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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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Liao, Y.-S., Deng, Y.-P., Song, J.-L., Yu, X., Li, Q., Lu, B., & Chen, G.-Y. (2026) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2026.1934020
“Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection and remains a major contributor to global mortality (Singer et al., 2016; Rudd et al., 2020).”
Feng, W.-Y., Chen, Y., Zhang, X.-Y., Fu, R., Hu, Q., Mo, F., & Wang, J.-F. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1978491
Liu, T., Wang, Y., Zeng, L., Miao, X., Peng, Y., Yu, J., Li, J., Zhao, Q., Chen, Z., Dai, R., et al. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1931628
Chinese Perioperative Septic Shock Investigators for the Chinese Peri-Operative Organ Protection Group, Li, C., Li, H., Zhang, H., Zhang, X., Zhao, B., 朱少俊, Huang, L., 马震俊, Wang, Y., et al. (2026) · JAMA · doi:10.1001/jama.2026.21322
Proteomic identification of resistin as a NET-associated neutrophil activity marker in sepsis
Hashiguchi, E., Shinkai, A., Katsuno, M., Hayakawa, M., Totoki, T., Tasaki, M., & Ito, T. (2026) · Journal of Intensive Care · doi:10.1186/s40560-026-00954-8
“According to the World Health Organization, there were an estimated 48.9 million cases of sepsis and 11 million sepsis-related deaths worldwide in 2020, accounting for approximately 20% of all global deaths [2, 3].”
InfluentialZhang, Y.-H., Liao, G.-Y., Liu, C.-H., Chen, G.-Y., Song, J.-L., Liao, Y.-T., & Zhang, L.-L. (2026) · Journal of Intensive Care · doi:10.1186/s40560-026-00953-9
“Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection and remains a major cause of death and resource use worldwide [1, 2].”
Zhang, L.-Y., Chen, P., Li, J., Xiao, W.-L., & Zhou, W.-T. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1864043
Quan, R.-L., Wang, C.-L., Li, W., Jiang, K.-P., & Huang, K.-Z. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1941213
Schisandra chinensis in sepsis intervention through multi-target mechanisms and organ protection
Chen, M., Wang, H., Bu, K., Raorao, Z., & Qin, C. (2026) · Fitoterapia · doi:10.1016/j.fitote.2026.107511
Gatti, M., Giorgi, B., Paola, R. D., Santarella, F., & Pea, F. (2026) · The Pediatric Infectious Disease Journal · doi:10.1097/inf.0000000000005429
Wu, Y., Lu, J., Mo, Y., Xu, Y., Yan, X., Yan, C., & Wang, Y. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1998563
Sulangi, C. W. (2026) · Natural Resources for Human Health · doi:10.53365/nrfhh.3339
“Globally, sepsis accounted for an estimated 48.9 million cases and 11 million deaths in 2017, underscoring its substantial contribution to preventable mortality [4,5] .”
InfluentialWilliams, J., Kollisch-Singule, M., Elmadany, N., Habashi, N., Nieman, G., & Varisco, B. (2026) · Intensive Care Medicine Experimental · doi:10.1186/s40635-026-00985-3
“According to the Global Burden of Disease data, approximately 49 million cases of sepsis are estimated to occur worldwide each year [1].”
Alevizopoulos, A. G., Anastasiou, G. G., Nomikos, P., & Kritikos, I. (2026) · Metabolism Open · doi:10.1016/j.metop.2026.100508
“Sepsis accounts for an estimated 11 million deaths annually, and the liver acts both as an effector of host defence and as a frequent target of injury [1 – 3].”
Ha, N. K., Lee, H.-U., Kim, C., 임찬주, Yoo, S., Kim, J., 허주원, Kim, H., & Son, M. (2026) · Hospitals · doi:10.3390/hospitals3040020
Huang, T., Tan, Z., Jiang, L., Yang, X., Wang, S., & Huang, Y. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1956921
Xiao, L., Pei, W., & Zhu, H. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1933045
Ding, R., Zhang, S., Liu, X., Jiang, H., Wang, C., Zhang, Z., Li, X., & Song, X. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1896167
“It imposes a substantial global burden, with an estimated 49 million new cases and 11 million deaths annually, accounting for nearly one-fifth of global mortality (5).”
Ding, Z.-Z., Li, Q., Ma, C.-Y., & Li, H. (2026) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2026.1845721
Almass, A., Alshihri, M. S., Alibrahim, N. S., Alotaibi, M. M., Alharbi, Z., Sharif, H. I., Alabbas, H., Alharbi, A., Alsayali, L., Althobaiti, A., et al. (2026) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph23101291
Ren, Y.-M., Meng, H.-Q., Li, B.-B., Wang, Y.-H., Gu, L.-L., Lv, R.-Y., Xue, L.-T., Xu, L., Zhang, H., Wang, D.-H., et al. (2026) · Frontiers in Pharmacology · doi:10.3389/fphar.2026.1901895
“The lower estimate comes from the GBD 2017 analysis, whereas the higher estimate comes from the GBD 2021 update, with differences in the observation period, input data, and estimation methods (Rudd et al., 2020; GBD, 2021 Global Sepsis Collaborators, 2025).”
