Global, regional, and national sepsis incidence and mortality, 1990–2021: a systematic analysis
Authia P Gray(University of Washington), Erin Chung(University of Washington), Rebecca Hsu(University of Washington), Daniel T Araki(University of Washington), Anna Gershberg Hayoon(University of Washington), Nicole Davis Weaver(University of Washington), Lucien R Swetschinski(University of Washington), Eve E Wool(University of Washington), Chieh Han(University of Washington), Tomislav Meštrović(University of Washington), Kevin S Ikuta(West Los Angeles College), Nasir Abbas(City University of Hong Kong), Madineh Abbasi(Tabriz University of Medical Sciences), Samar Abd ElHafeez(Alexandria University), Wakgari Mosisa Abdisa(Jimma University), Meriem Abdoun(University Ferhat Abbas of Setif), Auwal Abdullahi(Bayero University Kano), Mesfin Abebe(Dilla University), Asrat Agalu Abejew(Bahir Dar University), Alemwork Abie(Bahir Dar University), Hassan Abolhassani(Karolinska Institutet), Hana J Abukhadijah(Hamad Medical Corporation), Meshack Achore(Hofstra University), Lisa C. Adams(Palo Alto University), Kamoru A. Adedokun(Roswell Park Comprehensive Cancer Center), Ridwan Olamilekan Adesola(University of Missouri), Usha Adiga(Apollo Institute of Medical Sciences & Research), Qorinah Estiningtyas Sakilah Adnani(Padjadjaran University), Aanuoluwapo Adeyimika Afolabi, Williams Agyemang‐Duah(Queen's University), Mahsa Ahadi(Shiraz University of Medical Sciences), Aqeel Ahmad(Shaqra University), G Ahmed(University of Human Development), Haroon Ahmed(COMSATS University Islamabad), Meqdad Saleh Ahmed(University of Duhok), Syed Anees Ahmed(East Carolina University), Ema Akter(International Centre for Diarrhoeal Disease Research), Amani N. Alansari(Hamad Medical Corporation), Mohammed ALBashtawy(Al al-Bayt University), Shereen M. Aleidi(University of Jordan), Fentahun Alemnew(Bahir Dar University), Abdelazeem M. Algammal(Suez Canal University), Fahad A. Alhumaydhi(Qassim University), Mohammed Usman Ali(Hong Kong Polytechnic University), Rafat Ali(Jamia Millia Islamia), Syed Shujait Ali(University of Swat), Montaha Al‐Iede(University of Jordan), Samah W. Al‐Jabi(An-Najah National University), Sabah Al-Marwani, Hasan Y. Alniss(University of Sharjah), Mohammad R. Alosta(Zarqa University), Mohammad R Alqudimat(American University of the Middle East), Ahmad R. Al‐Qudimat(Hamad Medical Corporation), Ahmad Alrawashdeh(Jordan University of Science and Technology), Intima Alrimawi(Georgetown University), Sahel Majed Alrousan(Ministry of Finance), Najim Z. Alshahrani(University of Jeddah), Nelson Alvis‐Guzmán(University of Cartagena), Yaser Mohammed Al‐Worafi(Sana'a University), Hany Aly(Cleveland Clinic), Md. Akib Al‐Zubayer(International Centre for Diarrhoeal Disease Research), Filippos Anagnostakis(Laboratoire d’Imagerie Biomédicale), Saeid Anvari(Guilan University of Medical Sciences), Razique Anwer(Imam Mohammad ibn Saud Islamic University), Anayochukwu Edward Anyasodor(Charles Sturt University), Mahwish Arooj(University of Lahore), Nurila Aryntayeva(Al-Farabi Kazakh National University), Tahira Ashraf(Pakistan Health Research Council), Zelalem Asmare(Woldia University), Redeat Libanos Assefa(Johns Hopkins University), Alok Atreya(Nepal Medical College Teaching Hospital), J. Atta(The University of Texas Health Science Center at Houston), Avinash Aujayeb(Northumbria Healthcare NHS Foundation Trust), Ali Azargoonjahromi(Shiraz University of Medical Sciences), Sadat Abdulla Aziz(Cihan University-Erbil), Domenico Azzolino(Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico), Alaa Aboelnour Badran(Damietta University), Senthilkumar Balakrishnan(Uttarakhand State Council for Science and Technology), Wondu Feyisa Balcha(Bahir Dar University), Rajon Banik(International Centre for Diarrhoeal Disease Research), Simachew