Sepsis rates dropping in men, but still higher than for women

Sepsis-related deaths are falling in rich countries, but mortality is still higher in men than women in all countries except Australia, Austria and New Zealand.

The study of 34 countries, presented at the annual European Society of Intensive Care Medicine conference, shows that in rich countries overall, mortality from sepsis has fallen by around a quarter in men since 1985, with a smaller reduction in women.

While some countries (namely, Finland, Iceland, Ireland and New Zealand) have made spectacular progress to improve sepsis mortality, mortality rates continue to rise in others such as Denmark, Greece and Lithuania. In both the United States and the United Kingdom, while there has been progress, these countries still have sepsis rates above the global average reported in this study.

Sepsis is the body’s overwhelming and life-threatening response to infection, which can lead to tissue damage, organ failure and death. Sepsis consistently ranks among the most fatal disease syndromes globally. Various efforts have been made to improve standards for diagnosis, management and outcome reporting but it is unclear what effect, if any, these have had on mortality rates. Understanding the burden of disease is essential for monitoring the effectiveness of international strategies to improve management of sepsis.

In this new study, Dr Justin Salciccioli, from Mount Auburn Hospital and Harvard Medical School in the USA, and Dr Matthew Komorowski, Imperial College London, UK, and colleagues assessed 30-year temporal trends in sepsis mortality globally using the WHO Mortality Database. Sepsis was defined by the International Classification of Disease (ICD) versions 9 and 10. They obtained sepsis-related, sex-specific mortality data from countries with “high usability data” from the WHO Mortality database and computed Age-Standardised Death Rates (ASDR, deaths per 100,000 population). They then generated models to assess temporal trends in sepsis mortality over the 30-year period.

A total of 34 countries were included in Europe, Australasia and North America. For men, the countries with the greatest percentage change over the observation period include Finland (- 80.9%), Iceland (-76.0%), New Zealand (-70.2%) and Ireland (-68.9%), while increases in mortality were observed in Denmark (+5.8%), Israel (+15.9%), Greece (+16.3%) and Lithuania (+39.2%). For women, the greatest percentage decreases were observed in Finland (-79.4%), Iceland (-76.6%), Bulgaria (-70.0%) and Ireland (-62.3%), and increases were observed in Denmark (+20.4%), Lithuania (+23.0%), Greece (+33.5%) and Malta (+43.0%).

Countries that might have been expected to make substantial progress over these three decades, such as the United Kingdom and the United States, saw declines below the average found in this study. The UK, for example, saw rates fall by only 17% in men and only 12% in women from 1985 to 2015.

The authors also found gender differences in mortality in almost all countries. With the exception of Australia, Austria and New Zealand, all countries had higher rates of sepsis mortality in men than in women.

The authors concluded: “Overall, we observed a decrease in reported sepsis-related mortality across the majority of analysed nations between 1985 and 2015. However, there remains significant variability between health systems with respect to trends in sepsis-related mortality and between sexes in some countries. System-level and population-level factors may contribute to these differences and additional investigations are necessary to further explain these trends.”

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