Challenges to Reporting the Global Trends in the Epidemiology of ICU-Treated Sepsis and Septic Shock

Abstract

It is widely believed that the epidemiology of sepsis and septic shock treated in the intensive care unit (ICU) is changing. However, quantifying changes in occurrence and outcomes of ICU-treated sepsis and septic shock are challenged by a number of factors related to study designs as well as varied local resource availability and practices. The authors conducted a structured literature review to examine contemporary studies reporting trends in the prevalence, incidence and case-fatality rates of ICU-treated sepsis and septic shock around the world and further attempted to extrapolate the recent epidemiological trends. During 2015–2020, 13 observational studies with heterogenous methodologies were published from predominantly high-income countries that examined selected cohorts with ICU-treated sepsis, sepsis with end-organ failure (previously known as severe sepsis) and septic shock. The prevalence of sepsis and sepsis-related diagnoses ranged widely from 4.7–42.2% of ICU admissions. The population incidence varied widely between 88 and 370 cases per 100,000 for sepsis and 19 and 79 cases per 100,000 for septic shock. Mean case-fatality rates (deaths per number of cases, %) reported primarily as in-hospital deaths reduced from approximately 40–50% reported in previous years, to 30–40% in the past 5 years. There was a lack of recent studies specifically examining mortality at the population level. Contemporary studies have observed wide variation in prevalence and incidence of sepsis and septic shock along with reports of static or decreasing case-fatality rates, but we are not able to make generalised commentary on global trends from the results of existing studies. Further data from ICUs in low-income and middle-income countries is needed, and well-designed, consistent population-based studies are required in order to establish whether the burden of sepsis and septic shock is changing.