Deaths from sepsis around the world are twice as high as previously thought, with babies and small children in poorer countries at greatest risk, a major study has revealed.
There were almost 50 million sepsis cases worldwide and 11 million deaths in 2017, according to US researchers writing in the Lancet medical journal. Sepsis, an overcharged response by the body to infection, is associated with one in five deaths worldwide, they say.
By comparison, the World Health Organisation estimated there were 9.6 million deaths from cancer in 2018.
The new estimates come from an analysis of data in the Global Burden of Disease study run by the Institute of Health Metrics and Evaluation at the University of Washington in Seattle. The leap in numbers comes from an attempt to quantify what is happening in low and middle-income countries, where there is little data and children are worst affected. “More than half of all sepsis cases worldwide in 2017 occurred among children,” says the paper. Nearly 3 million died; many were under a month old.
“We are alarmed to find sepsis deaths are much higher than previously estimated, especially as the condition is both preventable and treatable,” said Dr Mohsen Naghavi, a senior author on the study and professor of health metrics sciences at the Institute.
He called for more focus on preventing sepsis among newborns through access to vaccines, clean water and other hygiene measures against infection, as well as action to tackle antimicrobial resistance, which he said was “an important driver of the condition”. Many infections are no longer easily treatable because bacteria and viruses have evolved to overpower some antibiotics.
The leading cause of sepsis was diarrhoeal disease and the leading cause of sepsis-related deaths was pneumonia.
“Watching a baby die of a disease that could have been prevented with basic public health measures really sticks with you,” said the lead author, Dr Kristina E Rudd, an assistant professor in Pitt’s Department of Critical Care Medicine.
The increase in cases they had found was not surprising, she said. “We are finally able to access data for children for areas of the world and groups of young children for which we had the least data previously.”
In high-income countries, by contrast, “we find similar or in some cases slightly lower levels of sepsis than previously,” she said. Most of those who developed sepsis already had a disease such as cancer or had had a stroke, which led to the infection causing sepsis.
The development of sepsis is preventable if the infection is caught early, with appropriate antibiotics and good-quality affordable and convenient medical care.
Prof Mervyn Singer, from the Bloomsbury Institute of Intensive Care Medicine at University College London, pointed out that the coding of sepsis in medical records is always problematic, because it is tied to infections and other medical conditions. Although the study says there are 47,860 sepsis cases in the UK, he and colleagues showed in a previous Lancet study that only 13,455 are recorded as having been admitted into an intensive care unit in England.
Deaths related to sepsis are far higher in the developing world. “In developed countries it’s more about age, frailty and underlying comorbidity [other medical conditions]. So patients here generally die ‘with’ rather than ‘of’ sepsis,” he said.
Dr Ron Daniels, the chief executive of the Global Sepsis Alliance and the UK Sepsis Trust, said: “Sepsis is now known to claim more lives than cancer. Whilst not all deaths from sepsis are preventable through earlier intervention, this reinforces the call to all UN member states to continue to implement national action plans on this prevalent and deadly condition. If we don’t urgently take steps to slow antibiotic resistance and develop new agents, then even with improved healthcare this death toll may begin to rise.”