Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study.,The Lancet

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Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study.
The Lancet ( IF 98.4 ) Pub Date : 2020-01-18 , DOI: 10.1016/s0140-6736(19)32989-7
Kristina E Rudd ₁ , Sarah Charlotte Johnson ₂ , Kareha M Agesa ₂ , Katya Anne Shackelford ₂ , Derrick Tsoi ₂ , Daniel Rhodes Kievlan ₁ , Danny V Colombara ₂ , Kevin S Ikuta ₃ , Niranjan Kissoon ₄ , Simon Finfer ₅ , Carolin Fleischmann-Struzek ₆ , Flavia R Machado ₇ , Konrad K Reinhart ₈ , Kathryn Rowan ₉ , Christopher W Seymour ₁ , R Scott Watson ₁₀ , T Eoin West ₁₁ , Fatima Marinho ₁₂ , Simon I Hay ₁₃ , Rafael Lozano ₁₃ , Alan D Lopez ₁₄ , Derek C Angus ₁ , Christopher J L Murray ₁₃ , Mohsen Naghavi ₁₃

Affiliation

Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.
Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia.
Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil.
Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Anästhesiologie mit Sp operative Intensivmeidzin, Charité University Medical Center Berlin, Berlin, Germany.
Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK; Faculty of Public Health & Policy linked to the Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
Department of Pediatrics, University of Washington, Seattle, WA, USA; Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, USA.
Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA.
Institute of Advanced Studies, University of São Paulo, São Paulo, Brazil.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; University of Melbourne, Melbourne, QLD, Australia.

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.

中文翻译：

1990-2017 年全球、区域和国家败血症发病率和死亡率：全球疾病负担研究分析。

背景脓毒症是由于宿主对感染的反应失调而导致的危及生命的器官功能障碍。它被认为是造成健康损失的主要原因，但脓毒症全球负担的数据有限。作为一种由潜在感染引起的综合征，脓毒症不属于标准全球疾病负担、伤害和危险因素研究 (GBD) 估计的一部分。准确的估计对于告知和监测卫生政策干预、资源分配和临床治疗举措非常重要。我们使用 GBD 2017 的数据估计了全球、区域和国家败血症的发病率和死亡率。方法我们使用来自 1.09 亿个人死亡记录的多种死因数据来计算 282 名患者中每人与败血症相关的死亡率。 2017 年 GBD 死亡的根本原因。使用混合效应线性回归对全球各地按 GBD 潜在原因划分的脓毒症相关死亡百分比进行了建模。通过将建模的特定原因分数应用于 GBD 2017 年死因估计，估计了每个年龄组、性别、地点、GBD 原因和年份（1990-2017 年）的脓毒症相关死亡率。我们使用 8·700 万份医院记录的数据来计算院内败血症相关的病死率，并按潜在的 GBD 病因进行分层。使用线性回归对每个地点的院内脓毒症相关病死率进行建模，并通过将模型病死率应用于脓毒症相关死亡率估计来估计脓毒症发病率。研究结果 2017 年，全球估计记录了 48·900 万（95% 不确定性区间 [UI] 38·9-62·9）脓毒症事件病例，其中 11·0 百万（10·1-12·0）脓毒症相关病例据报道，死亡人数占全球死亡人数的 19·7% (18·2-21·4)。从 1990 年到 2017 年，年龄标准化脓毒症发病率下降了 37·0% (95% UI 11·8-54·5)，死亡率下降了 52·8% (47·7-57·5)。脓毒症发病率和死亡率各不相同各地区的情况基本相同，其中撒哈拉以南非洲、大洋洲、南亚、东亚和东南亚的负担最高。解释尽管年龄标准化发病率和死亡率下降，脓毒症仍然是全世界健康损失的主要原因，并且在撒哈拉以南非洲地区的健康相关负担特别高。资助比尔及梅琳达·盖茨基金会、美国国立卫生研究院、匹兹堡大学、不列颠哥伦比亚省儿童医院基金会、威康信托基金会和弗莱明基金会。

更新日期：2020-01-17

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