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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2022

Open Access 01-12-2022 | Septicemia | Research

Frequency and mortality of sepsis and septic shock in China: a systematic review and meta-analysis

Authors: Yan-Cun Liu, Ying Yao, Mu-Ming Yu, Yu-Lei Gao, An-Long Qi, Tian-Yu Jiang, Zhen-Sen Chen, Song-Tao Shou, Yan-Fen Chai

Published in: BMC Infectious Diseases | Issue 1/2022

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Abstract

Background

Sepsis, a life-threatening organ dysfunction induced by infection, is a major public health problem. This study aimed to evaluate the frequency and mortality of sepsis, severe sepsis, and septic shock in China.

Methods

We Searched MEDLINE, Embase, PubMed, and Cochrane Library from 1 January 1992 to 1 June 2020 for studies that reported on the frequency and mortality of sepsis, severe sepsis, and septic shock conducted in China. Random effects models were performed to estimate the pooled frequency and mortality of sepsis, severe sepsis, and septic shock.

Results

Our search yielded 846 results, of which 29 studies were included in this review. The pooled frequency of sepsis was estimated at 33.6% (95% CI 25.9% to 41.3%, I2 = 99.2%; p < 0.001), and the pooled mortality of sepsis, severe sepsis and septic shock were 29.0% (95% CI 25.3%–32.8%, I2 = 92.1%; p = 0), 31.1% (95% CI 25.3% to 36.9%, I2 = 85.8%; p < 0.001) and 37.3% (95% CI 28.6%–46.0%, I2 = 93.5%; p < 0.001). There was significant heterogeneity between studies. With a small number of included studies and the changing definition of sepsis, trends in sepsis frequency and mortality were not sufficient for analysis. Epidemiological data on sepsis in the emergency department (ED) are severely lacking, and more research is urgently needed in this area is urgently needed.