Animen Bante(Bahir Dar University), Hiba Jawdat Barqawi(University of Sharjah), Amadou Barrow(University of the Gambia), Zarrin Basharat, Quique Bassat(Institució Catalana de Recerca i Estudis Avançats), Mohammad‐Mahdi Bastan(Iran University of Medical Sciences), Abdul‐Monim Batiha(King Khalid University), Matteo Bauckneht(University of Genoa), Asnake Gashaw Belayneh(Bahir Dar University), Gokce Belge Bilgin(Mayo Clinic in Arizona), Umar Muhammad Bello(Glasgow Caledonian University), Habib Benzian(York University), Abiye Assefa Berihun(Johns Hopkins University), Nikha Bhardwaj(All India Institute of Medical Sciences Jodhpur), Ashish Bhargava(Wayne State University), Sonu Bhaskar(National Cerebral and Cardiovascular Center), Zulfiqar A Bhutta(Aga Khan University), Ahmad Naoras Bitar(Sultan Zainal Abidin University), Hamed Borhany(Shahid Beheshti University of Medical Sciences), Mina Borran(Shahrekord University of Medical Sciences), Souad Bouaoud(University Ferhat Abbas of Setif), Linh Phuong Bui(Center for Creative Initiatives in Health and Population), Felix Busch(University of Cambridge), Yasser Bustanji(University of Jordan), Luis Alberto Cámera(Hospital Italiano de Buenos Aires), Angelo Capodici(Scuola Superiore Sant'Anna), Chiranjib Chakraborty(Hallym University), Chikondi Chapuma(University of Liverpool), Akhilanand Chaurasia(King George's Medical University), Hana Chen(Curtin University Sarawak), Bryan Chong(National University of Singapore), Hitesh Chopra(Chitkara University), Sonali G Choudhari(Jawaharlal Nehru Medical College), Dinh‐Toi Chu(Institute for Reproductive and Family Health), Muhammad Chutiyami(University of Technology Sydney), Claudia Cosma(University of Florence), Natália Martins(i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto), Ali Dabbagh(Shahid Beheshti University of Medical Sciences), Xiaochen Dai(University of Washington), Lucio D’Anna(Imperial College London), Dimash Davletov(Kazakh National Medical University), Aniket Dehadrai(Northwestern University), Hardik Dineshbhai Desai(Physical Research Laboratory), Vinoth Gnana Chellaiyan Devanbu(Chettinad Academy of Research and Education), Narender K Dhania(University of Delhi), Sameer Dhingra(National Institute of Pharmaceutical Education and Research), Marcello Di Pumpo(Università Cattolica del Sacro Cuore), Sushil Dohare(Jazan University), Mario D’Oria(University of Trieste), Fariba Dorostkar(Iran University of Medical Sciences), Robert Kokou Dowou(University of Health and Allied Sciences), Menayit Tamrat Dresse(University of Pittsburgh), Hisham Atan Edinur(Hospital Universiti Sains Malaysia), Ashkan Eighaei Sedeh(University of Massachusetts Amherst), Temitope Cyrus Ekundayo(Olusegun Agagu University of Science and Technology), Rabie Adel El Arab(Saad Specialist Hospital), Marwa Eldegwi(Kafrelsheikh University), Muhammed Elhadi(Korea University), Sherif Elkannishy(Mansoura University), Mohamed Hassan Elnaem(University of Ulster), Mohammed Elshaer(Mansoura University), Ibrahim Elsohaby(City University of Hong Kong), Chadi Eltaha(The University of Texas at Dallas), Amir Emami Zeydi(Mazandaran University of Medical Sciences), Fahima Nasrin Eva(North South University), Heidar Fadavian(Tarbiat Modares University), Adeniyi Francis Fagbamigbe(University of Ibadan), Syed Muhammad Yousaf Farooq, Rana Farsakoury(Hamad Medical Corporation), Timur Fazylov(Kazakh National Medical University), Ginenus Fekadu(City University of Hong Kong), Ulrich Membe Femoe(Tulane University), Carolin Fleischmann-Struzek(Friedrich Schiller University Jena), Behzad Foroutan(Iranshahr University), Matteo Foschi(University of L'Aquila), Muktar A Gadanya(Aminu Kano Teaching Hospital), Márió Gajdács(University of Szeged), Balasankar Ganesan(Health Education and Training Institute), David García‐Azorín(Universidad de Valladolid), Jacopo