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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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“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
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“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
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“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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“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
“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
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“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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“Clinically, it occurs when an infection triggers an excessive and uncontrolled inflammatory response, leading to widespread tissue damage, multiple organ failure and is one of the leading causes of death among hospitalized patients (Angus and Poll 2013; Rudd et al. 2020).”
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“In 2017, an estimated 48.9 million incident cases of sepsis were recorded worldwide, and 11.0 million sepsis-related deaths were reported, representing 19.7% of all global deaths [16].”
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Decoding Immune Dysregulation in Sepsis Through Extracellular Vesicles: A Path to Precision Medicine
Schiavello, M., Vizio, B., Bosco, O., Dini, C., Pivetta, E., Morello, F., & Lupia, E. (2026) · Pharmaceutics · doi:10.3390/pharmaceutics18050570 · Cited by 1
Odih, E., Abdulahi, J., Amulele, A., Bates, M., Heinz, E., Hu, W., Jain, K., Magobo, R., Olwagen, C., Tembo, J., et al. (2026) · PLoS Medicine · doi:10.1371/journal.pmed.1005077 · Cited by 1
“Sepsis is a leading cause of death among neonates, particularly in Africa and Asia, where the highest global incidence of neonatal mortality was recorded in 2022, with over 21 deaths per 1,000 live births [1–3].”
Zhang, H., Huang, W., Dai, X.-L., Zheng, J., Jiang, X., Yang, Y., Zhong, H., & Yang, G. (2026) · Biomedicines · doi:10.3390/biomedicines14051145 · Cited by 1
PPARα: Linking Cardiac Metabolism to Therapeutic Opportunities in Cardiovascular Diseases
Roes, M., Libert, C., & Vandewalle, J. (2026) · Cells · doi:10.3390/cells15100940 · Cited by 1
“Sepsis is a life-threatening inflammatory syndrome resulting from a dysregulated host response to infection, accounting for 1 out of 5 deaths worldwide [78].”
Yokoyama, R., Hayasaka, T., Yarimizu, K., Yamakawa, K., Tagami, T., Umemura, Y., & Endo, A. (2026) · Annals of Intensive Care · doi:10.1016/j.aicoj.2026.100088 · Cited by 1
Yang, Y., Dong, C., & Zhang, R. (2026) · International Journal of Biology and Life Sciences · doi:10.54097/vnn0pk11 · Cited by 1
“Epidemiological estimates suggest sepsis accounts for approximately 48.9 million cases and 11 million deaths annually, representing a mortality rate of roughly 22.5% [1].”
InfluentialZhou, Y., Ma, M., Xu, C., Wang, M., & Lu, Q. (2026) · British Journal of Pharmacology · doi:10.1111/bph.70478 · Cited by 1
“Its global burden is immense, with reported annual incidences surpassing 48.9 million cases, resulting in roughly 11 million deaths and constituting 20% of all-cause mortality (Rudd et al., 2020).”
InfluentialHu, S., Liu, Q.-L., Li, X.-Q., & Luo, L. (2026) · BMC Pediatrics · doi:10.1186/s12887-026-06791-w · Cited by 1
“Children are particularly vulnerable to sepsis, with approximately 25 million cases reported globally in 2017, resulting in over 3 million deaths [1].”
Lv, Y., Meng, Y., Rui, H., Li, T. Z., Zhang, J., Liu, J., Ma, X., Wang, J., Yuan, Y., Jiang, Y., et al. (2026) · PLoS ONE · doi:10.1371/journal.pone.0348261 · Cited by 1
“According to statistics from 2020, this condition affected 48.9 million people worldwide and contributed to 11 million deaths, accounting for approximately 20% of all fatalities globally [2].”
InfluentialTerteşş, R., Petcu, L., Ionescu, C., Bulbuc, I., Pînzaru, A. D., Niţu, B., Daba, L., Mocanu, E., Halichidis, S., Cârciumaru, N., et al. (2026) · Biomedicines · doi:10.3390/biomedicines14050990 · Cited by 1
“The World Health Organization recognizes sepsis as a global health priority, with approximately 11 million sepsis-related deaths reported annually worldwide [2], prompting urgent calls for improved prevention, early diagnosis, and risk-adapted therapeutic strategies [3,4].”
Li, Y., Ding, H., & Li, X. (2026) · BMC Infectious Diseases · doi:10.1186/s12879-026-13418-z
“In 2017, an estimated 48.9 million (95% uncertainty interval [UI] 38.9–62.9) sepsis cases and 11.0 million (10.1–12.0) sepsis-related deaths occurred worldwide, accounting for 19.7% (18.2–21.4) of global deaths [2].”
