Loading...
Global, regional, and national sepsis incidence and mortality, 1990–2021: a systematic analysis
Citations
Altmetric:
Video URL
Date
2025-10-21
Author
Chung, Erin, Hsu, Rebecca L, Araki, Daniel T, Gershberg Hayoon, Anna, Davis Weaver, Nicole, Swetschinski, Lucien R, Wool, Eve E, Han, Chieh, Mestrovic, Tomislav, Ikuta, Kevin S, Abbas, Nasir, Abbasi, Madineh, Abd ElHafeez, Samar, Abdisa, Wakgari Mosisa, Abdoun, Meriem, Abdullahi, Auwal, Abebe, Mesfin, Abejew, Asrat Agalu, Abie, Alemwork, Abolhassani, Hassan, Abukhadijah, Hana J, Achore, Meshack, Adams, Lisa C, Adedokun, Kamoru Ademola, Adesola, Ridwan Olamilekan, Adiga, Usha, Adnani, Qorinah Estiningtyas Sakilah, Afolabi, Aanuoluwapo Adeyimika, Agyemang-Duah, Williams, Ahadi, Mahsa, Ahmad, Aqeel, Ahmed, Gasha Salih, Ahmed, Haroon, Ahmed, Meqdad Saleh, Ahmed, Syed Anees, Akter, Ema, Alansari, Amani, Albashtawy, Mohammed, Aleidi, Shereen M, Alemnew, Fentahun, Algammal, Abdelazeem M, Alhumaydhi, Fahad A, Ali, Mohammed Usman, Ali, Rafat, Ali, Syed Shujait, Al-Iede, Montaha, Al-Jabi, Samah W, Al-Marwani, Sabah, Alniss, Hasan Yaser, Alosta, Mohammad R, Alqudimat, Mohammad R, Al-Qudimat, Ahmad Rajeh, Alrawashdeh, Ahmad, Alrimawi, Intima, Alrousan, Sahel Majed, Alshahrani, Najim Z, Alvis-Guzman, Nelson, Al-Worafi, Yaser Mohammed, Aly, Hany, Al-Zubayer, Md. Akib, Anagnostakis, Filippos, Anvari, Saeid, Anwer, Razique, Anyasodor, Anayochukwu Edward, Arooj, Mahwish, Aryntayeva, Nurila, Ashraf, Tahira, Asmare, Zelalem, Assefa, Redeat Libanos, Atreya, Alok, Atta, Julie Alaere, Aujayeb, Avinash, Azargoonjahromi, Ali, Aziz, Sadat Abdulla, Azzolino, Domenico, Badran, Alaa Aboelnour, Balakrishnan, Senthilkumar, Balcha, Wondu Feyisa, Banik, Rajon, Bante, Simachew Animen, Barqawi, Hiba Jawdat, Barrow, Amadou, Basharat, Zarrin, Bassat, Quique, Bastan, Mohammad-Mahdi, Batiha, Abdul-Monim, Bauckneht, Matteo, Belayneh, Asnake Gashaw, Belge Bilgin, Gokce, Bello, Umar Muhammad, Benzian, Habib, Berihun, Abiye Assefa, Bhardwaj, Nikha, Bhargava, Ashish, Bhaskar, Sonu, Bhutta, Zulfiqar A, Bitar, Ahmad Naoras, Borhany, Hamed, Borran, Mina, Bouaoud, Souad, Bui, Linh Phuong, Busch, Felix, Bustanji, Yasser, Cámera, Luis Alberto, Capodici, Angelo, Chakraborty, Chiranjib, Chapuma, Chikondi Isabel Joana, Chaurasia, Akhilanand, Chen, Hana, Chong, Bryan, Chopra, Hitesh, Choudhari, Sonali Gajanan, Chu, Dinh-Toi, Chutiyami, Muhammad, Cosma, Claudia, Cruz-Martins, Natalia, Dabbagh, Ali, Dai, Xiaochen, D'Anna, Lucio, Davletov, Dimash, Dehadrai, Aniket, Desai, Hardik Dineshbhai, Devanbu, Vinoth Gnana Chellaiyan, Dhania, Narender K, Dhingra, Sameer, Di Pumpo, Marcello, Dohare, Sushil, D'Oria, Mario, Dorostkar, Fariba, Dowou, Robert Kokou, Dresse, Menayit Tamrat, Edinur, Hisham Atan, Eighaei Sedeh, Ashkan, Ekundayo, Temitope Cyrus, El Arab, Rabie Adel, Eldegwi, Marwa, Elhadi, Muhammed, Elkannishy, Sherif, Elnaem, Mohamed Hassan, Elshaer, Mohammed, Elsohaby, Ibrahim, Eltaha, Chadi, Emami Zeydi, Amir, Eva, Fahima Nasrin, Fadavian, Heidar, Fagbamigbe, Adeniyi Francis, Farooq, Syed Muhammad Yousaf, Farsakoury, Rana, Fazylov, Timur, Fekadu, Ginenus, Femoe, Ulrich Membe, Fleischmann-Struzek, Carolin, Foroutan, Behzad, Foschi, Matteo, Gadanya, Muktar