Garlasco(University of Verona), Rupesh K. Gautam(Advanced Materials and Processes Research Institute), Feven Sahle Gebre(Addis Ababa University), Teferi Gebru Gebremeskel(Flinders University), Nsikakabasi Samuel George(Jagiellonian University), Kalab Yigermal Gete(Bahir Dar University), Kazem Ghaffari(Imam Khomeini Hospital), Omid Ghamarnejad(Klinikum Saarbrücken), Lobna Gharaibeh(Amman Arab University), Sama Ghoba(University of Washington), Ali Gholamrezanezhad(University of Southern California), Artyom Gil, Alessandro Girombelli(Ospedale SS. Annunziata), Davide Golinelli(Azienda Unità Sanitaria Locale Della Romagna), Melika Golmohammadi(Research Institute for Endocrine Sciences), Ayman Grada(Lake County Forest Preserves), Giovanni Guarducci(University of Ferrara), Mesay Dechasa(Haramaya University), Amit Gulati(Icahn School of Medicine at Mount Sinai), Damitha Asanga Gunawardane(University of Peradeniya), Anish Kumar Gupta(Max Super Speciality Hospital), Roberth Steven Gutiérrez-Murillo(Pontifícia Universidade Católica do Rio Grande do Sul), Tesfahun Simon Hadaro(Arba Minch University), Hassen Mosa Halil(Wollo University), Zitta Barrella Harboe(University of Copenhagen), Md. Kamrul Hasan(Impact), Stephen E. Hawes(University of Washington), Simon I Hay(University of Washington), Mehdi Hemmati(Georgetown University), Yuta Hiraike(The University of Tokyo), Ramesh Holla(Manipal Academy of Higher Education), Jon Gitz Holler(University of Copenhagen), Sorin Hostiuc(Carol Davila University of Medicine and Pharmacy), Vivian Chia‐Rong Hsieh(China Medical University), Junjie Huang(Chinese University of Hong Kong), A. M. Hussein(Koya University), Nawfal R Hussein(University of Zakho), Anel Ibrayeva(Kazakh National Medical University), Adalia Ikiroma, Irena M Ilic(University of Belgrade), Milena Ilić(University of Kragujevac), Faisal Ismail(National Center for Disease Control), Yerlan Ismoldayev(Kazakh National Medical University), Vikash Jaiswal(Larkin Community Hospital), Mohamed Jalloh(Medical College of Wisconsin), Javad Javidnia(Mazandaran University of Medical Sciences), Seogsong Jeong(Korea University), Nabi Jomehzadeh(Hamedan University of Medical Sciences), Anupam Jyoti(Parul University), Ashish Kumar Kakkar(Post Graduate Institute of Medical Education and Research), Sanjay Kalra(Chandigarh University), Manoj Kamal(All India Institute of Medical Sciences Jodhpur), Samuel Berchi Kankam(Harvard University), Mehrdad Karajizadeh(Shiraz University of Medical Sciences), Tomasz M. Karpiński(Poznan University of Medical Sciences), Hengameh Kasraei(Iran University of Medical Sciences), Fekadu Abera Kebede(Ethiopian Public Health Institute), Maseer Khan(Jazan University), Haitham Khatatbeh(Yarmouk University), Moawiah Khatatbeh(Yarmouk University), Daniel Kheradmand(Mashhad University of Medical Sciences), Atulya Aman Khosla(Beaumont Hospital, Royal Oak), Sepehr Khosravi(Center for Non-Communicable Diseases), Mahmood Khosrowjerdi(University of Inland Norway), Sakshi Khurana(Columbia University Irving Medical Center), Kwanghyun Kim(Creighton University), Niranjan Kissoon(University of British Columbia), Ali‐Asghar Kolahi(Shahid Beheshti University of Medical Sciences), Sindhura Lakshmi Koulmane Laxminarayana(Manipal Academy of Higher Education), James‐Paul Kretchy(Central University), Mohammed Kuddus(University of Ha'il), Ilari Kuitunen(University of Eastern Finland), Jogender Kumar(Post Graduate Institute of Medical Education and Research), Sanjay Kirshan Kumar(Abu Dhabi Falcon Hospital), Tushar Kumar(Rajendra Institute of Medical Sciences), Vijay Kumar(Manipal Hospital), Satyajit Kundu(Griffith University), Аlmagul Kurmanova(Al-Farabi Kazakh National University), Krishna Prasad Kurpad(University of Illinois Urbana-Champaign), Ville Kytö(University of Turku), Hanpeng Lai(Northern Jiangsu People's Hospital), Balzhan