InfluentialZhang, X.-J., Liu, J., Jiang, R., Yang, X.-Y., He, W.-C., Cao, R., & Chen, L. (2026) · BMC Pediatrics · doi:10.1186/s12887-026-06884-6 · Cited by 1
“This epidemiological shift creates substantial healthcare burdens, where 15–20% of critically ill children experience preventable deaths due to delayed risk stratification [2].”
Manika, M. M., Iteke, R. F., Barhayiga, B. N., Mujing’a, F. M., Éric, K. I., Matanda, S. K., Kakisingi, C. N., Teta, I. M., Yves, M. B., Djuma, J. R., et al. (2026) · Journal of Anesthesia Analgesia and Critical Care · doi:10.1186/s44158-026-00384-w · Cited by 1
“Comorbidities were highly prevalent among non-survivors, particularly stroke and HIV infection, conditions known to reduce physiological reserve and impair immune responses, thereby increasing vulnerability to sepsis-related complications [33, 40–42].”
Woo, H., Kim, S., Oh, J., Yim, Y., Woo, S.-L., Park, S., Pizzol, D., López-Gil, J., Hwang, H. S., & Yon, D. (2026) · Critical Care · doi:10.1186/s13054-026-06024-7 · Cited by 1
“Estimates from the GBD 2017 study suggested that global, regional, and national sepsis-related deaths declined from approximately 15.7 million in 1990 to 11 million in 2017, representing a 29.7% decrease [12].”
InfluentialSharma, A., Hanly, M., & Bhonagiri, D. (2026) · Critical Care Medicine · doi:10.1097/ccm.0000000000007126 · Cited by 1
Li, M., Wang, H.-B., Wang, H., & Xu, Z. (2026) · Medicine · doi:10.1097/md.0000000000048296 · Cited by 1
“[1] Defined by the Sepsis-3 criteria, it reflects a dysregulated host response to infection that precipitates organ dysfunction [2] and is characterized by systemic inflammation and progressive multi-organ failure.”
Hypothalamic arcuate microglia in sepsis: AgRP circuit engagement and ARHGAP24-dependent remodeling
Che, M., Feng, Z., Xu, W., Ling, X., Zhou, M., Peng, J., Wu, G., Li, K., Peng, J., Yung, K. K. L., et al. (2026) · Journal of Neuroinflammation · doi:10.1186/s12974-026-03786-3 · Cited by 1
“Sepsis represents a life-threatening syndrome of dysregulated host response to infection, affecting nearly 50 million individuals annually [3, 28].”
Zhang, R. Y., Long, F., Wu, J., Xu, W., Ruoming, T., Li, L., Long, Y., Su, L., & Qu, H. (2026) · Intensive and Critical Care Nursing · doi:10.1016/j.iccn.2026.104413 · Cited by 3
RetractedQiu, X.-H., Hu, B., Ke, J.-H., & Gu, J. (2026) · Archives of medical science : AMS · doi:10.5114/aoms/216397 · Cited by 1
“For standardized criteria defining these CVD conditions, detailed guidelines are available in a recently published comprehensive review article [22].”
Triglyceride‐Glucose Index‐Based Nomogram for Predicting Short‐Term Mortality in Sepsis Patients
Zhang, J., Jiang, Y.-J., Lv, Y., Li, T., & Ma, L. (2026) · Kaohsiung Journal of Medical Sciences · doi:10.1002/kjm2.70199 · Cited by 1
Baldetti, M., Velocci, S., Belardi, R., Lecce, V. N. D., Paganelli, C., Fortunato, N. A., Ricciardulli, T., Terrinoni, A., Pieri, M., Bernardini, S., et al. (2026) · Diagnostics · doi:10.3390/diagnostics16071076 · Cited by 1
“After 4 years, in 2021, 166 million sepsis cases were estimated, with 21.4 million of all-cause sepsis-related deaths reported, accounting for 31.5% of global deaths [2,3].”
InfluentialWang, X., Li, Y., Zhang, X., Li, W., Qin, B., & Bi, X. (2026) · Environmental Research · doi:10.1016/j.envres.2026.124425 · Cited by 2
Ren, X., & Xue, X. (2026) · Precision medicine and engineering. · doi:10.1016/j.preme.2026.100068 · Cited by 1
Singh, A., & Gupta, P. (2026) · Diagnostic microbiology and infectious disease · doi:10.1016/j.diagmicrobio.2026.117421 · Cited by 1
Galvan, M., Fujarski, M., Beslendi, C., Schaumburg, F., Varghese, J., & Liesche, J. (2026) · mLife · doi:10.1002/mlf2.70076 · Cited by 1
“The delayed start of treatment due to slow species identi fi cation (if microbiological laboratories are available at all) could contribute to the high incidence of sepsis in sub ‐ Saharan Africa, the most severe form of bloodstream infection 6 – 8 .”