A, Gajdács, Márió, Ganesan, Balasankar, Garcia-Azorin, David, Garlasco, Jacopo, Gautam, Rupesh K, Gebre, Feven Sahle, Gebremeskel, Teferi Gebru, George, Nsikakabasi Samuel, Gete, Kalab Yigermal, Ghaffari, Kazem, Ghamarnejad, Omid, Gharaibeh, Lobna, Ghoba, Sama, Gholamrezanezhad, Ali, Gil, Artyom Urievich, Girombelli, Alessandro, Golinelli, Davide, Golmohammadi, Melika, Grada, Ayman, Guarducci, Giovanni, Gudeta, Mesay Dechasa, Gulati, Amit, Gunawardane, Damitha Asanga, Gupta, Anish Kumar, Gutiérrez-Murillo, Roberth Steven, Hadaro, Tesfahun Simon, Halil, Hassen Mosa Mosa, Harboe, Zitta Barrella, Hasan, Md Kamrul, Hawes, Stephen E, Hay, Simon I, Hemmati, Mehdi, Hiraike, Yuta, Holla, Ramesh, Holler, Jon Gitz, Hostiuc, Sorin, Hsieh, Vivian Chia-rong, Huang, Junjie, Hussein, Ali M, Hussein, Nawfal R, Ibrayeva, Anel, Ikiroma, Adalia, Ilic, Irena M, Ilic, Milena D, Ismail, Faisal, Ismoldayev, Yerlan, Jaiswal, Vikash, Jalloh, Mohamed, Javidnia, Javad, Jeong, Seogsong, Jomehzadeh, Nabi, Jyoti, Anupam, Kakkar, Ashish Kumar, Kalra, Sanjay, Kamal, Manoj, Kankam, Samuel Berchi, Karajizadeh, Mehrdad, Karpinski, Tomasz M, Kasraei, Hengameh, Kebede, Fekadu Abera, Khan, Maseer, Khatatbeh, Haitham, Khatatbeh, Moawiah Mohammad, Kheradmand, Daniel, Khosla, Atulya Aman, Khosravi, Sepehr, Khosrowjerdi, Mahmood, Khurana, Sakshi, Kim, Kwanghyun, Kissoon, Niranjan, Kolahi, Ali-Asghar, Koulmane Laxminarayana, Sindhura Lakshmi, Kretchy, James-Paul, Kuddus, Mohammed, Kuitunen, Ilari, Kumar, Jogender, Kumar, Sanjay Kirshan, Kumar, Tushar, Kumar, Vijay, Kundu, Satyajit, Kurmanova, Almagul, Kurpad, Krishna Prasad, Kytö, Ville, Lai, Hanpeng, Lakanova, Balzhan, Landires, Iván, Le, Huyen Thi Thanh, Ledda, Caterina, Leivaditis, Vasileios, Lin, Jialing, Liu, Vincent, Llanaj, Erand, Lubinda, Jailos, Lucchetti, Giancarlo, Lytras, Miltiadis D, Lytvyak, Ellina, Ma, Kevin Sheng-Kai, Mabrok, Mahmoud, Mahmood, Nozad Hussein, Makram, Abdelrahman M, Mannethodi, Kamaruddeen, Manzoor, Shaista, Markazi Moghadam, Hamed, Martins-Melo, Francisco Rogerlândio, Marzo, Roy Rillera, Marzouk, Sammer, Mathangasinghe, Yasith, Mayaki, Suleiman, Mehto, Subhash, Menezes, Godfred Antony, Mengstie, Leweyehu Alemaw, Mettananda, Sachith, Mohammad, Taj, Mohammadi, Abdolreza, Mohammadzadeh, Ibrahim, Mohan, Syam, Mohsenzadeh, Amin, Mokdad, Ali H, Mollaei, Amirabbas, Monasta, Lorenzo, Moni, Mohammad Ali, Morsy, Mahmoud M, Mozahheb Yousefi, Kimia, Mulatu, Sileshi, Mulita, Francesk, Murray, Christopher J L, Musa, Sani, Mushtaq, Ali, Mustafa, Ghulam, Muthu, Sathish, Naga Rajeev, L, Naghavi, Pirouz, Naik, Hiten, Najmuldeen, Hastyar Hama Rashid, Nashwan, Abdulqadir J, Nassar, Mahmoud, Nazri-Panjaki, Athare, Nega, Amanuel Tebabal, Negoi, Ionut, Negoi, Ruxandra Irina, Nepal, Samata, Netsere, Henok Biresaw, Ngabonziza, Jean Claude Semuto, Nikravangolsefid, Nasrin, Noor, Syed Toukir Ahmed, Nri-Ezedi, Chisom Adaobi, Nyande, Felix Kwasi, Oancea, Bogdan, Okeke, Sylvester Reuben, Okesanya, Olalekan John, Olorukooba, Abdulhakeem Abayomi, Olusanya, Bolajoko Olubukunola, Onyeaghala, Chizaram A, Opitz, Marcel, Ortiz-Prado, Esteban, Osborne, Augustus, Othman, Elham