Conclusions

Our findings indicated that the frequency and mortality of sepsis and septic shock in China were much higher than North America and Europe countries. Based on our results, an extremely high incidence and mortality of sepsis and septic shock in China's mainland requires more healthcare budget support. Epidemiological data on sepsis and septic shock in ED are severely lacking, and more research is urgently needed in this area.
Trial registration This systematic review was conducted according to the statement of the preferred reporting items for systematic review (PROSPERO CRD42021243325) and the meta-analysis protocols (PRISMA-P).
Appendix
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Literature
1.
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–247.PubMedPubMedCentralCrossRef
2.
Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200–11.PubMedPubMedCentralCrossRef
3.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–55.PubMedCrossRef
4.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637.PubMedCrossRef
5.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801–10.PubMedPubMedCentralCrossRef
6.
Bauer M, Gerlach H, Vogelmann T, Preissing F, Stiefel J, Adam D. Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019- results from a systematic review and meta-analysis. Crit Care. 2020;24(1):239.PubMedPubMedCentralCrossRef
7.
Vincent JL, Jones G, David S, Olariu E, Cadwell KK. Frequency and mortality of septic shock in Europe and North America: a systematic review and meta-analysis. Crit Care. 2019;23(1):196.PubMedPubMedCentralCrossRef
8.
Xie J, Wang H, Kang Y, Zhou L, Liu Z, Qin B, et al. The epidemiology of sepsis in Chinese ICUs: a national cross-sectional survey. Crit Care Med. 2020;48(3):e209–18.PubMedCrossRef
9.
Weng L, Zeng XY, Yin P, Wang LJ, Wang CY, Jiang W, et al. Sepsis-related mortality in China: a descriptive analysis. Intensive Care Med. 2018;44(7):1071–80.PubMedCrossRef
10.
Zhou J, Tian H, Du X, Xi X, An Y, Duan M, et al. Population-based epidemiology of sepsis in a subdistrict of Beijing. Crit Care Med. 2017;45(7):1168–76.PubMedCrossRef
11.
Chen XC, Yang YF, Wang R, Gou HF, Chen XZ. Epidemiology and microbiology of sepsis in mainland China in the first decade of the 21st century. IJID. 2015;31:9–14.PubMed
12.
13.
14.
Dong R, Tian H, Zhou J, Weng L, Hu X, Peng J, et al. External validity of adult sepsis event’s simplified eSOFA criteria: a retrospective analysis of patients with confirmed infection in China. Ann Intensive Care. 2020;10(1):14.PubMedPubMedCentralCrossRef
15.
Tan B, Wong JJ, Sultana R, Koh J, Jit M, Mok YH, et al. Global case-fatality rates in pediatric severe sepsis and septic shock: a systematic review and meta-analysis. JAMA Pediatr. 2019;173(4):352–62.PubMedPubMedCentralCrossRef
16.
Li XM, Zhang FJ. Emergency department crowding delayed antibiotics but did not increased mortality for sepsis? Ann Emerg Med. 2019;74(4):606–7.PubMedCrossRef
17.
18.
19.
Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34(1):15–21.PubMedCrossRef
20.
21.
Investigators P, Rowan KM, Angus DC, Bailey M, Barnato AE, Bellomo R, et al. Early, goal-directed therapy for septic shock—a patient-level meta-analysis. N Engl J Med. 2017;376(23):2223–34.CrossRef
22.
Cheng B, Xie G, Yao S, Wu X, Guo Q, Gu M, et al. Epidemiology of severe sepsis in critically ill surgical patients in ten university hospitals in China. Crit Care Med. 2007;35(11):2538–46.PubMedCrossRef
23.
Yang Y, Liu L, Zhao B, Li MQ, Wu B, Yan Z, et al. Relationship between adrenal function and prognosis in patients with severe sepsis. Chin Med J (Engl). 2007;120(18):1578–82.CrossRef
24.
Xie GH, Fang XM, Fang Q, Wu XM, Jin YH, Wang JL, et al. Impact of invasive fungal infection on outcomes of severe sepsis: a multicenter matched cohort study in critically ill surgical patients. Crit Care. 2008;12(1):R5.PubMedPubMedCentralCrossRef
25.
Chen Y, Li C. Prognostic significance of brain natriuretic peptide obtained in the ED in patients with SIRS or sepsis. Am J Emerg Med. 2009;27(6):701–6.PubMedCrossRef
26.
Li ZQ, Xi XM, Luo X, Li J, Jiang L. Implementing surviving sepsis campaign bundles in China: a prospective cohort study. Chin Med J (Engl). 2013;126(10):1819–25.
27.
Wu J, Zhou L, Liu J, Ma G, Kou Q, He Z, et al. The efficacy of thymosin alpha 1 for severe sepsis (ETASS): a multicenter, single-blind, randomized and controlled trial. Crit Care. 2013;17(1):R8.PubMedPubMedCentralCrossRef
28.
Wang D, Zhong X, Huang D, Chen R, Bai G, Li Q, et al. Functional polymorphisms of interferon-gamma affect pneumonia-induced sepsis. PLoS ONE. 2014;9(1): e87049.PubMedPubMedCentralCrossRef
