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Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study
Open accessAbstract
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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In the citing paper
“A clear relationship can be seen – the poorest nations, all former European colonies, have the highest sepsis incidence”
From On race, human variation, and who gets and dies of sepsis (2022) · cites this paper as Rudd et al., 2020
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“This approach follows the methods validated by many studies on the epidemiology of sepsis26, 27, 28, 29 and was used by Rudd and colleagues.10”
From Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050 (2024) · cites this paper as [10]
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In the citing paper
“Previously published global estimates reported a 53% decline in age-standardised sepsis-related deaths from 1990 to 2017.10”
From Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050 (2024) · cites this paper as [10]
In the citing paper
“8.2 million of the 11.1 million sepsis deaths worldwide that year occurred in low and middle income nations”
From On race, human variation, and who gets and dies of sepsis (2022) · cites this paper as Rudd et al., 2020
In the citing paper
“more people in middle and low income nations die of sepsis per incident than in wealthy nations”
From On race, human variation, and who gets and dies of sepsis (2022) · cites this paper as Rudd et al., 2020
In the citing paper
“The majority of the world's sepsis burden is borne by the least wealthiest nations, most former European colonies.”
From On race, human variation, and who gets and dies of sepsis (2022) · cites this paper as Rudd et al., 2020
In the citing paper
“Worldwide, the bulk of sepsis burden falls on marginalized peoples (Gracey & King, 2009; Rudd et al., 2020).”
From On race, human variation, and who gets and dies of sepsis (2022) · cites this paper as Rudd et al., 2020
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“According to estimates from the World Health Organization, sepsis currently affects approximately 49 million people and accounts for nearly 20% of total global deaths, placing a substantial burden on healthcare systems worldwide (Rudd et al., 2020).”
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InfluentialSerum cholinesterase as a biomarker for sepsis-associated immunosuppression via Hub gene RORA
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“Every year, almost 49 million people worldwide suffer from sepsis, which results in nearly 11 million deaths, nearly 20% of all deaths worldwide [4].”
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“Globally, sepsis accounts for approximately 11 million deaths annually, representing one-fifth of all mortality cases [5, 6].”
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Liang, J., Wei, R., Yi, W., Chen, J.-C., Li, D.-X., Xiao, L., Lai, Q., Fang, Q., Lu, J.-B., Wei, Y., et al. (2026) · Medicine · doi:10.1097/md.0000000000048476
“[2] Notably, neonates and young infants represent a highly vulnerable population, with perinatal bacterial infections being a major cause of neonatal mortality.”
Sona, G., Anitha, D., & Narmatha, B. (2026) · Journal of Innovative Image Processing · doi:10.36548/jiip.2026.2.005
“Recent medical reports reveal that sepsis leads to about 50 million cases and 11 million fatalities per year while accounting for nearly 5% of global fatalities in general [1].”
Ren, Y., Dang, H., Fu, Y.-Q., Liu, C.-J., & Li, J. (2026) · BMC Infectious Diseases · doi:10.1186/s12879-026-13402-7
“Sepsis is a major cause of mortality and critical illness globally, with a high disease burden and patients often having long-term physical, psychological and cognitive impairments, making it an important public health problem [3].”
Ji, Y., Huang, L., Cao, C., Xiao, W.-Y., Hua, T.-F., & Yang, M. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1770215
“In China, the in-hospital mortality rate for sepsis reaches 28.4% (4, 5).”
InfluentialYang, Y.-L., Xiao, Z.-Y., Liu, L.-J., Hu, T., Liu, Y., & Wang, D. (2026) · Renal Failure · doi:10.1080/0886022x.2026.2657652
“Sepsis represents a major factor inducing mortality among critical cases, with approximately 49 million individuals affected globally and a mortality rate of 19.7% [3].”
InfluentialJiang, Y., Ding, H.-F., & Li, X.-Q. (2026) · BMC Infectious Diseases · doi:10.1186/s12879-026-13339-x
“Global estimates in 2017 indicated 48.9 million sepsis cases and 11.0 million sepsis-related deaths, accounting for 19.7% of all global deaths [3].”