Lakanova(Kazakh National Medical University), Iván Landires(Ministerio de Salud Pública), Hang Tran Thi Le(University of Medicine and Pharmacy at Ho Chi Minh City), Caterina Ledda(University of Catania), Vasileios Leivaditis(University of Patras), Jialing Lin(UNSW Sydney), Vincent Liu(Kaiser Permanente), Erand Llanaj(Deutsches Diabetes-Zentrum e.V.), Jailos Lubinda(The Kids Research Institute Australia), Giancarlo Lucchetti(Universidade Federal de Juiz de Fora), Miltiadis D. Lytras(Effat University), Ellina Lytvyak(Tulane University), Kevin Sheng-Kai(Center for Global Health), Mahmoud Mabrok(Suez Canal University), Nozad Hussein Mahmood(Cihan University-Erbil), Abdelrahman M Makram(October 6 University), Kamaruddeen Mannethodi(Hamad Medical Corporation), Shaista Manzoor(University of Sharjah), Hamed Markazi Moghadam(Leibniz University Hannover), Francisco Rogerlândio Martins‐Melo(Universidade Federal do Ceará), Roy Rillera Marzo(Monash University Malaysia), Sammer Marzouk(Northwestern University), Yasith Mathangasinghe(Monash University), Suleiman Mayaki(Liverpool School of Tropical Medicine), Subhash Mehto(Indian Institute of Technology Dharwad), Godfred Antony Menezes(Manipal Academy of Higher Education), Leweyehu Alemaw Mengstie(Debre Berhan University), Sachith Mettananda(University of Kelaniya), Taj Mohammad(Jamia Millia Islamia), Abdolreza Mohammadi(Tehran University of Medical Sciences), Ibrahim Mohammadzadeh(Shahid Beheshti University of Medical Sciences), Syam Mohan(ASA College), Amin Mohsenzadeh(Tehran University of Medical Sciences), Ali H. Mokdad(University of Washington), Amirabbas Mollaei(Golestan University), Lorenzo Monasta(IRCCS Materno Infantile Burlo Garofolo), Mohammad Ali Moni(Charles Sturt University), Mahmoud M Morsy(October 6 University), Kimia Mozahheb Yousefi(Iran University of Medical Sciences), Sileshi Mulatu(Bahir Dar University), Francesk Mulita(University of Thessaly), Christopher J L Murray(University of Washington), Sani Musa(Ahmadu Bello University), Ali Mushtaq(Cleveland Clinic), Ghulam Mustafa(Shaqra University), Sathish Muthu(Orthopaedic Research Group), L Naga Rajeev(Dr. D. Y. Patil Medical College, Hospital and Research Centre), Pirouz Naghavi(University of Illinois Urbana-Champaign), Hiten Naik(University of British Columbia), Hastyar Hama Rashid Najmuldeen(Cihan University-Erbil), Abdulqadir J. Nashwan(Hamad Medical Corporation), Mahmoud Nassar(University of Vermont), Athare Nazri-Panjaki(Zahedan University of Medical Sciences), Amanuel Tebabal Nega(Bahir Dar University), Ionuţ Negoi(Carol Davila University of Medicine and Pharmacy), Ruxandra Irina Negoi(Carol Davila University of Medicine and Pharmacy), Samata Nepal(Nepal Medical College Teaching Hospital), Henok Biresaw Netsere(Bahir Dar University), Jean Claude Semuto Ngabonziza(Rwanda Biomedical Center), Nasrin Nikravangolsefid(Mayo Clinic), Syed Toukir Ahmed Noor(Shahjalal University of Science and Technology), Chisom Adaobi Nri-Ezedi(Nnamdi Azikiwe University), Felix Kwasi Nyande(University of Health and Allied Sciences), Bogdan Oancea(University of Bucharest), Sylvester Reuben Okeke(The University of Sydney), Olalekan John Okesanya(University of Thessaly), Abdulhakeem Abayomi Olorukooba(Ahmadu Bello University), Bolajoko O. Olusanya(Centre for Healthy Start Initiative), Chizaram Onyeaghala(University of Port Harcourt Teaching Hospital), Marcel Opitz(Essen University Hospital), Esteban Ortiz‐Prado(Universidad de Las Américas), Augustus Osborne(University of Sierra Leone), Elham H. Othman(Applied Science Private University), Oche Joseph Otorkpa(Texila American University), Amel Ouyahia(University Ferhat Abbas of Setif), Irene Amoakoh Owusu(University of Ghana), Tope Oyelade(University College London), Tamás Palicz(Semmelweis University), Sujogya Kumar Panda(Siksha O Anusandhan