Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study

Abstract

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. FindingsIn 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.

Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections

“…In aggregate, acute respiratory tract illnesses were estimated to be responsible for approximately 2.38 million deaths worldwide in 2016 [2,3]. Indeed, severe lower respiratory tract infections were the most common cause of sepsis-related death globally from 1990-2017 [4].…”

How to close the maternal and neonatal sepsis gap in sub-Saharan Africa

“…1 The incidence of sepsis, as estimated by the Global Burden of Disease study, was 48.9 million cases with 11 million deaths in 2017. 2 In sub-Saharan Africa (SSA), the burden is highest, with an estimated 16.7 million cases and sepsis accounting for up to 45% of all deaths, in many SSA countries. 2 Maternal sepsis is a sepsis that occurs during pregnancy, childbirth, postabortion or in the postpartum period and neonatal sepsis is a sepsis that occurs within the first 28 days of life.…”

“…2 In sub-Saharan Africa (SSA), the burden is highest, with an estimated 16.7 million cases and sepsis accounting for up to 45% of all deaths, in many SSA countries. 2 Maternal sepsis is a sepsis that occurs during pregnancy, childbirth, postabortion or in the postpartum period and neonatal sepsis is a sepsis that occurs within the first 28 days of life. Reliable estimates of the incidence and mortality of maternal and neonatal sepsis in SSA are incomplete.…”

“…Notwithstanding this limitation, the most recent estimate suggests that sepsis is responsible for 130 000 maternal deaths 3 and 300 000 neonatal deaths annually, though this may be an underestimate, 4 in view of the recent Global Burden of Disease study report. 2 Sepsis-related deaths in SSA reflect underlying political, poverty, health inequity and health system challenges across Africa. 5 These challenges affect preventative and public health efforts to prevent sepsis and limit prompt and effective recognition and treatment of sepsis to prevent mortality.…”

Macrophage-derived miR-21 drives overwhelming glycolytic and inflammatory response during sepsis via repression of the PGE2/IL-10 axis

“…Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection (1,2). Regarding the last sepsis reports, 48.9 million incident cases of sepsis and 11 million sepsis-related deaths were reported worldwide in 2017 (3). The net between the infecting microorganisms and the host innate immune system culminates in a complex pathogenesis event associated with sepsis (4)(5)(6).…”