Nafamostat mesilate improves sepsis outcomes by modulating complement and coagulation pathways.
He, Q., Yang, Y.-J., Xie, Z., Wu, Y., Yang, C.-H., Qian, Y.-Q., & Zhong, M. (2026) · Journal of Advanced Research · doi:10.1016/j.jare.2026.04.041 · Cited by 1
Hübner, T., & Schöffski, O. (2026) · Healthcare · doi:10.3390/healthcare14081103 · Cited by 1
“In Western healthcare systems, costs associated with sepsis management now exceed those of oncology [3], while intensive care services alone represent 10–20% of total hospital costs [5].”
Cuproptosis in Sepsis: Cell Type-Specific Mechanisms and Clinical Prospects
Fang, S., Li, W., Chang, Z., Tang, X., Niu, X., Chen, Y., & Hu, X. (2026) · Drug Design Development and Therapy · doi:10.2147/dddt.s600729 · Cited by 2
Li, Y.-Q., Liu, A.-H., Zhang, X., Lv, N., Chen, T.-Q., Hao, C.-P., & Wu, D.-M. (2026) · Science in progress · doi:10.1177/00368504261442885 · Cited by 1
Smith, L. A., Augustin, B., Jacob, V., Black, L. P., Bertrand, A. H., Hopson, C., Cagmat, E. B., Datta, S., Reddy, S. T., Guirgis, F. W., et al. (2026) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2026.03.28.714506
Zhou, Y., Zheng, X., Zheng, Y., & Yang, Z. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1767422 · Cited by 1
Tan, D., Zhang, P., Zheng, T. M., Liang, K. Y. H., Su, C., Chen, Y., Lu, T., Richards, J. B., Chong, A. Y.-Y., Lawler, P. R., et al. (2026) · medRxiv · doi:10.64898/2026.03.25.26349312 · Cited by 1
“Sepsis is a critical medical condition caused by dysregulated immune response to infection, accounting for an estimated 20% of global mortality 1,2 .”
Wu, F., Li, X., Su, X., Tao, Z., Huang, Z., & Lu, Z.-Q. (2026) · International Journal of Pharmaceutics: X · doi:10.1016/j.ijpx.2026.100528 · Cited by 1
“Despite significant progress in antimicrobial therapy and critical care, sepsis remains a leading cause of mortality worldwide, with an estimated 48.9 million cases and 11 million related deaths each year (Rudd et al., 2020).”
InfluentialLiu, F., Liu, L., Zhao, X., & Zhou, F. (2026) · Molecular Biology Reports · doi:10.1007/s11033-026-11715-z · Cited by 1
“Despite significant advancements in antibiotic therapy, fluid resuscitation, and supportive care, sepsis-related mortality remains high [1, 2].”
Daşıran, M., Akbaş, A., Akbaş, B., Bora, E., Aygun, H., & Erbaş, O. (2026) · Medicina · doi:10.3390/medicina62040621 · Cited by 1
Monocyte Distribution Width as a Biomarker of Sepsis
Kotsiri, I., Theodoridis, D., Tsifi, A., & Magiorkinis, E. (2026) · LabMed · doi:10.3390/labmed3020009 · Cited by 1
“Host-response biomarkers—including CRP and PCT—provide valuable supportive information but cannot independently diagnose sepsis, particularly in the emergency department where rapid clinical decisions are required [70].”
Qin, R.-Q., Gao, X.-C., & He, J. (2026) · BMC Pulmonary Medicine · doi:10.1186/s12890-026-04191-5 · Cited by 1
“Sepsis is a life-threatening condition characterized by organ dysfunction resulting from a dysregulated host response to infection, with mortality rates reaching up to 22.5% [1, 2].”
InfluentialKo, L., Nierhaus, A., & Kluge, S. (2026) · Pneumologie · doi:10.1055/a-2853-3828 · Cited by 1
Cao, Y.-Q., Chen, K., Chen, C.-F., Qiu, M., Chen, F.-Y., Zhao, L., Li, F., Luo, J.-Y., Tang, W.-H., Wang, Y.-Y., et al. (2026) · PeerJ · doi:10.7717/peerj.20844 · Cited by 1
“…sepsis, characterized by dysregulation of the immune system, abnormal platelet function, an excessive inflammatory response, and systemic multi-organ dysfunction, is acknowledged globally as a significant public health issue, associated with high morbidity and mortality ( Rudd et al., 2020 ).”
Marcus, C., Hof, S., Gesing, A., Thelen, P., Orzol, S., Vocke, A., Schulz, J., Kuebart, A., Truse, R., Vollmer, C., et al. (2026) · Intensive Care Medicine Experimental · doi:10.1186/s40635-026-00881-w · Cited by 1
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
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