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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
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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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“However, the global mortality of FG has remained high, ranging from 20% to 40% [13,14].”
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McMullan, R. R., Bhavani, S. V., & Sinha, P. (2026) · Critical Care Clinics · doi:10.1016/j.ccc.2026.05.008
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Early Recognition and Management of Sepsis
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Interpretable Machine Learning for Early Sepsis Prediction
Stylianides, C., Nicolaou, A., Vavlitou, A., Palazis, L., Kyriacou, E. C., Pattichis, M. S., Pattichis, C. S., & Panayides, A. S. (2026) · Proceedings - IEEE Symposium on Computer-Based Medical Systems · doi:10.1109/cbms69103.2026.00062
Pei, S., Li, D.-Q., Yu, X.-L., Huang, X.-F., Liu, J.-F., Song, Y., Zhu, L., Cui, J.-T., Cui, Y., & Xie, K.-L. (2026) · Renal Failure · doi:10.1080/0886022x.2026.2667584
“…were around 48.9 million sepsis cases globally in 2017, of which 11 million resulted in death, accounting for 19.7% of all fatalities worldwide [2]. only around half of patients with sepsis will fully recover, and 17% of those who survive will develop post-sepsis syndrome (PSS), which…”
InfluentialPradeep, A., Zubair, Z., Jia, K.-Y., Moumneh, M., Ennab, M., Khayat, O., Zayed, A. A., & Amor, M. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15114252
“Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection and remains a leading cause of in-hospital mortality and long-term morbidity worldwide [1,2].”
Phosphorylated toll-like receptor 4 defines a high-risk sepsis endotype
Mühlhaus, M., Dyck, B., Witowski, A., Unterberg, M., Wolf, A., Haberl, H., von Busch, A., Ziehe, D., Thon, P., Palmowski, L., et al. (2026) · Critical Care · doi:10.1186/s13054-026-06115-5
“Sepsis is a complex and life-threatening disease [1], claiming millions of lives each year [2].”
Chiang, D.-P., Pfaffl, M., Schelling, G., Meidert, A. S., Brandes, F., Ludwig, C., Wudy, S. I., Kirchner, B., Yu, M. S. C., Zenner, C., et al. (2026) · Scientific Reports · doi:10.1038/s41598-026-54598-7
Wiranata, S., Manuaba, I., Supadmanaba, I. G. P., Prabawa, I. P. Y., & Lestari, A. A. (2026) · Hematology, Transfusion and Cell Therapy · doi:10.1016/j.htct.2026.106476
“Furthermore, data analysis across 109 million individual death records under-scores the substantial global burden of the condition [2].”
Der Notfall Sepsis – Ersteinschätzung, Screening, Stabilisierung und Transport
Taeger, F., Moegelin-Last, E., & Gründling, M. (2026) · Notfallmedizin up2date · doi:10.1055/a-2573-8133
McKinlay, A., Barrington, G., Prior, S. J., & Tran, V. (2026) · Healthcare · doi:10.3390/healthcare14111509
Targeting VISTA for immunomodulation in sepsis: mechanisms and therapeutic potentials
Hu, B., Yan, J., Ji, W., Wang, H., Tao, T., & Bo, L. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1850679
Gao, Q., Lai, X., Tian, Y., Wang, T., Zheng, X., & Zhang, A. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1722950
Quan, Z., Wang, T.-Y., Liu, D., Sun, Y., Zhang, B.-C., Niu, F., & Xu, J. (2026) · Discover Oncology · doi:10.1007/s12672-026-05215-6
“Sepsis and colorectal cancer (CRC) are high-burden diseases worldwide [1, 2].”
International survey on immunological diagnostics in children with sepsis
Schöbi, N., Agyeman, P., Sancho-Shimizu, V., Trück, J., Fitzgerald, J. C., & Schlapbach, L. (2026) · Intensive Care Medicine · doi:10.1007/s44253-026-00120-w
“Globally, sepsis accounts for approximately three million childhood deaths per year [3].”
Boolean Algebra -- Driven Sepsis Diagnosis
Weber, M., Kappert, K., Reidelbach, M., Gleixne, A., Fackeldey, K., & Bauer, W. (2026) · doi:10.48550/arxiv.2605.29686
“Rudd, Johnson, Agesa et al. used multicausal cause of death statistics for 2017 to determine a global incidence of 677.5 per 100,000 person-years [2].”
InfluentialFeng, X., Xu, P., Li, H., Peng, L.-N., Li, S., Ma, J., Ma, J.-B., Ma, Z.-J., Ma, L., Li, K., et al. (2026) · Frontiers in Microbiology · doi:10.3389/fmicb.2026.1820338
“According to statistics released by the Global Burden of Disease Study, there were over 166 million cases of sepsis worldwide in 2021, with sepsis-related deaths accounting for nearly 31.5% of all global deaths (Rudd et al., 2020).”
InfluentialZhou, J., Liu, Y., Hu, Q., Xu, C.-Z., Yin, F., Lu, Y., & Shi, Q. (2026) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2026.1749207
“Sepsis represents a formidable global health challenge, responsible for an estimated 48.9 million cases and 11 million deaths annually (Fleischmann-Struzek et al., 2020; Rudd et al., 2020), accounting for up to 50% of all in-hospital fatalities.”
InfluentialGüldoğan, E., Yağın, B., Korkmaz, Y., Alzakari, S. A., Alkhalifa, A. K., Al-Hashem, F., & Yagin, F. H. (2026) · Diagnostics · doi:10.3390/diagnostics16111643
“…advances in our understanding of sepsis pathophysiology and therapeutic interventions over the past decades, the condition continues to impose a devastating burden on global healthcare systems, accounting for approximately 11 million deaths annually—representing nearly 20% of all global deaths [2].”