University), Ioannis Pantazopoulos(University of Bern), Utsav Parekh(All India Institute of Medical Sciences), Seyedeh Yasamin Parvar(Shiraz University of Medical Sciences), Maja Pasovic(University of Washington), Roberto Passera(Azienda Ospedaliera Citta' della Salute e della Scienza di Torino), SV Patil(Roseman University of Health Sciences), Dimitrios Patoulias(Aristotle University of Thessaloniki), Shubhadarshini Pawar(Cedars-Sinai Medical Center), Nilanka Perera(University of Sri Jayewardenepura), Ionela-Roxana Petcu(Bucharest University of Economic Studies), Hoang Nhat Pham(University of Arizona), Edoardo Pirera(University of Palermo), Dimitri Poddighe(VinUniversity), Ramesh Poluru(INCLEN Trust International), Farzad Pourghazi(Mayo Clinic in Florida), Jagadeesh Puvvula(University of Pennsylvania), Muhammad Usman Qamar(University of Geneva), Nameer Hashim Qasim(Kyiv National University of Construction and Architecture), Gangzhen Qian, Navid Rabiee(Saveetha University), Fryad Majeed Rahman(American University of Iraq Sulaimani), Hakim Rahmoune(University Ferhat Abbas of Setif), Diego Raimondo(Azienda USL di Bologna), Erta Rajabi(Tehran University of Medical Sciences), Mahmoud M. Ramadan(Mansoura University), C. Ramasamy(Siddhartha Medical College), Shakthi Kumaran Ramasamy(Stanford University), Adrienne G. Randolph(Boston Children's Hospital), Fatemeh Ranjbar Noei(Golestan University), Sowmya J Rao(MNR Dental College and Hospital), Devarajan Rathish(Rajarata University of Sri Lanka), David Laith Rawaf(Imperial College London), Luis Felipe Reyes(Universidad de La Sabana), Mohsen Rezaeian(Rafsanjan University of Medical Sciences), Gisela Robles Aguilar(University of Oxford), Jefferson Antonio Buendía(Universidad de Antioquia), Leonardo Roever(Universidade de São Paulo), Ravi Rohilla(Government Medical College), Moustaq Karim Khan Rony(ActionAid), Emily Rosenblad(University of Washington), Himanshu Sekhar Rout(Utkal University), Aly M A Saad(Zagazig University), Mohamed Saad(Hamad Medical Corporation), Mοhd Saeed(University of Ha'il), Umar Saeed(Near East University), Nondo Saha(International Centre for Diarrhoeal Disease Research), Pragyan Monalisa Sahoo(Utkal University), Morteza Saki(Ahvaz Jundishapur University of Medical Sciences), Luciane Bresciani Salaroli(Universidade Federal do Espírito Santo), Yoseph Leonardo Samodra(National Taiwan University), Babak Saravi(Düsseldorf University Hospital), Gargi S. Sarode(Dr. D.Y. Patil Vidyapeeth, Pune), Sachin C. Sarode(Dr. D.Y. Patil Vidyapeeth, Pune), Benn Sartorius(The University of Queensland), Brijesh Sathian(Hamad Medical Corporation), Reza Sattarpour(Tabriz University of Medical Sciences), Juhi Saxena(Parul University), Md. Abu Sayeed(International Centre for Diarrhoeal Disease Research), Chrıstophe Schınckus(University of the Fraser Valley), Austin E Schumacher(University of Washington), Pallav Sengupta(Gulf Medical University), Dragoş Şerban(Carol Davila University of Medicine and Pharmacy), Abebaw B Seyoum(University of Virginia), Muhammad Shahab(Guangdong Medical College), Fatemeh Shahrahmani(Mashhad University of Medical Sciences), Moyad Shahwan(Ajman University), Alireza Shakeri(Shahid Beheshti University of Medical Sciences), Sadia Shakoor(Aga Khan University), Mohammad Ali Shamshirgaran(Shahid Bahonar University of Kerman), Dan Shan(Ollscoil na Gaillimhe – University of Galway), Amin Sharifan(Universität für Weiterbildung Krems), Javad Sharifi‐Rad(Korea University), Vishal Sharma(Panjab University), Rajesh P. Shastry(Yenepoya University), Ramzi Shawahna(An-Najah National University), Mahabalesh Shetty(Nitte University), Aminu Shittu(Usmanu Danfodiyo University), Velizar Shivarov(Medical University Pleven), Sina Shool(Iran University of Medical Sciences), Colin R Simpson(Victoria University of Wellington), Harmanjit Singh(Government Medical