H, Otorkpa, Oche Joseph, Ouyahia, Amel, Owusu, Irene Amoakoh, Oyelade, Tope, Palicz, Tamás, Panda, Sujogya Kumar, Pantazopoulos, Ioannis, Parekh, Utsav, Parvar, S. Yasamin, Pasovic, Maja, Passera, Roberto, Patil, Shankargouda, Patoulias, Dimitrios, Pawar, Shubhadarshini, Perera, Nilanka, Petcu, Ionela-Roxana, Pham, Hoang Nhat, Pirera, Edoardo, Poddighe, Dimitri, Poluru, Ramesh, Pourghazi, Farzad, Puvvula, Jagadeesh, Qamar, Muhammad Usman, Qasim, Nameer Hashim, Qian, Gangzhen, Rabiee, Navid, Rahman, Fryad Majeed, Rahmoune, Hakim, Raimondo, Diego, Rajabi, Erta, Ramadan, Mahmoud Mohammed, Ramasamy, Chitra, Ramasamy, Shakthi Kumaran, Randolph, Adrienne G, Ranjbar Noei, Fatemeh, Rao, Sowmya J, Rathish, Devarajan, Rawaf, David Laith, Reyes, Luis Felipe, Rezaeian, Mohsen, Robles Aguilar, Gisela, Rodriguez, Jefferson Antonio Buendia, Roever, Leonardo, Rohilla, Ravi, Rony, Moustaq Karim Khan, Rosenblad, Emily, Rout, Himanshu Sekhar, Saad, Aly M A, Saad, Mohamed Omar, Saeed, Mohd, Saeed, Umar, Saha, Nondo, Sahoo, Pragyan Monalisa, Saki, Morteza, Salaroli, Luciane B, Samodra, Yoseph Leonardo, Saravi, Babak, Sarode, Gargi Sachin, Sarode, Sachin C, Sartorius, Benn, Sathian, Brijesh, Sattarpour, Reza, Saxena, Juhi, Sayeed, Abu, Schinckus, Christophe, Schumacher, Austin E, Sengupta, Pallav, Serban, Dragos, Seyoum, Abebaw B, Shahab, Muhammad, Shahrahmani, Fatemeh, Shahwan, Moyad Jamal, Shakeri, Alireza, Shakoor, Sadia, Shamshirgaran, Mohammad Ali, Shan, Dan, Sharifan, Amin, Sharifi Rad, Javad, Sharma, Vishal, Shastry, Rajesh P, Shawahna, Ramzi, Shetty, Mahabalesh, Shittu, Aminu, Shivarov, Velizar, Shool, Sina, Simpson, Colin R, Singh, Harmanjit, Singh, Kalpana, Singh, Puneetpal, Singh, Surendra, Sinha, Ratnesh, Siyoum, Dagne Feleke, Skryabin, Valentin Yurievich, Soliman, Ahmed M, Soliman, May Mohamed Sherif, Soliman, Noha Salah, Soraneh, Soroush, Srichawla, Bahadar S, Srivastava, Devin Bailey, Stanaway, Jeffrey D, Stergachis, Andy, Subramaniyan, Vetriselvan, Suleiman, Auwal Garba, Sun, Jing, Szarpak, Lukasz, Talukdar, Jhalok Ronjan, Tamuzi, Jacques Lukenze, Tan, Ker-Kan, Temsah, Mohamad-Hani, Thangaraju, Pugazhenthan, Thangavelu, Lakshmi, Thayumana Sundaram, Mahalakshmi, Ticoalu, Jansje Henny Vera, Tiruye, Tenaw Yimer, Tleshev, Madi, Tomo, Sojit, Tovani-Palone, Marcos Roberto, Tran, Quynh Thuy Huong, Tran, Thang Huu, Tran Minh Duc, Nguyen, Tuglo, Lawrence Sena, Ullah, Saeed, Umar, Umar Muhammad, Upadhyay, Era, Usman, Jibrin Sammani, Uzunçibuk, Hande, Vaithinathan, Asokan Govindaraj, Venkatesh, Balasubramanian, Verma, Anjul, Veroux, Massimiliano, Verras, Georgios-Ioannis, Villafañe, Jorge Hugo, Villani, Leonardo, Vizzielli, Giuseppe, Waheed, Yasir, Wang, Yanzhong, West, T. Eoin, Wicaksana, Anggi Lukman, Wickramasinghe, Dakshitha Praneeth, Wireko, Andrew Awuah, Yadav, Mukesh Kumar, Yadav, Vikas, Yasufuku, Yuichi, Yaya, Sanni, Ye, Pengpeng, Yezli, Saber, Yin, Dehui, Yon, Dong Keon, Yuce, Deniz, Zaghampour, Manijeh, Zakham, Fathiah, Zamagni, Giulia, Zamora, Nelson, Zastrozhin, Michael, Zheng, David X, Zhumagaliuly, Abzal, Zumla, Alimuddin, Zyoud, Sa'ed H, Naghavi, Mohsen, Gray, Authia P
Collections
Files
Abstract
