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David Oliver: Sepsis—what’s behind the “hype”?

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6327 (Published 07 November 2019) Cite this as: BMJ 2019;367:l6327

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Re: David Oliver: Sepsis—what’s behind the “hype”?

Sepsis: excess “hype” or hydrogen peroxide?

Dear Editor:

The commentary entitled “Sepsis—what’s behind the “hype”?” in the November 2019 issue of The BMJ (1) and the initial correspondence in The Lancet that prompted the BMJ commentary (2) both reflect the the stark reality of trying to treat a life-threatening illness such as sepsis without any specific treatment.

The mortality statistics, however, would be very different if we knew the exact molecule in the body that causes sepsis. In this regard, my 2014 publication provides an evidence-based pathogenesis of sepsis that implicates hydrogen peroxide as the causal molecule responsible for sepsis (3). Studies have shown that blood hydrogen peroxide is significantly elevated in human sepsis with values reported up to 558uM, which is over 100 times the normal upper limit of 5uM and over eleven times the 50 uM upper limit at which H2O2 becomes cytotoxic (4,5). The ability of hydrogen peroxide toxicity to mirror the clinical and laboratory abnormalities in sepsis should focus our attention on a possible causal role for this toxic metabolite in the pathogenesis of this often-fatal condition. This is consistent with the multiple organ failure and fatal sepsis reported in a previously healthy young man after receiving intravenous hydrogen peroxide (6).

Despite the focus on the immune system, there is no evidence that any component of the immune response is responsible for the syndrome known as sepsis. It’s time to throw-out preconceived notions about the cause of sepsis and follow the evidence, which suggests that sepsis is an endogenous hydrogen peroxide induced systemic metabolic poisoning. It’s very simple to find out if hydrogen peroxide is the cause of sepsis. We just need to repeat the above study (ref #4) that demonstrated pathological levels of hydrogen peroxide in the blood of sepsis patients and compare hydrogen peroxide levels in the blood of sepsis survivors vs non-survivors, this time with a larger cohort of patients. This simple study might open the door to saving the lives of millions of people world-wide who succumb to sepsis each year.

Sincerely

Jay Pravda MD MPH

1. Oliver D. Sepsis—what’s behind the “hype”? BMJ 2019;367:l6327
2. Singer M, Inada-Kim M, Shankar-Hari M. Sepsis hysteria: excess hype and unrealistic expectations. The Lancet. 2019 Oct 26;394(10208):1513-4.

3. Pravda J. Metabolic theory of septic shock. World journal of critical care medicine. 2014;3:45-54.

4. van Asbeck, B.S et al. Hydrogen Peroxide In Blood of Patients with Sepsis Syndrome: A Realistic Phenomenon. Critical Care Medicine. 1995 Jan 1;23(1):A169.

5. Forman HJ, Bernardo A, Davies KJ. What is the concentration of hydrogen peroxide in blood and plasma?. Archives of biochemistry and biophysics. 2016 Aug 1;603:48-53.

6. Wetter DA, Davis MD. Ulceration of the arm attributed to a spider bite and treated with intravenous hydrogen peroxide: a cautionary tale. Arch Dermatol 2006; 142: 1658-1659.

Competing interests: No competing interests

09 November 2019
Jay Pravda
physician scientist
No affiliation
4371 Northlake Blvd #247 Palm Beach Gardens Florida 33410 USA