Epidemiology
There is a lack of reliable sepsis incidence and prevalence data. This is due to the absence of a consistent definition for sepsis and differences in coding practice between professionals and organizations.[11] Sepsis is one of the leading causes of death in the US and globally; in 2017 the age-standardized mortality rate for sepsis in the US was estimated to be 35.1 per 100,000, and the global rate was estimated to be 148.1 per 100,000.[12] Globally, sepsis was estimated to affect 49 million people in 2017 and was related to 11 million potentially avoidable deaths.[13] In 2018, more than 1 million US Medicare beneficiaries were admitted to hospital with a sepsis diagnosis.[14]
One cohort reviewing the medical records of 568 patients admitted to six US hospitals showed sepsis was present in 52.8% of hospitalizations that culminated in death, and directly caused death in 34.9% of those patients.[15]
Some estimates of population-based incidence of sepsis are as high as 176-380 people in 100,000 per year.[16][17][18][19] However, incidence rates depend on the definition of sepsis, with rates in Canada cited as 15.7 people in 100,000 population per year requiring admission to an intensive care unit.[20]
Most epidemiologic studies find sepsis to be more common in men than in women. People aged over 65 years are particularly susceptible, with one study finding almost two-thirds of cases to be in this age group.[21]
Risk factors
Risk of sepsis is high in people with indwelling lines or catheters.[10]
Associated with an increased risk of sepsis (RR 208.7, 95% CI 142.9 to 296.3).[20]
Decreased resistance to infections, complications of diabetes, and increased surgical complications play a role (RR 5.9, 95% CI 4.4 to 7.8).[20]
Risk of sepsis is high in people who use drugs intravenously.[10]
Associated with an increased risk of sepsis (RR 5.6, 95% CI 3.8 to 8.0).[20]
Risk of sepsis is high in people with any breach of skin integrity (e.g., cuts, burns, blisters, or skin infection).[10]
Pregnancy or recent pregnancy is a risk factor for the development of sepsis.[10]
Risk of sepsis among women may be higher if they have impaired immunity, gestational diabetes, diabetes (or other comorbid condition), needed invasive procedures during pregnancy (e.g., cesarean section, forceps delivery, removal of retained products of conception), had prolonged rupture of membranes during pregnancy, had preeclampsia or postpartum hemorrhage, had multiple births, have or have been in close contact with people with group A streptococcal infection (e.g., scarlet fever), or have continued vaginal bleeding or an abnormal vaginal discharge with odor.[10][64]
May predispose to increased exposure to infections and drug-resistant pathogens (RR 2.4, 95% CI 1.2 to 5.6).[20]
Weakly associated with sepsis (RR 3.8, 95% CI 2.6 to 5.4).[20]
May be at greater risk (odds ratio [OR] 1.28, 95% CI 1.24 to 1.32).[16]
May be at increased risk (OR 1.90, 95% CI 1.80 to 2.00).[16]
Seasonal infections (e.g., respiratory infections in winter) are weakly associated with sepsis.
Sepsis is 1.4 times more likely to occur in the winter than in the fall.[28]
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