Incidence and mortality of hospital- and ICU-treated sepsis: results from an updated and expanded systematic review and meta-analysis

C Fleischmann-Struzek, L Mellhammar, N Rose, A Cassini, K E Rudd, P Schlattmann, B Allegranzi, K Reinhart, C Fleischmann-Struzek, L Mellhammar, N Rose, A Cassini, K E Rudd, P Schlattmann, B Allegranzi, K Reinhart

Abstract

Purpose: To investigate the global burden of sepsis in hospitalized adults by updating and expanding a systematic review and meta-analysis and to compare findings with recent Institute for Health Metrics and Evaluation (IHME) sepsis estimates.

Methods: Thirteen electronic databases were searched for studies on population-level sepsis incidence defined according to clinical criteria (Sepsis-1, -2: severe sepsis criteria, or sepsis-3: sepsis criteria) or relevant ICD-codes. The search of the original systematic review was updated for studies published 05/2015-02/2019 and complemented by a search targeting low- or middle-income-country (LMIC) studies published 01/1979-02/2019. We performed a random-effects meta-analysis with incidence of hospital- and ICU-treated sepsis and proportion of deaths among these sepsis cases as outcomes.

Results: Of 4746 results, 28 met the inclusion criteria. 21 studies contributed data for the meta-analysis and were pooled with 30 studies from the original meta-analysis. Pooled incidence was 189 [95% CI 133, 267] hospital-treated sepsis cases per 100,000 person-years. An estimated 26.7% [22.9, 30.7] of sepsis patients died. Estimated incidence of ICU-treated sepsis was 58 [42, 81] per 100,000 person-years, of which 41.9% [95% CI 36.2, 47.7] died prior to hospital discharge. There was a considerably higher incidence of hospital-treated sepsis observed after 2008 (+ 46% compared to the overall time frame).

Conclusions: Compared to results from the IHME study, we found an approximately 50% lower incidence of hospital-treated sepsis. The majority of studies included were based on administrative data, thus limiting our ability to assess temporal trends and regional differences. The incidence of sepsis remains unknown for the vast majority of LMICs, highlighting the urgent need for improved epidemiological sepsis surveillance.

Keywords: Burden; Epidemiology; Incidence; Mortality; Sepsis.

Conflict of interest statement

KR reports grants from the Innovation Funds of the German Government, personal fees from Adrenomed Berlin, and is unpaid President for the Global Sepsis Alliance, outside of the submitted work. CFS and NR received funding from the Innovation Funds of the German Government (FKZ 01VSF17010). The other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study inclusion
Fig. 2
Fig. 2
Country-level coverage of studies on sepsis incidence
Fig. 3
Fig. 3
Random-effects meta-analysis estimators for the incidence of a hospital-treated sepsis, and b ICU-treated sepsis per 100,000 person-years
Fig. 4
Fig. 4
Random-effects meta-analysis estimators for the mortality of a hospital-treated sepsis, and b ICU-treated sepsis

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