title: Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations.
abstract: BACKGROUND
  Reducing the global burden of sepsis, a recognized global health challenge, requires comprehensive data on the incidence and mortality on a global scale.
  
  
  OBJECTIVE
  To estimate the worldwide incidence and mortality of sepsis and identify knowledge gaps based on available evidence from observational studies.
  
  
  METHODS
  We systematically searched 15 international citation databases for population-level estimates of sepsis incidence rates and fatality in adult populations using consensus criteria and published in the last 36 years.
  
  
  RESULTS
  The search yielded 1,553 reports from 1979 to 2015, of which 45 met our criteria. A total of 27 studies from seven high-income countries provided data for metaanalysis. For these countries, the population incidence rate was 288 (95% confidence interval [CI], 215-386; τ = 0.55) for hospital-treated sepsis cases and 148 (95% CI, 98-226; τ = 0.99) for hospital-treated severe sepsis cases per 100,000 person-years. Restricted to the last decade, the incidence rate was 437 (95% CI, 334-571; τ = 0.38) for sepsis and 270 (95% CI, 176-412; τ = 0.60) for severe sepsis cases per 100,000 person-years. Hospital mortality was 17% for sepsis and 26% for severe sepsis during this period. There were no population-level sepsis incidence estimates from lower-income countries, which limits the prediction of global cases and deaths. However, a tentative extrapolation from high-income country data suggests global estimates of 31.5 million sepsis and 19.4 million severe sepsis cases, with potentially 5.3 million deaths annually.
  
  
  CONCLUSIONS
  Population-level epidemiologic data for sepsis are scarce and nonexistent for low- and middle-income countries. Our analyses underline the urgent need to implement global strategies to measure sepsis morbidity and mortality, particularly in low- and middle-income countries.
authors.affiliation: 1 Department for Anesthesiology and Intensive Care Medicine.|2 Integrated Research and Treatment Center, Center for Sepsis Control and Care.
authors.forename: Carolin
authors.initials: C
authors.lastname: Fleischmann
authors.affiliation: 3 Clinical Epidemiology, Integrated Research and Treatment Center, Center for Sepsis Control and Care, and.
authors.forename: André
authors.initials: A
authors.lastname: Scherag
authors.affiliation: 4 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Neill K J
authors.initials: NK
authors.lastname: Adhikari
authors.affiliation: 1 Department for Anesthesiology and Intensive Care Medicine.|2 Integrated Research and Treatment Center, Center for Sepsis Control and Care.
authors.forename: Christiane S
authors.initials: CS
authors.lastname: Hartog
authors.affiliation: 5 4th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece; and.
authors.forename: Thomas
authors.initials: T
authors.lastname: Tsaganos
authors.affiliation: 6 Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schlattmann
authors.affiliation: 7 Critical Care Medicine Division, Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
authors.affiliation: 1 Department for Anesthesiology and Intensive Care Medicine.|2 Integrated Research and Treatment Center, Center for Sepsis Control and Care.
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
mesh_terms: D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality
keywords: epidemiology; incidence; metaanalysis; mortality; sepsis