InfluentialLi, Y., Luo, W., Zhang, Q., Bai, F., Wei, J., Ling, T. A. N. G., Deng, Y., Zuo, D., Peng, T., Li, H., et al. (2026) · BMC Infectious Diseases · doi:10.1186/s12879-026-13279-6 · Cited by 1
“Epidemiological data show that there are approximately 48.9 million cases of sepsis globally each year, resulting in 11 million deaths, accounting for 19.7% of global mortality [2].”
InfluentialKLF2 alleviates sepsis-induced acute kidney injury via the lncRNA GAS6-AS2/GOLPH3 axis
Feng, W., Zhu, Y.-F., Li, K., Xu, X.-S., Zhang, B.-Y., & Zhou, J. (2026) · BMC Nephrology · doi:10.1186/s12882-026-04908-y
“Global disease burden of SA-AKI is substantial, with approximately 49 million sepsis cases occurring annually worldwide and SA-AKI complicating 40–50% of these patients [3, 4].”
Cisneros, P., Caviedes, J. F. O., Ladino, L. M. P., Quintero, N., Cervera, V. G. O., Ospina, J. D. U., & Alcantar, E. P. C. (2026) · Interactive Journal of Medical Research · doi:10.2196/98772
“Sepsis affected an estimated 48.9 million people and caused 11 million deaths worldwide in 2017 (nearly 1 in 5 deaths globally), equating to more than 30,000 deaths per day [1].”
InfluentialLong‐term hippocampal alterations and cognitive impairment in a murine model of surgical sepsis
Cho, D. S., Schmitt, R. E., Dasgupta, A., Ducharme, A. M., & Doles, J. D. (2026) · FEBS Open Bio · doi:10.1002/2211-5463.70240
Wang, Q.-X., Zhao, Y.-H., Ma, Y., Wang, J., Han, Y., & Huang, H.-B. (2026) · BMC Infectious Diseases · doi:10.1186/s12879-026-13272-z
“Survivors also frequently experience long-term sequelae, placing a substantial burden on patients and healthcare systems [4–6].”
Rahman, M. D. S., Azad, T. B., Hasan, M. N., Jahan, S., Hride, H. K., & Ahmed, H. (2026) · IEEE International Conference on Quantum Photonics, Artificial Intelligence & Networking (QPAIN) · doi:10.1109/qpain69676.2026.11546115
“Sepsis is responsible for approximately 11 million deaths each year worldwide and affects nearly 49 million people globally [1].”
Nguyễn, P. V., Trương, H. X., Sorya, S., Sojam, N., Đinh, Q. H., Đỗ, L. M., Trần, T., Phan, K., & Nguyễn, H. H. (2026) · Tạp chí Y học Quân sự · doi:10.59459/1859-1655/jmm.966
“Theo báo cáo về gánh nặng bệnh tật toàn cầu, mỗi năm có khoảng 48,9 triệu ca mắc NKH và 11 triệu ca TV vì NKH, chiếm gần 20% tổng số ca TV toàn cầu [2].”
Zheng, H., Bei, C.-Y., Mo, Z.-C., & Wei, B. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1816016
Xu, Y.-L., Wang, X.-Y., Li, A., Guo, S., & Mei, X. (2026) · Scientific Reports · doi:10.1038/s41598-026-47654-9
Chen, J., Lin, J., Wang, H., Gu, C.-F., Lu, X., & Sun, C. (2026) · Medicine · doi:10.1097/md.0000000000048209
“[1] With shifting demographics, older adults are now constituting an increasing proportion of critically ill patients.”
Biomarkers in predicting mortality among ICU patients with sepsis
Uğur, S., & Kaçmaz, M. (2026) · Medicine · doi:10.1097/md.0000000000048284
“[1] Given these striking figures, it is of crucial importance to evaluate the prognoses of patients with sepsis on the day of ICU admission, which may be facilitated by readily available biomarkers.”
