Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study

Summary

Background 背景

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.

脓毒症是感染引起的宿主反应失调导致的致命性器官功能障碍。脓毒症是引发健康损害的重要原因，但有关全球脓毒症负担的数据非常有限。作为感染引起的一种临床综合征，脓毒症并非标准全球疾病、创伤及危险因素负担(GBD)研究的一部分。准确的估计对于卫生干预政策的制定与实施，资源分配，临床治疗等非常重要。我们采用GBD 2017的数据，对全球、地区和国家脓毒症发病率及死亡率进行了估算。

Methods 方法

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.

根据1亿9百万人死亡记录中的多死因数据，我们对GBD 2017中282种死因的每种死因，计算脓毒症相关死亡率。对全球每个地区基础GBD死因中脓毒症相关死亡的百分比采用混合效应线性回归建模。对于各年龄组、性别、地点、GBD死因及年份(1990–2017)，采用建模的死因特异性分数，根据GBD 2017死因数据计算脓毒症相关死亡率。我们使用870万人住院病例数据计算脓毒症相关住院病死率，并根据基础GBD死因分层。对于每个地区采用线性回归对脓毒症相关住院病死率建模，并将建模的病死率结合脓毒症相关死亡率数据估算脓毒症发病率。

Findings 结果

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.

在2017年，估算全球有4890万新发脓毒症病例(95% 不确定区间[UI] 38·9–62·9)，其中1100万(10·1–12·0)例脓毒症相关死亡，相当于全球所有死亡的 19·7% (18·2–21·4)。从1990年至2017年，年龄标化的脓毒症发病率降低 37·0% (95% UI 11·8–54·5)，死亡率降低 52·8% (47·7–57·5)。不同地区的脓毒症发病率与病死率差异极大，最大负担来自撒哈拉以南非洲、大洋洲、南亚、东亚和东南亚。

Interpretation 结论

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.

尽管年龄标化发病率与死亡率均降低，但脓毒症仍然是威胁全球健康的重要病因，尤其在撒哈拉以南非洲地区造成非常高的健康相关负担。

Funding 资助

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.