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Cited by 7,971Sepsis Diagnosis and TreatmentGlobal Health and EpidemiologyNeonatal and Maternal Infections

Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study

Open access
Rudd, Kristina E, Johnson, Sarah Charlotte, Agesa, Kareha M, Shackelford, Katya Anne, Tsoi, Derrick, Kievlan, Daniel Rhodes, Colombara, Danny V, Ikuta, Kevin S +16 more·2020·The Lancet
DOI 10.1016/s0140-6736(19)32989-7PMC PMC6970225
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Abstract

BACKGROUND: Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. It is considered a major cause of health loss, but data for the global burden of sepsis are limited. As a syndrome caused by underlying infection, sepsis is not part of standard Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimates. Accurate estimates are important to inform and monitor health policy interventions, allocation of resources, and clinical treatment initiatives. We estimated the global, regional, and national incidence of sepsis and mortality from this disorder using data from GBD 2017. METHODS: We used multiple cause-of-death data from 109 million individual death records to calculate mortality related to sepsis among each of the 282 underlying causes of death in GBD 2017. The percentage of sepsis-related deaths by underlying GBD cause in each location worldwide was modelled using mixed-effects linear regression. Sepsis-related mortality for each age group, sex, location, GBD cause, and year (1990-2017) was estimated by applying modelled cause-specific fractions to GBD 2017 cause-of-death estimates. We used data for 8·7 million individual hospital records to calculate in-hospital sepsis-associated case-fatality, stratified by underlying GBD cause. In-hospital sepsis-associated case-fatality was modelled for each location using linear regression, and sepsis incidence was estimated by applying modelled case-fatality to sepsis-related mortality estimates. FINDINGS: In 2017, an estimated 48·9 million (95% uncertainty interval [UI] 38·9-62·9) incident cases of sepsis were recorded worldwide and 11·0 million (10·1-12·0) sepsis-related deaths were reported, representing 19·7% (18·2-21·4) of all global deaths. Age-standardised sepsis incidence fell by 37·0% (95% UI 11·8-54·5) and mortality decreased by 52·8% (47·7-57·5) from 1990 to 2017. Sepsis incidence and mortality varied substantially across regions, with the highest burden in sub-Saharan Africa, Oceania, south Asia, east Asia, and southeast Asia. INTERPRETATION: Despite declining age-standardised incidence and mortality, sepsis remains a major cause of health loss worldwide and has an especially high health-related burden in sub-Saharan Africa. FUNDING: The Bill & Melinda Gates Foundation, the National Institutes of Health, the University of Pittsburgh, the British Columbia Children's Hospital Foundation, the Wellcome Trust, and the Fleming Fund.

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  1. [1]Singer M Deutschman CS Seymour CW The third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA 315 2016 801 810 26903338 PMC4968574
  2. [3]Torio CM Moore BJ National inpatient hospital costs: the most expensive conditions by payer, 2013 https://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.pdf May, 2016 (accessed Nov 6, 2019). 27359025
  3. [35]Iwashyna TJ Odden A Rohde J Identifying patients with severe sepsis using administrative claims Med Care 52 2014 e39 e43 23001437 PMC3568444

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Authors
Rudd, K. E., Johnson, S. C., Agesa, K. M., Shackelford, K. A., Tsoi, D., Kievlan, D. R., Colombara, D. V., Ikuta, K. S., Kissoon, N., Finfer, S., Fleischmann-Struzek, C., Machado, F. R., Reinhart, K. K., Rowan, K., Seymour, C. W., Watson, R. S., West, T. E., Marinho, F., Hay, S. I., Lozano, R., Lopez, A. D., Angus, D. C., Murray, C. J. L., & Naghavi, M.
Affiliations
  • University of Pittsburgh (US)
  • University of Washington (US)
  • University of British Columbia (CA)
  • UNSW Sydney (AU)
  • Jena University Hospital (DE)
  • Seattle Children's Hospital (US)
  • Universidade de São Paulo (BR)
Corresponding author
Naghavi, Mohsen
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2020-01
Volume
395
Issue
10219
Pages
200-211
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(19)32989-7
PMC
PMC6970225
OpenAlex
W2998853022
Cited by
7,971
References
42
Citations by year
2026: 1540 · 2025: 1722 · 2024: 1545 · 2023: 1195 · 2022: 899 · 2021: 735 · 2020: 329 · 2019: 1
FWCI
567.33
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
Funders
  • Bill & Melinda Gates Foundation
  • National Institutes of Health (T32HL007287, T32HL007820, R35GM119519)
  • National Health and Medical Research Council (no 1117230)
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
Keywords
sepsis, sepsis incidence, sepsis mortality, global burden of disease, case fatality, underlying cause of death, age-standardized incidence rate, temporal trends, regional variation, sub-Saharan Africa, South Asia, hospital records, cause-specific mortality, health policy interventions, resource allocation, health loss, nosocomial infections, infection-related mortality, sepsis surveillance
MeSH terms
Global Burden of Disease, Adolescent, Adult, Aged, Aged, 80 and over, Cause of Death, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Socioeconomic Factors, Incidence, Age Distribution, Sex Distribution, Sepsis, Young Adult

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