BackgroundThe global burden of sepsis, a life-threatening dysregulated host response to infection leading to organ dysfunction, remains challenging to quantify. We aimed to comprehensively estimate the global, regional, and national burden of sepsis, including the impact of the COVID-19 pandemic and underlying causes of sepsis-related deaths with co-occurring infectious syndromes. MethodsWe used multiple cause-of-death, hospital, minimally invasive tissue sampling, and linked death certificate and hospital record data representing 149 million deaths, covering 4290 location-years with mortality estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to capture explicit and implicit sepsis cases and deaths. We estimated age-location-sex-specific fractions of sepsis-related deaths from 195 underlying causes of death and 22 infectious syndromes from 1990 to 2021 using binomial logistic regression models, and estimated sepsis-related deaths using GBD cause-specific mortality estimates. Using 250 million hospital admissions and 7·82 million deaths from hospital data, representing 1310 location-years, we modelled case fatality rates by use of binomial logistic regression, applied to sepsis death estimates to estimate sepsis incidence by age, location, and year. FindingsIn 2021, we estimated 166 million (95% uncertainty interval 135–201) sepsis cases and 21·4 million (20·3–22·5) all-cause sepsis-related deaths globally, representing 31·5% of total global deaths. Sepsis-related deaths decreased between 1990 and 2019, followed by a surge in 2020 and 2021. As of 2021, individuals aged 15 years and older experienced increases across incidence (230%) and mortality (26·3%) since 1990. Those aged 70 years and older had the highest sepsis-related mortality in 2021 (9·28 million [8·74–9·86] deaths). Sepsis-related deaths from infectious underlying causes decreased from 11·8 million (11·1–12·5) in 1990 to 8·34 million (7·72–9·01) in 2019, then increased by 86·4% to 15·5 million (14·7–16·4) in 2021. Sepsis-related mortality due to non-infectious underlying causes of death increased from 4·69 million (4·35–5·05) in 1990 to 5·81 million (5·40–6·25) in 2021; the leading non-infectious underlying causes of death with sepsis were stroke, chronic obstructive pulmonary disease, and cirrhosis. In 2021, bloodstream infections inclusive of HIV and malaria (3·08 million [2·83–3·35]) and lower respiratory infections inclusive of COVID-19 (11·33 million [1·20–1·47]) were the most prominent infectious syndromes complicating sepsis-related deaths from non-infectious underlying causes, representing a consistent trend since 1990. InterpretationThe global burden of sepsis increased in 2020 and 2021, reversing progress from 1990. Sepsis incidence and mortality increased in people aged 15 years and older, especially those aged 70 years and older, and as a complication of non-infectious underlying causes of death such as stroke, primarily through bloodstream infections and lower respiratory infections. The global burden of sepsis is substantial, and sepsis is increasingly a complication of non-infectious causes of death. FundingGates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.