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Am J Respir Crit Care Med. 2016 Feb 1;193(3):259-72. doi: 10.1164/rccm.201504-0781OC.

Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations.

Author information

1
1 Department for Anesthesiology and Intensive Care Medicine.
2
2 Integrated Research and Treatment Center, Center for Sepsis Control and Care.
3
3 Clinical Epidemiology, Integrated Research and Treatment Center, Center for Sepsis Control and Care, and.
4
4 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada.
5
5 4th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece; and.
6
6 Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany.
7
7 Critical Care Medicine Division, Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.

Abstract

RATIONALE:

Reducing the global burden of sepsis, a recognized global health challenge, requires comprehensive data on the incidence and mortality on a global scale.

OBJECTIVES:

To estimate the worldwide incidence and mortality of sepsis and identify knowledge gaps based on available evidence from observational studies.

METHODS:

We systematically searched 15 international citation databases for population-level estimates of sepsis incidence rates and fatality in adult populations using consensus criteria and published in the last 36 years.

MEASUREMENTS AND MAIN RESULTS:

The search yielded 1,553 reports from 1979 to 2015, of which 45 met our criteria. A total of 27 studies from seven high-income countries provided data for metaanalysis. For these countries, the population incidence rate was 288 (95% confidence interval [CI], 215-386; τ = 0.55) for hospital-treated sepsis cases and 148 (95% CI, 98-226; τ = 0.99) for hospital-treated severe sepsis cases per 100,000 person-years. Restricted to the last decade, the incidence rate was 437 (95% CI, 334-571; τ = 0.38) for sepsis and 270 (95% CI, 176-412; τ = 0.60) for severe sepsis cases per 100,000 person-years. Hospital mortality was 17% for sepsis and 26% for severe sepsis during this period. There were no population-level sepsis incidence estimates from lower-income countries, which limits the prediction of global cases and deaths. However, a tentative extrapolation from high-income country data suggests global estimates of 31.5 million sepsis and 19.4 million severe sepsis cases, with potentially 5.3 million deaths annually.

CONCLUSIONS:

Population-level epidemiologic data for sepsis are scarce and nonexistent for low- and middle-income countries. Our analyses underline the urgent need to implement global strategies to measure sepsis morbidity and mortality, particularly in low- and middle-income countries.

KEYWORDS:

epidemiology; incidence; metaanalysis; mortality; sepsis

PMID:
26414292
DOI:
10.1164/rccm.201504-0781OC
[Indexed for MEDLINE]
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