The DOI matches its Crossref record; 39 of the 42 references it cites were found in a registry or an index.
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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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
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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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CLEC-1 promotes early IFN response in cDC1s and favors immune dysregulation during sepsis in mice
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A single-cell transcriptomic atlas reveals the immune panorama of neonatal sepsis.
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Amuyao, F. M., & Adisa, I. T. (2026) · International Journal of Innovative Science and Research Technology (IJISRT) · doi:10.38124/ijisrt/26jul1334
“Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, accounting for over 270,000 deaths annually in the United States [1,2].”
Zhang, M., Yi, K., Zhang, L., Li, D.-H., Liang, S., Tang, Z., & Gao, X.-X. (2026) · Canadian Liver Journal · doi:10.3138/canlivj-2026-0016
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“According to the statistical report of World Health Organization (WHO), approximately 49 million people worldwide develop sepsis annually, with the death toll reaching 11 million, accounting for 20% of all global deaths[2].”
Jiang, L.-Y., Li, L., Xu, Y.-T., Liu, J., Ding, W.-F., Liu, J.-L., Yin, D.-F., Ou, S., & Wen, L. (2026) · Annals medicus · doi:10.1080/07853890.2026.2717823
“Notably, sepsis accounted for an estimated 11 million deaths in 2017, comprising nearly one-fifth of all-cause mortality globally [2].”
Zhang, G., Liu, H., Zhang, Q., Cheng, S., Ling, S., Xue, J., Kou, N., Wu, J.-Q., Li, X., Yang, H., et al. (2026) · Frontiers in Pharmacology · doi:10.3389/fphar.2026.1785167
“Epidemiological data from 2017 showed that there were 48.9 million newly diagnosed sepsis cases and 11 million sepsis-associated deaths globally, with the latter accounting for 19.7% of all deaths worldwide (Meyer and Prescott, 2024; Rudd et al., 2020).”
InfluentialWei, Y., Xu, S., & Yang, M.-J. (2026) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2026.1888879
Liu, L., Cai, B., & He, B. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1906761
Microcirculatory alterations and dysfunction in sepsis
Liu, S., Liu, W., & Zhang, L.-P. (2026) · Hemodynamics · doi:10.1097/hd9.0000000000000035
Wu, W., Ma, C., Xi, W.-J., Zhao, L., Huang, M., Yang, S., Fu, R., Kang, Y., & Chi, X.-J. (2026) · ACS Applied Materials and Interfaces · doi:10.1021/acsami.6c09916
Beyond Supportive Care: Targeting the Microcirculation in Septic Shock.
Wieruszewski, P. (2026) · Critical Care Medicine · doi:10.1097/ccm.0000000000007324
Kiakou, D., Zachariou, M., Bourdakou, M., Kyprianou, T., & Spyrou, G. M. (2026) · Frontiers in Bioinformatics · doi:10.3389/fbinf.2026.1890081
“Subsequently, sepsis has become an important public health challenge (Rudd et al., 2020) and even though advances in diagnosis have led to successful treatments under multidimensional data collection (Lafon et al., 2026), the risk of patient deterioration yet remains.”
Wang, L., Gao, Z., Wang, C., Zhao, Y., Deng, Z., Bai, Y., Yang, M., Zou, Y., & Kang, H. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1881375
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Alamgir, K., Muhammad, S., Shahid, M., Makki, L. K., Alnuwaysir, S. N., Alharbi, R., Alnizami, A., Alhaggass, N. S., Al-Megrin, W., Allemailem, K. S., et al. (2026) · Scientific Reports · doi:10.1038/s41598-026-66747-z
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Sepsis care and management: Where do we stand?
Giamarellos-Bourboulis, E. (2026) · Journal of Internal Medicine · doi:10.1111/joim.70154
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“…anchors, indications, and timing windows would allow meaningful cross-site comparison and focus efforts of improvement on steps most likely to improve bundle completion — including earlier cultures and lactate testing — without compromising the priority of timely antibiotic administration [1, 2].”
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“Previous studies have found that mortality rates for adults with sepsis [2–4] and acute respiratory distress syndrome (ARDS) [5–7] are higher in resource-limited settings compared to resource-rich settings.”
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“It is a severe and frequent condition in the intensive care unit (ICU), with a high mortality rate [2].”
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“Its most severe form can progress to Acute Respiratory Dis - tress Syndrome (ARDS), which carries a mortality rate of 25%−40% and accounts for approximately 20% of global deaths, thereby representing a growing public health challenge worldwide (Rudd et al. 2020; Long et al. 2022).”
Human beta defensins 3 and 6 serve as diagnostic tools for identifying sepsis and pneumonia
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“According to the World Health Organization (WHO), sepsis is responsible for up to 20% of global deaths, ranking it among the leading causes of mortality worldwide (2).”
Aonuma, K., Kumasawa, J., & Hasegawa, K. (2026) · Journal of critical care · doi:10.1016/j.jcrc.2026.155709
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“Recent epidemiological studies estimate that sepsis affects approximately 48.9 million individuals worldwide, with sepsis-related deaths comprising 19.7% of the total annual deaths [1].”
InfluentialSallee, C., Noa, A. S., Bhowmik, M., Nobles, A. C., Wang, Z.-J., Liu, J., Richter, J. R., Blalock, J., Patel, R., Gaggar, A., et al. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1893157
Micro/nanorobotics for sepsis diagnosis and therapy: a frontier in precision medicine
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A 24-hour landmark machine learning model for predicting new-onset sepsis-associated encephalopathy
Hong, W., Jiang, Z., Ruan, J., Weng, D., Zhang, R., & Dong, L. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1904524
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“Sepsis remains a major global health challenge and a leading cause of morbidity and mortality, particularly in low-and middle-income countries (LMICs), where the burden is disproportionately high [1, 2].”
Zhang, B.-X., Li, X., Xu, Q., Wang, T., Sun, Y.-L., Aji, N., Zhou, X.-T., Zhao, K.-K., Wu, Y.-H., & Cheng, Z. (2026) · Molecular Biology Reports · doi:10.1007/s11033-026-12556-6
IL-37 and IL-38 in sepsis: immune-metabolic rheostats in a dynamic inflammatory continuum
Yan, H.-L., Ma, L.-T., Huang, X.-J., Dang, X.-B., Ma, L.-Y., Dai, W., Gao, W.-S., He, W., Bao, S., & Du, G.-L. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1869119
The Potential for Severe, Acute Inflammation to Impact Tissue Oxygenation—A Narrative Review
Nimmo, A. J., & Younsi, A. (2026) · Oxygen · doi:10.3390/oxygen6030022
Zimmerman, J. J., Raman, S., Butt, W., Cermelli, S., Davis, R. F., Killien, E., George, S., Gibbons, K. S., Irwin, A. D., Navalkar, K., et al. (2026) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000004027
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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