Global Sepsis Deaths Are Double Previous Estimates

Elliott Davis

Global deaths associated with sepsis are now double the previous estimates, according to a study published on Thursday, findings that researchers say can profoundly improve treatment in developing countries.

The study, led by researchers at the University of Pittsburgh and University of Washington schools of medicine, found 48.9 million global cases of sepsis and 11 million deaths in 2017, which is nearly 20% of all fatalities, according to a news release accompanying the study. The new numbers are roughly double the leading previous estimate published in 2016, says Dr. Kristina Rudd, assistant professor in the University of Pittsburgh Department of Critical Care Medicine and lead author of the study.

Sepsis is defined as "when a person's organs cease to function properly as the result of an out-of-control immune response to infection," according to the release. The researchers found that more than 40% of all cases occur in children under 5 years old.

The findings require "urgent attention," the authors wrote.

"There's a huge burden in low and middle-income countries that had never been previously quantified," says Rudd, who is also a critical care physician at the University of Pittsburgh Medical Center.

Approximately 85% of sepsis cases in 2017 occurred in countries with low or middle sociodemographic status, according to the release. Many of the countries with the highest sepsis death rates are located in Africa: the Central African Republic, Chad, South Sudan, Lesotho, Somalia and Niger. Those countries with the highest burden are "least equipped to prevent, identify or treat sepsis," the authors wrote.

"What our colleagues who live and work in those settings have been saying for decades is that clinically every single day, they're seeing a tremendous burden of sepsis," Rudd says. "So I think finally we have data to put to that experience of our colleagues. And indeed, they were right."

The countries with the lowest sepsis deaths rates include Qatar, Kuwait, Lebanon, Oman and Bahrain.

The authors also found that the number of sepsis cases and deaths worldwide have declined from 1990 to 2017. There were approximately 60 million sepsis cases and 15.7 million deaths in 1990, which dropped to nearly 49 million cases and 11 million deaths in 2017.

Rudd also notes that now, "for the first time, we have a better understanding that it's not only acute infection that is leading to sepsis, but a lot of folks, in fact, almost half of the sepsis cases, people have a chronic disease like cancer or stroke that put them directly at risk for that infection."

She adds that the findings provide opportunities to better understand "how we can target those highest risk groups in preventing the infection to begin with or do a better job of treating the sepsis once they have it."

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Achieving universal prevention and diagnosis for sepsis is a challenge, according to the World Health Organization. Rudd says it is a "work in progress," especially during the past 10 years.

"There's been a lot of conversation about whether it should be a combination of physical exams or labs or whether there might be more novel methods that could help us identify these patients," she says. "So I think that there is still a lot of future work to be done because we know that the best way to prevent death due to sepsis is to identify it early and treat people early with appropriate antibiotics. We have to be able to do that accurately."

Rudd also says that this study has implications for where research is being focused.

"This really highlights how important it is that with every single thing that we're doing, whether it's a clinical trial or an observational study, we have to be mindful of including more heterogeneous populations and more heterogeneous locations in our work," she explains. "Because if we continue to carry our research that's limited to, you know, the U.S., the U.K. and Australia, we're gonna miss the story and it's going to be wasted time and money and effort."

The research was funded by 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, according to the study. The authors noted that these organizations "had no role in study design, data collection, data analysis, data interpretation or writing of the report."

Elliott Davis is a graduate of University of Maryland's Merrill College of Journalism and is a yearlong News intern.