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Seattle – Sepsis is responsible for twice as many deaths worldwide as previously thought. A study in Lancet (2010; doi: 10.1016 / S0140-6736 (19) 32989-7) estimates that almost 50 million people develop sepsis each year and 11 million die from it. The sepsis would then be responsible for 1/5 of all deaths worldwide.
In previous publications of the GBD (Global Burden of Disease) study, which was initiated by the World Bank and funded by the Gates Foundation, sepsis did not appear among the world’s leading diseases and causes of death. The “systemic response of the organism to an uncontrolled infection”, according to a current definition, was seen as an intermediate stage rather than the cause of death.
However, since sepsis is an avoidable and often treatable complication, Mohsen Naghavi of the Institute for Health Metrics and Evaluation in Seattle (IHME), who performs the GBD analysis, deserves more attention.
The IHME researchers therefore re-analyzed the data pool of the GBD study to highlight the involvement of sepsis in serious illnesses and deaths. This was only possible to a limited extent, since the death certificates only gave usable information on the involvement of sepsis in 4 countries.
In the hospital statistics, only the data from 10 countries could be used. The estimates are correspondingly uncertain, especially since the share of sepsis in morbidity and mortality is highest in poorer countries, especially Africa. There was no reliable data from there. With these drawbacks, however, the study provides interesting new insights.
They show that in 2017, 48.9 million people had twice as many people with sepsis than previous estimates suggested. Nevertheless, these numbers represent a decline of almost 1/5 compared to 1990, when 60.2 million people worldwide still suffered from sepsis.
Although infection is always involved in sepsis, it was only the cause in 33.1 million cases. In the other 15.8 million, sepsis developed after a serious injury or on the basis of a non-communicable disease. In most cases, this is cancer, in the end stage of which sepsis often occurs.
Diarrheal diseases dominate among infections worldwide. In the richer countries, they rarely lead to sepsis and death. In Africa and other low-income regions, however, diarrheal disease has remained a common cause of death, especially in young children who develop and die from sepsis as a complication.
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Globally, there is therefore a first childhood disease summit with 20.3 million cases. The second disease peak occurs in older age.
Around 85% of all sepsis cases occur in low- and middle-income countries. Naghavi records the highest incidence for Mali, Niger, Chad and Nigeria with over 2,500 sepsis cases per 100,000 inhabitants annually. The richest oil / gas producing countries in the Arabian Gulf have the lowest incidence. In Qatar, fewer than 100 out of 100,000 people develop sepsis each year.
Every fifth sepsis worldwide ends with death. Naghavi puts the worldwide number of deaths at 11.0 million. Almost half of these deaths (5.11 million) occur in patients with non-communicable diseases (such as cancer), in whom death is usually unavoidable even without sepsis.
Naghavi again determines the highest death rate for sub-Saharan countries. In Chad, South Sudan and Lesotho, more than 500 out of 100,000 people die of sepsis every year. In the Central African Republic, according to the study, there are even 771 out of 100,000 inhabitants.
Naghavi believes that the health significance of sepsis should not be underestimated. Progress could be made particularly in the poorer countries, where sepsis occurs mainly as a result of infections that can usually be treated well. © warmth / aerzteblatt.de
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