Implementasi qSOFA sebagai Alat Deteksi Dini Sepsis pada Infeksi Akut: Sebuah Literature Review
Silvia, D., Melastuti, E., & Wahyuningsih, I. (2026) · Jurnal Locus Penelitian dan Pengabdian · doi:10.58344/locus.v5i10.6171
Pancreatic Stone Protein: A Promising Biomarker for Sepsis Detection – A Review
Fathima, H., & Faseela, T. (2026) · Archives of Medicine and Health Sciences · doi:10.4103/amhs.amhs_237_25
Evaluation of a Commercial Pediatric Sepsis Early Detection Alert in the Emergency Department
Mitchell, C. M., Zhang, Z., Ranard, B. L., Hruby, G. W., Lee, S. M., Qian, M., Tsze, D. S., Malia, L. A., Babineau, J., Adelman, J. S., et al. (2026) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2026.4575
Pan, B.-C., Sun, Y.-N., Yang, G.-Y., Fu, H.-P., Li, X., & Sun, Y.-Z. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1952142
Clinically Contextualized State Spaces Provide Continuous Representations of Sepsis
Kobara, S., Kay, M., Choudhary, T., Krishnamoorthy, V., Podgoreanu, M., Hayashi, Y., Agarwal, S., & Kamaleswaran, R. (2026) · Research Square · doi:10.21203/rs.3.rs-11221040/v1
“Precision medicine in sepsis remains an unmet need in critical care, given its unacceptably high mortality despite advances in supportive care 1–3 .”
Anti-Inflammatory Effects of Hypoxia, Hypercapnia, and Hypercapnic Hypoxia: Prospects for Use
ZhA, D., & Baranova, E. V. (2026) · Journal of Evolutionary Biochemistry and Physiology · doi:10.1134/s0022093026050042
“In 2017, approximately 48.9 million cases of sepsis were recorded worldwide, of which 11 million patients died from this pathology, accounting for 19.7% of all deaths globally [21].”
InfluentialYılmaz, H., Tulunay, M., & Yılmaz, A. A. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15197731
“In 2017, an estimated 48.9 million incident cases of sepsis and 11.0 million sepsis-related deaths occurred worldwide, representing 19.7% of all global deaths [1].”
InfluentialArumairaj, A., Dhanani, D., Tashrifwala, F., Veluswamy, A. S., Venugopalan, A., Annam, R., Dhorajiya, P., & Vajjala, V. (2026) · Infectious Disease Reports · doi:10.3390/idr18050118
“Sepsis continues to be a leading cause of morbidity, mortality, and healthcare expenditure worldwide [3].”
InfluentialJeongmin, M., Yoon, C., Jeong, H. H., Park, S.-H., & Kim, K. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15207848
“Given the recommendations of the World Health Assembly and the substantial global and Korean burden of sepsis [19–21], a more explicit national approach should be implemented.”
InfluentialPoroșnicu, T. M., Gindac, C., Elagez, A., Păpurică, M., Pescariu, A., Bratosin, F., Hogea, E., Sandesc, D., & Bedreag, O. (2026) · Biomedicines · doi:10.3390/biomedicines14102230
“…one of the leading causes of death in intensive care units worldwide, with an estimated 48.9 million incident cases and 11 million sepsis-related deaths in 2017, and its current definition emphasises life-threatening organ dysfunction caused by a dysregulated host response to infection [1,2].”
InfluentialCTSM: A novel cumulative-time-based stacking algorithm for predicting sepsis onset
Liu, X., Liu, S., He, W., & Mao, S. (2026) · Biomedical Signal Processing and Control · doi:10.1016/j.bspc.2026.110764
Infections chez le patient immunodéprimé en réanimation
Mokart, D., Bisbal, M., Gonzalez, F., Chow‐Chine, L., Faucher, M., & Roger, C. (2026) · EMC-Anesthésie réanimation/Encyclopédie médico-chirurgicale. Anesthésie, réanimation · doi:10.1016/s0246-0289(26)49706-6
Prognostic value of T lymphocyte CD40L expression levels in patients with sepsis
Shao, B., Huang, Z., Liu, Y., Wang, Z., Huang, F., & Wang, J. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1949041
Mu, Y., Tang, H., Zeng, Y., Wang, Q., Huang, T., Li, W., Wu, X., & Pi, S.-M. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1915095
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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