Sepsis accounts for 1 in 5 deaths worldwide

"If you look at any top 10 list of deaths globally, sepsis is not listed because it hasn’t been counted." (Credit: Getty Images)

Twice as many people as previously believed are dying of sepsis worldwide, according to a new study. A disproportionately high number of the deaths are children in poor areas.

The study reveals 48.9 million global cases of sepsis in 2017 and 11 million deaths, or 1 in 5 deaths worldwide.

Sepsis occurs when a person’s organs cease to function properly as the result of an out-of-control immune response to infection. Even when sepsis doesn’t kill its victims, it can create lifelong disabilities in survivors, researchers say.

Sepsis in low-income countries

The large majority of sepsis cases—85% in 2017—occurred in low- or middle-income countries. The study found the highest burden in sub-Saharan Africa, the South Pacific islands near Australia, and South, East, and Southeast Asia. Females had a higher incidence of sepsis incidence than males. By age, the incidence of sepsis peaks in early childhood, with more than 40% of all cases occurring in children younger than five.

“I’ve worked in rural Uganda, and sepsis is what we saw every single day. Watching a baby die of a disease that could have been prevented with basic public health measures really sticks with you,” says lead author Kristina E. Rudd, assistant professor in the University of Pittsburgh’s critical care medicine department.

“I want to contribute to solving this tragedy, so I participate in research on sepsis. However, how can we know if we’re making progress if we don’t even know the size of the problem? If you look at any top 10 list of deaths globally, sepsis is not listed because it hasn’t been counted.”

For the new analysis in The Lancet, researchers used the Global Burden of Disease Study, a comprehensive epidemiological analysis coordinated from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine.

“We are alarmed to find sepsis deaths are much higher than previously estimated, especially as the condition is both preventable and treatable.”

The GBD 2017 Study currently reports on 282 primary causes of death not including sepsis, which health experts consider an intermediate cause of death. A primary cause of death is the underlying condition (e.g. cancer), which leads to the intermediate cause (sepsis) that ultimately results in death.

Sepsis prevention among newborns

A reliance on hospital databases from a select group of middle- and high-income countries limited .previous global estimates for sepsis, researchers say. Further, previous estimates overlooked the substantial burden of sepsis that occurs outside of the hospital, especially in low-income countries. The new findings are unprecedented as they represent mortality both in and out of the hospital.

“We are alarmed to find sepsis deaths are much higher than previously estimated, especially as the condition is both preventable and treatable,” says senior author Mohsen Naghavi, professor of health metrics sciences at IHME at the University of Washington School of Medicine. “We need renewed focus on sepsis prevention among newborns and on tackling antimicrobial resistance, an important driver of the condition.”

The study authors analyzed annual sepsis incidence and mortality trends from 1990 through 2017 and found improving rates. In 1990, there were an estimated 60.2 million sepsis cases and 15.7 million deaths; in 2017, incidence had dropped 19% to 48.9 million cases and deaths had dropped 30% to 11.0 million.

The most common underlying cause of sepsis-related death in both 1990 and 2017 was lower respiratory infection.

“So what is the solution? Well, to start with it’s basic public health infrastructure. “Vaccines, making sure everyone has access to a toilet and clean drinking water, adequate nutrition for children, and maternal health care would address a lot of these cases,” says Rudd, who also is a critical care physician.

“But sepsis is still a problem here in the US, where it is the number one killer of hospital patients. Everyone can reduce their odds of developing it by getting the flu shot, and the pneumonia vaccine when appropriate. Beyond that, we need to do a better job preventing hospital-acquired infections and chronic diseases, like diabetes, that make people more susceptible to infections.”

The Bill & Melinda Gates Foundation, the National Institutes of Health, the British Columbia Children’s Hospital Foundation, the Wellcome Trust, and the Fleming Fund supported the work.

Source: University of Pittsburgh