Sepsis Incidence Underestimated, Remains Major Health Burden Worldwide

The current estimated burden of sepsis cases worldwide is roughly double that of previous estimates and is largely attributable to the greater burden among people living in areas with a lower sociodemographic index, according to results of a study published in Lancet.

To estimate the global, regional, and national incidence of sepsis and associated mortality, researchers collected data from 109 million individual death records from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate mortality related to sepsis for each age group, sex, location, GBD cause, and year between 1990 and 2017. Death certificates with International Statistical Classification of Diseases and Related Health Problem (ICD) codes (9^th and 10^th revisions) of explicit sepsis, infectious disease, or organ dysfunction. Individual records were denoted as explicit, implicit, or no-sepsis status. Researchers used linear regression to model in-hospital sepsis-associated case-fatality for each location, and they estimated sepsis incidence by applying modeled case-fatality to sepsis-related mortality estimates.

There were an estimated 60.2 million cases (95% uncertainty interval [UI], 47.2-79.7) of sepsis worldwide in 1990 and 48.9 million cases of sepsis (95% UI, 38.9-62.9) in 2017, representing a decrease of 18.8% (95% UI, 5.9-42.2). Of all cases of sepsis in 2017, results demonstrated that 33.1 million (95% UI, 24.1-45.9 [67.4%; 95% UI, 59.1-75.7]) were associated with an underlying infectious cause of health loss, and 15.8 million cases (95% UI, 12.7-20.0 [32.6%, 24.3-40.9]) occurred in individuals with underlying injuries or noncommunicable diseases. Patterns of sepsis incidence varied substantially according to region; 85.0% of age-standardized incidences occurred in countries with a low, low-middle, or middle sociodemographic index in 2017 (41.5 million; 95% UI, 32.1-54.5).

Limitations of this study included input data restricted to the available sources at the time of analysis. The ICD code-based approach has an imperfect correlation with clinician chart review as a means of identifying patients with sepsis. The ICD code approach for implicit sepsis was novel, in that infection codes had to be listed as the underlying cause of death, which restricted the identification and might have led to an underestimate of the burden. The ICD codes were substantially modified to reflect the most current definition of sepsis, modern understanding of sepsis pathophysiology, and global infection patterns. There is a risk for misclassification with any ICD code-based method. This study was not designed to distinguish between hospital-acquired and community-acquired sepsis.

Researchers noted several important implications of their findings. “First, the global burden of sepsis is larger than previously appreciated, requiring urgent attention. Second, there is substantial variation in sepsis incidence and mortality according to HAQ Index, with the highest burden in locations that are least equipped to prevent, identify, or treat sepsis. Third, more robust infection-prevention measures should be assessed and implemented in areas with the highest incidence of sepsis and among populations on which sepsis will have the greatest impact, such as neonates.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200-211.