Bao, J., Gao, H., & Jiang, J. (2026) · Frontiers in Pharmacology · doi:10.3389/fphar.2026.1755295
“The key parameter settings of CiteSpace were as follows: (Singer et al., 2026): Timespan: 2005–2025 (Slice Length = 1); (Rudd et al., 2020); Selection Criteria: g-index (k = 25), LRF = 2.5, L/N = 10, LBY = 5, e = 1.0; (Morrissey et al., 2025); Nodes Labeled: 1.0%; (Gao X. et al., FIGURE 1 The…”
InfluentialCSTA and DDX24: potential biomarkers regulating ferroptosis in sepsis and their diagnostic value
Shen, X., Jin, Y., Yang, K., Qian, X., & Guo, J. (2026) · BMC Medical Genomics · doi:10.1186/s12920-026-02358-x
“A 2017 global health assessment estimated that sepsis affected approximately 48.9 million individuals, with a fatality rate of 22.5%, contributing to nearly one-fifth of all deaths worldwide [3, 4].”
InfluentialGoel, M., & Popli, R. (2026) · International Conference on Computing for Sustainable Global Development · doi:10.23919/indiacom70271.2026.11526345
“Septic patients may develop clinical deterioration at a rapid rate, and in many cases, the deterioration may escalate to severe sepsis or septic shock within hours, which enhances the risk of multi-organ failure and death [2].”
Zhang, T.-Y., Gao, H., & Wang, S. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1805614
Bunea, A., Ghibea, O., Popovici, D.-M., Daniel, I., & Andronic, O. (2026) · arXiv.org · doi:10.48550/arxiv.2604.04698
Jain, K., Bharate, P. B., Patil, A., Wadde, S. K., Kinge, A. D., & Bagul, D. (2026) · International Journal of Drug Delivery Technology · doi:10.25258/ijddt.16.2.48
“The Global Burden of Disease study estimated nearly 49 million sepsis cases and 11 million sepsis-related deaths worldwide in 2017, representing approximately 20% of all global mortality [1].”
Bezerra, M. L. C., Maia, J. M., & Motta, F. A. (2026) · 2026 Global Medical Engineering Physics Exchanges/ Pan American Health Care Exchanges (GMEPE/PAHCE) · doi:10.1109/gmepe/pahce69420.2026.11550307
A Histone Deacetylase Activity Model for the Discovery and Validation of Sepsis Biomarkers
Wang, Y.-Y., Shu, T., Li, Y.-P., Kang, Q.-Q., Jia, Z.-S., & Ma, C.-Y. (2026) · Endocrine, Metabolic & Immune Disorders - Drug Targets · doi:10.2174/0118715303458056260211101424
Proton-activated chloride channel 1 is essential for innate host defense against bacterial sepsis
Garo, L. P., Brueck, K., Walachowski, S., Jayaraman, A., Strueve, M., Xu, S., Yang, H., Helmkamp, M. M., Choi, S. H., Reinhardt, C., et al. (2026) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2515768123
“Bacterial sepsis remains a major health burden (1).”
Hybrid inverse reinforcement learning for mimicking clinicians' decision‑making in sepsis treatment
Wang, Z., Zhou, C., Wang, Y.-F., Chen, T., & Hadjiiski, L. (2026) · Medical Imaging · doi:10.1117/12.3085828
Hu, J., Gao, X., Li, G. P., He, X., Ke, Y., Zhang, Z., Pang, D., Lin, Z., Xie, C., Chen, X., et al. (2026) · PLoS Pathogens · doi:10.1371/journal.ppat.1014192
“Sepsis is a leading cause of death in critically ill patients, affecting 48.9 million people annually and causing up to 11 million deaths [1,2].”
