美国华盛顿大学Mohsen Naghavi团队近日取得一项新成果。经过不懈努力，他们对1990-2017年全球、地区和国家脓毒症的发病率和死亡率进行了统计分析。该项研究成果发表在2020年1月18日出版的《柳叶刀》上。

脓毒症是由于宿主对感染的反应失调而引起的危及生命的器官功能障碍，严重损害人体健康，但全球脓毒症负担数据有限。脓毒症是由潜在感染引起的综合征，不属于全球疾病、伤害和危险因素负担（GBD）研究的一部分。

但脓毒症的准确估计对于通知监测卫生政策干预、资源分配和临床治疗计划非常重要。因此，研究组采用2017年的GBD数据对全球、地区和国家的败血症发病率与死亡率进行统计分析，共统计了1.09亿份个人死亡记录的多死因数据，对282个潜在死因中与脓毒症相关的死亡率进行分析。

统计结果显示，2017年全球共记录约4890万脓毒症病例， 其中1100万例患者因脓毒症而死亡，占全球死亡人数的19.7%。1990-2017年间年龄标准化脓毒症发病率下降了37.0%，死亡率下降了52.8%。脓毒症的发病率和死亡率在不同地区间差异较大，其中撒哈拉以南非洲、大洋洲、南亚、东亚和东南亚的发病率和死亡率最高。

总之，尽管年龄标准化的脓毒症发病率和死亡率有所下降，但脓毒症仍是全世界健康威胁的主要原因，撒哈拉以南非洲脓毒症的健康负担最为沉重。

附：英文原文

Title: Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study

Author: Kristina E Rudd, Sarah Charlotte Johnson, Kareha M Agesa, Katya Anne Shackelford, Derrick Tsoi, Daniel Rhodes Kievlan, Danny V Colombara, Kevin S Ikuta, Niranjan Kissoon, Simon Finfer, Carolin Fleischmann-Struzek, Flavia R Machado, Konrad K Reinhart, Kathryn Rowan, Christopher W Seymour, R Scott Watson, T Eoin West, Fatima Marinho, Simon I Hay, Rafael Lozano, Alan D Lopez, Derek C Angus, Christopher J L Murray, Mohsen Naghavi

Issue&Volume: 2020/01/18

Abstract:

Background

Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. It is considered a major cause of health loss, but data for the global burden of sepsis are limited. As a syndrome caused by underlying infection, sepsis is not part of standard Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimates. Accurate estimates are important to inform and monitor health policy interventions, allocation of resources, and clinical treatment initiatives. We estimated the global, regional, and national incidence of sepsis and mortality from this disorder using data from GBD 2017.

Methods

We used multiple cause-of-death data from 109 million individual death records to calculate mortality related to sepsis among each of the 282 underlying causes of death in GBD 2017. The percentage of sepsis-related deaths by underlying GBD cause in each location worldwide was modelled using mixed-effects linear regression. Sepsis-related mortality for each age group, sex, location, GBD cause, and year (1990–2017) was estimated by applying modelled cause-specific fractions to GBD 2017 cause-of-death estimates. We used data for 8·7 million individual hospital records to calculate in-hospital sepsis-associated case-fatality, stratified by underlying GBD cause. In-hospital sepsis-associated case-fatality was modelled for each location using linear regression, and sepsis incidence was estimated by applying modelled case-fatality to sepsis-related mortality estimates.

Findings

In 2017, an estimated 48·9 million (95% uncertainty interval [UI] 38·9–62·9) incident cases of sepsis were recorded worldwide and 11·0 million (10·1–12·0) sepsis-related deaths were reported, representing 19·7% (18·2–21·4) of all global deaths. Age-standardised sepsis incidence fell by 37·0% (95% UI 11·8–54·5) and mortality decreased by 52·8% (47·7–57·5) from 1990 to 2017. Sepsis incidence and mortality varied substantially across regions, with the highest burden in sub-Saharan Africa, Oceania, south Asia, east Asia, and southeast Asia.

Interpretation

Despite 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.

DOI: 10.1016/S0140-6736(19)32989-7

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32989-7/fulltext