From Associated to Attributable Burden of Sepsis

Abstract

Sepsis is a dysregulated host response to infection that leads to life-threatening end organ dysfunction and has historically been excluded from global health estimates. In 2020 global estimates for sepsis were produced as an analysis of the Global Burden of Disease Study (GBD) but these estimates only described the number of deaths where sepsis occurred, not the deaths attributable to sepsis. In this study we describe methods for estimating the attributable burden of sepsis to produce estimates on the number of deaths and years of life lost (YLL) attributable to sepsis. We utilize a population attributable fraction (PAF) approach with two components, proportion of population exposed to sepsis and the excess risk of death associated with sepsis admission compared to hospital admission without sepsis. Using this PAF method we estimate 3.0 million (95% UI 2.4 – 3.7) deaths and 192.2 million (95% UI 160.9 – 224.6) YLLs attributable to sepsis in 2017. In 1990 there were an estimated 5.2 million (95% UI 4.4 – 6.1) deaths and 429 million (95% UI 362 – 496) YLLs attributable to sepsis. There was significant heterogeneity across age and region with more than half of all sepsis attributable deaths occurring in children under 5 and a 28-fold difference in age-standardized sepsis death rates between the high-income super-region and Sub-Saharan Africa in 2017. The disparities in deaths and YLLs attributable to sepsis across regions is more pronounced than previously appreciated and should further increase the urgency of infection prevention interventions, infrastructure building, and sepsis treatment trials in LMIC.