InfluentialIdentify value of rate pressure product in children with compensatory septic shock
Ge, H.-Y., Qu, D., Yu, C., Liu, S., & Zhang, J. (2026) · European Journal of Medical Research · doi:10.1186/s40001-026-04316-w
“Compared to those with compensatory septic shock, children with decompensated septic shock had significantly higher median 24-h pSOFA score (9 [6.5, 10] vs. 6 [4, 9]; P = 0.04), Phoenix score (5 [3, 7] vs. 4 [2, 6]; P = 0.041), and vasoactive-inotropic score (40 [10, 80] vs. 10 [0, 40]; P = 0.016).”
InfluentialTejada, S., Giglio, A., Aranda, M., Socias, A., del Castillo, A., Mena, J., Franco, S., Ortega, M., Nieto, Y., & Borges-Sa, M. (2026) · Biomedicines · doi:10.3390/biomedicines14040839
“It remains one of the leading causes of in-hospital mortality worldwide [2].”
Kim, S.-Y., Kim, U., Kim, N., Lee, T.-E., Lee, J., Oh, D.-K., & Shin, H. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27083356
“However, current clinical management remains largely limited to infection control and supportive measures aimed at preserving organ function, as no approved disease-specific therapies for sepsis are currently available [3,4].”
Lai, Z., & Zhang, H. (2026) · International Journal of General Medicine · doi:10.2147/ijgm.s590306
Zhang, X., Chen, M., Zhang, B., Gao, T., Xu, Y., Chen, X., & Yu, W. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15083038
“Advancements in the concepts and technologies of critical care medicine have enabled a growing number of patients to survive critical illnesses, such as sepsis, severe trauma, and severe acute pancreatitis [1–3].”
Fenofibrate Mitigates Acute Lung Injury in a Rat Model of Feces-Induced Peritonitis
Akbaş, A., Daşıran, M., Daghmoura, H., Akbaş, B., Aygun, H., Serdaroglu, A., Uyanıkgil, Y., Ercan, G., & Erbaş, O. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27083556
“Sepsis remains a major global health problem and a leading cause of death and long-term morbidity [1].”
Zirhirhi, K., Joutey, O. T., Lamghari, S., Chabbar, S., Mounir, A., & Bouhouri, M. A. (2026) · Cureus · doi:10.7759/cureus.107160
Huang, X.-F., Zhang, A.-Q., Wen, D., Li, H., & Zeng, L. (2026) · Pathogens · doi:10.3390/pathogens15040433
“The biologically active form of vitamin D, 1 α ,25-dihydroxyvitamin D 3 [1,25-(OH) 2 D 3 ], exerted its effects mainly by binding to the vitamin D receptor (VDR) and initiated downstream transcriptional regulation.”
Update der S3-Leitlinie Sepsis 2025 – was ist neu?
Rusev, S., Bergmann, L., Unterberg, M., Adamzik, M., & Rahmel, T. (2026) · AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie · doi:10.1055/a-2697-1050 · Cited by 1
“Trotz medi-zinischer Fortschritte sterben weltweit noch immer etwa 20 30% der Patienten mit Sepsis während ihrer Behand-lung im Krankenhaus, bei septischem Schock sogar bis zu 40 50% [2].”
Rajeev, A., Shaikh, S., Kaur, H., Sharma, A., Dimowo, P. K., & Murugesh, B. (2026) · Cureus · doi:10.7759/cureus.107323
RanGAP1 plays a vital role in anti-infective functions of macrophages and sepsis progression.
Mao, L., Liu, G.-M., Zhang, J., Zhao, Q.-Z., Zhang, X.-Y., Zhang, S., Zhang, Y., & Bai, X.-C. (2026) · Immunology Letters · doi:10.1016/j.imlet.2026.107180
Kulkarni, M., Bourne, C. M., Mahale, A. B., Exconde, P. M., Murphy, C., Goodrow, H. T., Cervantes, S., Kardhashi, M., Kambayashi, M., Yoo, W., et al. (2026) · PLoS Pathogens · doi:10.1371/journal.ppat.1014178 · Cited by 2
Metadata
- 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
- 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
- FWCI
- 567.33
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- 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 › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Epidemiology
- Health Sciences › Medicine › Pediatrics, Perinatology and Child 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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