Xue, Y., Chen, S.-X., Chen, G.-R., Lin, W., Yu, X.-F., Lin, H., & Chen, R. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1758229
Rapid Microbiological Diagnostics for Sepsis: Narrative Review of Current and Prospective Approaches
Harrison, L. B., Sohani, Z. N., Lasry, D. E., Cheng, M. P., Lee, T. C., Babiker, A., Kadri, S. S., & Lawandi, A. (2026) · Critical Care Explorations · doi:10.1097/cce.0000000000001415
Kuriyama, A., Heels‐Ansdell, D., Fernando, S. M., Adhikari, N. K. J., Lamontagne, F., Teja, B. J., Lewis, K. A., Rochwerg, B. N., Carayannopoulos, K. L., Vázquez‐Grande, G., et al. (2026) · Acta Anaesthesiologica Scandinavica · doi:10.1111/aas.70267
Therapeutic effect of cilastatin administration in LPS-induced retinotoxicity
Felipe, D. S., Martín‐Sánchez, B., González-Nicolás, M. Á., Llorente, R., Marco, E. M., López‐Gallardo, M., & Lázaro, A. (2026) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2026.119557
Bonnefil, V., Standage, S., Lautz, A., Stanski, N. L., Harmon, K., Lahni, P., Fitzgerald, J. C., Schwarz, A., Thomas, N. J., Haileselassie, B., et al. (2026) · Critical Care Explorations · doi:10.1097/cce.0000000000001410
Zhang, X., Ye, Q., Shi, Y., Wang, S., Ye, B., & Zhao, W. (2026) · European journal of medical research · doi:10.1186/s40001-026-04524-4
“Annually, sepsis affects approximately 50 million individuals globally, causing around 11 million fatalities and accounting for 20% of all mortalities worldwide [2].”
Zhuang, Y.-F., Zhang, X.-Y., Wang, D.-C., Chen, Q., Zhuang, X., & Yin, X.-P. (2026) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-026-03575-1
“Sepsis remains a leading cause of mortality in critical care, with an estimated 48.9 million incident cases and 11.0 million deaths globally in 2017, accounting for 19.7% of all deaths [1, 2].”
InfluentialQi, K., Guo, C., & Yang, L. (2026) · Shock · doi:10.1097/shk.0000000000002870
“With an estimated global burden of 48.9 million incident cases and 11 million deaths annually (3), it remains a leading cause of mortality in critically ill patients (2).”
InfluentialThe Cellular Response Capacity as Diagnostic Head Start in Neutrophil Endotoxemia Sensing
Messerer, D. A. C., Mohamed, A. O. K., Wohlgemuth, L., Vidoni, L., Knapp, C. L., Müller, P., Thomaß, B. D., Föhr, K. J., Barth, E., Weiss, M., et al. (2026) · The FASEB Journal · doi:10.1096/fj.202504316r
Zou, G., Chen, X., Chen, X., Huang, S. H. M., Song, F., Hu, B., Liu, G., Li, X., & Li, H. (2026) · Frontiers in Pharmacology · doi:10.3389/fphar.2026.1741601
“Observational data link tachycardia to worse outcomes in sepsis, underscoring the clinical relevance of heart rate (HR) control in this setting (Rudd et al., 2020; Levy et al., 2021; Na et al., 2023).”
Garcés, M. G., García, J. V., Triana, C. J., Montoya, J. C., & Rincón, E. H. H. (2026) · Frontiers in Digital Health · doi:10.3389/fdgth.2026.1794922
Ge, Z., Zhang, Y., Ma, K.-M., Xia, Z., Cao, J., Zhao, H., & Hu, J. (2026) · Journal of Thoracic Disease · doi:10.21037/jtd-2026-1-0346
“The incidence of sepsis has been reported to be alarmingly high, with estimates suggesting that nearly 50 million cases occur worldwide each year, resulting in approximately 11 million deaths annually (3).”
Unal, R. U., Ozhan, O., Balkaya, E. S., Yıldız, A., Dogru, F., Balkar, M. E., Maden, A., Yücekaya, A., Kucukakcali, Z., & Parlakpınar, H. (2026) · Scientific Reports · doi:10.1038/s41598-026-52131-4
Treml4 Drives Microglial Activation via the Lyn/Syk/ERK Pathway in Sepsis-Associated Encephalopathy
Li, R., Xie, J., Li, Q.-Q., Ouyang, Y., Zhang, Q., Wang, J.-F., & Deng, X.-M. (2026) · Neurochemical Research · doi:10.1007/s11064-026-04773-z
“The clinical features of SAE range from sickness behavior to impaired consciousness without overt central nervous system (CNS) infection, structural brain injury, or other identifiable metabolic abnormalities, with a prevalence of over 50% [5].”
Zhuo, L.-Y., Bao, X., Lai, M.-X., Shah, M. A. A., Chen, X.-F., Jiang, S., Zhen-yang, W., Chen, R., & Zhang, S. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1823604
Zhang, L., Wang, M., Miao, D., Wang, R., Li, L., Li, Z., Wang, L., & He, G. (2026) · BMC Pulmonary Medicine · doi:10.1186/s12890-026-04304-0
“Presently, UCR is considered an independent risk factor for mortality in critical patients with acute heart failure and COVID-19, and patients undergoing hemodialysis [18–20].”
Role of CSF Presepsin in Critically Ill Patients with Cerebral Damage
Hudák, V., Tomajková, E., Capková, J., Večurkovská, I., Pallas, T., Firment, J., Grega, R., Adawi, R. A., & Mareková, M. (2026) · Bratislava Medical Journal · doi:10.1007/s44411-026-00630-1
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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