Sepsis represents a substantial health care burden, and there is limited epidemiologic
information about the demography of sepsis or about the temporal changes in its incidence
and outcome. We investigated the epidemiology of sepsis in the United States, with
specific examination of race and sex, causative organisms, the disposition of patients,
and the incidence and outcome.
We analyzed the occurrence of sepsis from 1979 through 2000 using a nationally representative
sample of all nonfederal acute care hospitals in the United States. Data on new cases
were obtained from hospital discharge records coded according to the International
Classification of Diseases, Ninth Revision, Clinical Modification.
Review of discharge data on approximately 750 million hospitalizations in the United
States over the 22-year period identified 10,319,418 cases of sepsis. Sepsis was more
common among men than among women (mean annual relative risk, 1.28 [95 percent confidence
interval, 1.24 to 1.32]) and among nonwhite persons than among white persons (mean
annual relative risk, 1.90 [95 percent confidence interval, 1.81 to 2.00]). Between
1979 and 2000, there was an annualized increase in the incidence of sepsis of 8.7
percent, from about 164,000 cases (82.7 per 100,000 population) to nearly 660,000
cases (240.4 per 100,000 population). The rate of sepsis due to fungal organisms increased
by 207 percent, with gram-positive bacteria becoming the predominant pathogens after
1987. The total in-hospital mortality rate fell from 27.8 percent during the period
from 1979 through 1984 to 17.9 percent during the period from 1995 through 2000, yet
the total number of deaths continued to increase. Mortality was highest among black
men. Organ failure contributed cumulatively to mortality, with temporal improvements
in survival among patients with fewer than three failing organs. The average length
of the hospital stay decreased, and the rate of discharge to nonacute care medical
facilities increased.
The incidence of sepsis and the number of sepsis-related deaths are increasing, although
the overall mortality rate among patients with sepsis is declining. There are also
disparities among races and between men and women in the incidence of sepsis. Gram-positive
bacteria and fungal organisms are increasingly common causes of sepsis.
Copyright 2003 Massachusetts Medical Society