Sepsis deaths may have doubled, compared with previous estimates

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Researchers from the University of Pittsburgh (PA, USA) and the University of Washington Schools of Medicine (UWSM; WA, USA) have discovered that sepsis-related deaths may have been grossly underestimated.

“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,” stated lead author Kristina Rudd (University of Pittsburgh).

“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.”

The study, recently published in The Lancet and presented at the Critical Care Reviews Meeting in Belfast (UK, 16–17 January 2019), utilized epidemiological data from the Global Burden of Disease Study, which is coordinated by the Institute of Health Metrics and Evaluation (UWSM).

An intermediate cause of death, defined as the disease or injury directly leading to death, is not regularly used in the compilation of annual statistics because it is usually prefaced with an underlying condition, which has given rise to the intermediate cause. For example, type two diabetes (underlying condition) and sepsis (intermediate cause of death).

This, in addition to previous global estimates heavily relying on data provided by hospitals from high- and middle-income countries, led to an underestimation of the global number of sepsis-related deaths.

Further data analysis from 1990–2017 revealed that sepsis incidence had reduced by 19% (from 60.2 million to 48.9 million, respectively), with sepsis deaths reducing by 30% (15.7 million to 11 million, respectively). However, these numbers are double the previous estimates, suggesting that sepsis is associated with 1 in 5 deaths, globally.

“We are alarmed to find sepsis deaths are much higher than previously estimated, especially as the condition is both preventable and treatable,” commented author Mohsen Naghavi (UWSM)

“We need renewed focus on sepsis prevention among newborns and on tackling antimicrobial resistance, an important driver of the condition.”

Rudd explained that public health infrastructure, including the availability of vaccines, safe drinking water, adequate nutrition and access to toilets, especially for children and in maternal health care facilities, could address many of the causes of sepsis.

Rudd also stated: “Sepsis is still a problem here in the US, where it is the number 1 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.

“Finally, for people in high-income countries who want to help reduce the rates of sepsis in low-income areas, we need to support research into treatments and advocate to our elected officials for the importance of supporting sepsis prevention and control efforts in low-income communities.”

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Sources: Rudd KE, Johnson SC, Agesa KM et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. The Lancet. 395(10219), 200–211 (2020); www.upmc.com/media/news/011620-rudd-global-sepsis

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