

Provider approved by the California Board of Registered Nursing, Provider Number CEP17068 for 3.6 contact hours.

Other healthcare professionals will receive a certificate of attendance for 3.0 contact hours.

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