College and Hospital), Kalpana Singh(Hamad Medical Corporation), Puneetpal Singh(Punjabi University), Surendra Singh(Government Medical College), Ratnesh Sinha(ESIC Hospital), Dagne Feleke Siyoum(Passaic County Community College), Valentin Yurievich Skryabin(Royal College of Psychiatrists), Ahmed M. Soliman(Kafrelsheikh University), May Mohamed Sherif Soliman(Cairo University), Noha Salah Soliman(Cairo University), Soroush Soraneh(Urmia University), Bahadar S. Srichawla(University of Massachusetts Chan Medical School), Devin Bailey Srivastava(Northwestern University), Jeffrey D Stanaway(University of Washington), Andy Stergachis(University of Washington), Vetriselvan Subramaniyan(Sunway University), Auwal Garba Suleiman(Ahmadu Bello University), Jing Sun(Griffith University), Łukasz Szarpak(John Paul II Catholic University of Lublin), Jhalok Ronjan Talukdar(McMaster University), Jacques Lukenze Tamuzi(Stellenbosch University), Ker‐Kan Tan(National University of Singapore), Mohamad‐Hani Temsah(King Saud University), Pugazhenthan Thangaraju(All India Institute of Medical Sciences Raipur), Lakshmi Thangavelu(Saveetha University), Mahalakshmi Thayumana Sundaram(St. John's National Academy of Health Sciences), Jansje Henny Vera Ticoalu(Sam Ratulangi University), Tenaw Yimer Tiruye(University of South Australia), Madi Tleshev(Kazakh National Medical University), Sojit Tomo(All India Institute of Medical Sciences Jodhpur), Marcos Roberto Tovani‐Palone(Saveetha University), Quynh Thuy Huong Tran(Kansai Medical University), Thang Huu Tran(University of Massachusetts Dartmouth), Nguyen Tran Minh Duc(Shiga University of Medical Science), Lawrence Sena Tuglo(University of Health and Allied Sciences), Saeed Ullah(University of Karachi), Umar Muhammad Umar(Ahmadu Bello University), Era Upadhyay, Jibrin Sammani Usman(Hong Kong Polytechnic University), Hande Uzunçıbuk(Trakya University), Asokan Govindaraj Vaithinathan(University of Bahrain), Balasubramanian Venkatesh(UNSW Sydney), Anjul Verma(Texas Tech University), Massimiliano Veroux(University of Catania), Georgios‐Ioannis Verras(University of Southampton), Jorge Hugo Villafañe(Universidad Europea de Madrid), Leonardo Villani(Università Cattolica del Sacro Cuore), Giuseppe Vizzielli(University of Udine), Yasir Waheed(Széchenyi István University), Yanzhong Wang(King's College London), T. Eoin West(University of Washington), Anggi Lukman Wicaksana(Universitas Gadjah Mada), Dakshitha Praneeth Wickramasinghe(University of Colombo), Wireko Andrew Awuah(Continental (Germany)), Mukesh Yadav(Central University of Punjab), Vikas Yadav(ICMR National Institute for Research in Environmental Health), Yuichi Yasufuku(The University of Osaka), Sanni Yaya(The George Institute for Global Health), Pengpeng Ye(UNSW Sydney), Saber Yezli(King Faisal Specialist Hospital & Research Centre), Dehui Yin(Xuzhou Medical College), Dong Keon Yon(Kyung Hee University), Deniz Yüce(Hacettepe University Hospital), Manijeh Zaghampour(Islamic Azad University, Tehran), Fathiah Zakham(Hodeidah University), Giulia Zamagni(IRCCS Materno Infantile Burlo Garofolo), Nelson Rodríguez(Universidad Católica Bolivia San Pablo), Михаил Сергеевич Застрожин(University of California, San Francisco), David X. Zheng(Massachusetts General Hospital), Abzal Zhumagaliuly(Kazakh National Medical University), Alimuddin Zumla(UCL Biomedical Research Centre), Sa’ed H. Zyoud(An-Najah National University), Mohsen Naghavi(University of Washington)
Cited by 80Open Access
Abstract
BACKGROUND: The 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. METHODS: We 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. FINDINGS: In 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. INTERPRETATION: The 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. FUNDING: Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.