Sepsis

Abstract

Kristina Rudd and colleagues1Rudd KE Johnson SC Agesa KM et al.Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study.Lancet. 2020; 395: 200-211Summary Full Text Full Text PDF PubMed Scopus (563) Google Scholar give formidable insights into the distribution and prevalence rates of sepsis globally. We agree that use of administrative data for identification of true rates of sepsis is problematic, “leading to disparate estimates”.1Rudd KE Johnson SC Agesa KM et al.Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study.Lancet. 2020; 395: 200-211Summary Full Text Full Text PDF PubMed Scopus (563) Google Scholar To this end, we offer three observations and three practical solutions. We, clinicians, use the term sepsis loosely, often when we are simply referring to an infectious disease. International Classification of Diseases, ninth edition (ICD-9), and ICD-10 codes originated decades before the current definition of sepsis was published.2Singer M Deutschman CS Seymour CW et al.The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).JAMA. 2016; 315: 801-810Crossref PubMed Scopus (8275) Google Scholar For these reasons, the explicit ICD-9 and ICD-10 codes for sepsis are inconsistent and unreliable. We offer the following practical solutions. Explicit ICD-9 and ICD-10 codes for sepsis are best interpreted as codes for an infectious disease. The diagnosis of sepsis from administrative data should be restricted to an implicit coding method, similar to that used by the authors.1Rudd KE Johnson SC Agesa KM et al.Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study.Lancet. 2020; 395: 200-211Summary Full Text Full Text PDF PubMed Scopus (563) Google Scholar Such diagnosis requires two simultaneous diagnosis codes: one for an infectious disease and another for an acute organ dysfunction diagnosis, syndrome, sign, or intervention. This method has been published recently.3Duke GJ Moran JL Santamaria JD Pilcher D Sepsis in the new millennium–are we improving?.J Crit Care. 2020; 56: 273-280Crossref Scopus (2) Google Scholar Additionally, any method for identifying sepsis from administrative data should be validated by chart review. We agree with the authors that sole reliance on explicit sepsis codes will underestimate the true prevalence of sepsis. However, inclusion of explicit (with implicit) sepsis codes is likely to lead to an overestimate. We declare no competing interests. SepsisKristina Rudd and colleagues1 used data from more than 100 million individuals to quantify the burden of sepsis. Their alarming findings showed that, despite a decrease in incidence and mortality compared with 1990, 19·7% of global deaths in 2017 were related to sepsis. How many of the 56 million deaths in 2017 could have been preventable if sepsis had been successfully defeated? The proportion of preventable deaths is the essential quantity to draw conclusions on the potential benefit of preventive interventions. Full-Text PDF SepsisWe welcome the work of Kristina Rudd and colleagues,1 highlighting the global burden of sepsis that is high in low-income and middle-income countries (LMICs). The burden of sepsis might be reduced with novel digital solutions. Full-Text PDF Sepsis – Authors' replyWe thank Maja von Cube and colleagues, Tanca Minderhoud and colleagues, Graeme Duke and colleagues, and Meera Joshi and colleagues for their thoughtful Correspondence regarding our Article1 about the estimation of global, regional, and national sepsis incidence and mortality between 1990 and 2017. Full-Text PDF Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease StudyDespite declining age-standardised incidence and mortality, sepsis remains a major cause of health loss worldwide and has an especially high health-related burden in sub-Saharan Africa. Full-Text PDF Open AccessSepsisKristina Rudd and colleagues1 reported the global burden of sepsis incidence and mortality, which has resulted in demanding more effort to be put into reducing its incidence. However, we doubt if the focus on the term sepsis really benefits our patients. Full-Text PDF