29.
Xu Q, Yan J, Cai G, Chen J, Li L, Hu C. Effect of two volume responsiveness evaluation methods on fluid resuscitation and prognosis in septic shock patients. Chin Med J (Engl). 2014;127(3):483–7.
30.
Yin Q, Liu B, Chen Y, Zhao Y, Li C. Prognostic value of the International Society on Thrombosis and Haemostasis scoring system for overt disseminated intravascular coagulation in emergency department sepsis. Infection. 2014;42(4):629–37.PubMedCrossRef
31.
Zhou J, Qian C, Zhao M, Yu X, Kang Y, Ma X, et al. Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China. PLoS ONE. 2014;9(9): e107181.PubMedPubMedCentralCrossRef
32.
Luo JC, Qiu XH, Pan C, Xie JF, Yu T, Liu L, et al. Increased cardiac index attenuates septic acute kidney injury: a prospective observational study. BMC Anesthesiol. 2015;15:22.PubMedPubMedCentralCrossRef
33.
Wu C, Wang X, Yu W, Tian F, Liu S, Li P, et al. Hypermetabolism in the initial phase of intensive care is related to a poor outcome in severe sepsis patients. Ann Nutr Metab. 2015;66(4):188–95.PubMedCrossRef
34.
Li Y, Zhang X, Lin P, Qiu H, Wei J, Cao Y, et al. Effects of Shenfu Injection in the treatment of septic shock patients: a multicenter, controlled, randomized, open-label trial. Evid Based Complement Alternat Med. 2016;2016:2565169.PubMedPubMedCentral
35.
Lu CX, Qiu T, Tong HS, Liu ZF, Su L, Cheng B. Peripheral T-lymphocyte and natural killer cell population imbalance is associated with septic encephalopathy in patients with severe sepsis. Exp Ther Med. 2016;11(3):1077–84.PubMedPubMedCentralCrossRef
36.
Cheng B, Li Z, Wang J, Xie G, Liu X, Xu Z, et al. Comparison of the performance between sepsis-1 and sepsis-3 in ICUs in China: a retrospective multicenter study. Shock. 2017;48(3):301–6.PubMedPubMedCentralCrossRef
37.
Wang X, Li S. Effect of small-dose levosimendan on mortality rates and organ functions in Chinese elderly patients with sepsis. Clin Interv Aging. 2017;12:917–21.PubMedPubMedCentralCrossRef
38.
Yan J, Zhou X, Hu B, Gong S, Yu Y, Cai G, et al. Prognostic value of left ventricular-arterial coupling in elderly patients with septic shock. J Crit Care. 2017;42:289–93.PubMedCrossRef
39.
Huang Z, Jiang H, Cui X, Liang G, Chen Y, Wang T, et al. Elevated serum levels of lipoproteinassociated phospholipase A2 predict mortality rates in patients with sepsis. Mol Med Rep. 2018;17(1):1791–8.PubMed
40.
Zhou Q, Wang M, Li S, Zhang J, Ma Q, Ding Y, et al. Impact of body mass index on survival of medical patients with sepsis: a prospective cohort study in a university hospital in China. BMJ Open. 2018;8(9): e021979.PubMedPubMedCentralCrossRef
41.
Liu ZM, Chen J, Kou Q, Lin Q, Huang X, Tang Z, et al. Terlipressin versus norepinephrine as infusion in patients with septic shock: a multicentre, randomised, double-blinded trial. Intensive Care Med. 2018;44(11):1816–25.PubMedCrossRef
42.
Jiang J, Liang QL, Liu LH, Cai SQ, Du ZY, Kong JL, et al. Septic pulmonary embolism in China: clinical features and analysis of prognostic factors for mortality in 98 cases. BMC Infect Dis. 2019;19(1):1082.PubMedPubMedCentralCrossRef
43.
Liang J, Li Z, Dong H, Xu C. Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit: a single-center, retrospective cohort study of 905 patients. Medicine (Baltimore). 2019;98(42): e17592.CrossRef
44.
Xing X, Zhi Y, Lu J, Lei S, Huang L, Zhu M, et al. Traditional Chinese medicine bundle therapy for septic acute gastrointestinal injury: a multicenter randomized controlled trial. Complement Ther Med. 2019;47: 102194.PubMedCrossRef
45.
Xue M, Xie J, Liu L, Huang Y, Guo F, Xu J, et al. Early and dynamic alterations of Th2/Th1 in previously immunocompetent patients with community-acquired severe sepsis: a prospective observational study. J Transl Med. 2019;17(1):57.PubMedPubMedCentralCrossRef
46.
Zhang Z, Bokhari F, Guo Y, Goyal H. Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission. Emerg Med J. 2019;36(2):82–7.PubMed
47.
Zhao J, He Y, Xu P, Liu J, Ye S, Cao Y. Serum ammonia levels on admission for predicting sepsis patient mortality at D28 in the emergency department: A 2-center retrospective study. Medicine (Baltimore). 2020;99(11): e19477.CrossRef
Metadata
Title
Frequency and mortality of sepsis and septic shock in China: a systematic review and meta-analysis
Authors
Yan-Cun Liu
Ying Yao
Mu-Ming Yu
Yu-Lei Gao
An-Long Qi
Tian-Yu Jiang
Zhen-Sen Chen
Song-Tao Shou
Yan-Fen Chai
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2022
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-022-07543-8

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