National incidence and mortality of hospitalized sepsis in China

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Abstract

Background

Sepsis is a leading cause of preventable death around the world. Population-based estimation of sepsis incidence is lacking in China. In this study, we aimed to estimate the population-based incidence and geographic variation of hospitalized sepsis in China.

Methods

We retrospectively identified hospitalized sepsis from the nationwide National Data Center for Medical Service (NDCMS) and the National Mortality Surveillance System (NMSS) by ICD-10 codes for the period from 2017 to 2019. In-hospital sepsis case fatality and mortality rate were calculated to extrapolate the national incidence of hospitalized sepsis. The geographic distribution of hospitalized sepsis incidence was examined using Global Moran's Index.

Results

We identified 9,455,279 patients with 10,682,625 implicit-coded sepsis admissions in NDCMS and 806,728 sepsis-related deaths in NMSS. We estimated that the annual standardized incidence of hospitalized sepsis was 328.25 (95% CI 315.41–341.09), 359.26 (95% CI 345.4–373.12) and 421.85 (95% CI 406.65–437.05) cases per 100,000 in 2017, 2018 and 2019, respectively. We observed 8.7% of the incidences occurred among neonates less than 1 year old, 11.7% among children aged 1–9 years, and 57.5% among elderly older than 65 years. Significant spatial autocorrelation for incidence of hospitalized sepsis was observed across China (Moran's Index 0.42, p = 0.001; 0.45, p = 0.001; 0.26, p = 0.011 for 2017, 2018, 2019, respectively). Higher number of hospital bed supply and higher disposable income per capita were significantly associated with a higher incidence of hospitalized sepsis.

Conclusion

Our study showed a greater burden of sepsis hospitalizations than previous estimated. The geographical disparities suggested more efforts were needed in prevention of sepsis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-023-04385-x.

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Most cited references 32

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The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

Mervyn Singer, Clifford S Deutschman, Christopher Warren Seymour … (2016)

Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.

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

Kristina Rudd, Sarah Charlotte Johnson, Kareha M Agesa … (2020)

Summary 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.

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Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations.

Carolin Fleischmann, André Scherag, Neill K. J. Adhikari … (2016)

Reducing the global burden of sepsis, a recognized global health challenge, requires comprehensive data on the incidence and mortality on a global scale.

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Author and article information

Contributors

Mai-geng Zhou: maigengzhou@126.com

Bin Du: dubin98@gmail.com

Journal

Journal ID (nlm-ta): Crit Care

Title: Critical Care

Publisher: BioMed Central (London )

ISSN (Print): 1364-8535

ISSN (Electronic): 1466-609X

Publication date (Electronic): 4 March 2023

Publication date PMC-release: 4 March 2023

Publication date Collection: 2023

Volume: 27

Electronic Location Identifier: 84

Affiliations

[1 ]GRID grid.506261.6, ISNI 0000 0001 0706 7839, Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, , Peking Union Medical College and Chinese Academy of Medical Sciences, ; 1 Shuai Fu Yuan, Beijing, 100730 China

[2 ]GRID grid.411472.5, ISNI 0000 0004 1764 1621, Peking University Clinical Research Institute, , Peking University First Hospital, ; Beijing, China

[3 ]GRID grid.4714.6, ISNI 0000 0004 1937 0626, Department of Medical Epidemiology and Biostatistics, , Karolinska Institute, ; Stockholm, Sweden

[4 ]GRID grid.198530.6, ISNI 0000 0000 8803 2373, National Center for Chronic and Noncommunicable Disease Control and Prevention, , Chinese Center for Disease Control and Prevention, ; 27 Nanwei Road, Beijing, 100050 China

[5 ]GRID grid.506261.6, ISNI 0000 0001 0706 7839, Medical Record Department, Peking Union Medical College Hospital, , Chinese Academy of Medical Sciences and Peking Union Medical College, ; Beijing, China

[6 ]GRID grid.11135.37, ISNI 0000 0001 2256 9319, Department of Epidemiology and Biostatistics, School of Public Health, , Peking University, ; Beijing, China

Article

Publisher ID: 4385

DOI: 10.1186/s13054-023-04385-x

PMC ID: 9985297

PubMed ID: 36870989

SO-VID: 3760808c-214a-44f6-9621-56757c78ea0a

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 8 January 2023

Date accepted : 27 February 2023

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100019018, Chinese Academy of Medical Sciences Initiative for Innovative Medicine;

Award ID: 2021-I2M-1-062

Award Recipient : Li Weng Yan Chen Shan Li Jin-min Peng Xiao-yun Hu Wei Jiang Chun-yao Wang Bin Du

Funded by: National key clinical specialty construction projects from National Health Commission

Funded by: FundRef http://dx.doi.org/10.13039/501100012166, National Key Research and Development Program of China;

Award ID: 2021YFC2500801

Award Recipient : Bin Du

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ScienceOpen disciplines: Emergency medicine & Trauma

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National incidence and mortality of hospitalized sepsis in China

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Abstract

Background

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Supplementary Information

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Irish Journal of Paramedicine

Most cited references 32

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

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

Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations.

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Cited by 20

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