There were 11 million deaths in 2017 – more than from cancer – with children in poorer countries most at risk, study finds

Deaths from sepsis around the world are twice as high as previously thought, with babies and small children in poorer countries at greatest risk, a major study has revealed.

There were almost 50m sepsis cases worldwide and 11m deaths in 2017, according to US researchers writing in the Lancet medical journal. Sepsis, an overcharged response by the body to infection, is associated with one in five deaths worldwide, they say. By comparison, the World Health Organisation estimated that there were 9.6 million deaths from cancer in 2018.

The new estimates come from an analysis of data in the Global Burden of Disease study run by the Institute of Health Metrics and Evaluation at the University of Washington in Seattle. The leap in numbers comes from an attempt to quantify what is happening in low- and middle-income countries, where there is little data and children are worst affected. “More than half of all sepsis cases worldwide in 2017 occurred among children,” says the paper. Nearly 3 million died; many were under a month old.

“We are alarmed to find sepsis deaths are much higher than previously estimated, especially as the condition is both preventable and treatable,” said Dr Mohsen Naghavi, a senior author on the study and professor of health metrics sciences at the Institute.

He called for more focus on preventing sepsis among newborns through access to vaccines, clean water and other hygiene measures against infection, as well as action to tackle antimicrobial resistance, which he said was “an important driver of the condition”. Many infections are no longer easily treatable because bacteria and viruses have evolved to overpower some antibiotics.

The leading cause of sepsis was diarrhoeal disease and the leading cause of sepsis-related deaths was pneumonia.

“Watching a baby die of a disease that could have been prevented with basic public health measures really sticks with you,” said the lead author, Dr Kristina E Rudd, an assistant professor in Pitt’s Department of Critical Care Medicine.

Quick guide What is sepsis and what causes it? Show Hide What is sepsis? Sepsis is not blood poisoning, as many people think. It's an out-of-control response of the body to infection and most common in young and old who have fragile or impaired immune systems. In severe sepsis, the immune system goes into overdrive in an attempt to fight off an infection – most commonly pneumonia – and the body’s organs shut down. Sepsis can be, but is not always, a complication of septicaemia, which is severe blood poisoning. It is difficult to diagnose and life-threatening if not caught quickly. Those who survive can suffer severe disabilities. What are the signs? It varies depending on the age of the sufferer. In children under the age of five, people should look for whether they appear “mottled, bluish or pale”, whether they are “very lethargic or difficult to wake” and if the child is “abnormally cold to touch”, says the NHS. Fast breathing, a rash that does not fade and fits or convulsions are also warning signs. In anyone older, early symptoms include: a “high temperature (fever) or low body temperature” and chills, as well as fast breathing and heart rate. Sepsis is often mistaken for flu, so sufferers are advised to seek medical help if they get those symptoms after having had an infection or an injury. How common is it? The Global Burden of Disease study says there were almost 50 million cases worldwide in 2017 and 11 million deaths – 85% of them in low and middle-income countries. It affects babies and small children most – more than 40% of deaths were in children under 5. In the UK there were nearly 48,000 adult and child cases that year. UCL experts say about 150 children die each year. What causes it? Elderly people in affluent countries with chronic conditions such as heart failure and type 2 diabetes and newborn babies in low income countries are particularly at risk from sepsis because they have weak or under-developed immune systems, which allow an infection to spread around the body. That can be any serious infection, such as flu, pneumonia, Group B strep or a hospital-acquired infection. The immune system fights back, but the chemicals it releases to fight the infection affect the entire body, causing widespread inflammation, damaging tissue and interfering with blood flow. That can lead to low blood pressure and less oxygenation of organs, which may shut down as a result.

The increase in cases they had found was not surprising, she said. “We are finally able to access data for children for areas of the world and groups of young children for which we had the least data previously.”

In high-income countries, by contrast, “we find similar or in some cases slightly lower levels of sepsis than previously,” she said. Most of those who developed sepsis already had a disease such as cancer or had had a stroke, which led to the infection causing sepsis. The development of sepsis is preventable if the infection is caught early, with appropriate antibiotics and good-quality affordable and convenient medical care.

Prof Mervyn Singer, of the Bloomsbury Institute of Intensive Care Medicine at University College London, pointed out that the coding of sepsis in medical records is always problematic, because it is tied to infections and other medical conditions. Although the study says there are 47,860 sepsis cases in the UK, he and colleagues showed in a previous Lancet study that only 13,455 were recorded as having been admitted into an intensive care unit in England.

Deaths related to sepsis are far higher in the developing world. “In developed countries it’s more about age, frailty and underlying comorbidity [other medical conditions]. So patients here generally die ‘with’ rather than ‘of’ sepsis,” he said.

Dr Ron Daniels, chief executive of the Global Sepsis Alliance and the UK Sepsis Trust, said: “Sepsis is now known to claim more lives than cancer. Whilst not all deaths from sepsis are preventable through earlier intervention, this reinforces the call to all UN member states to continue to implement national action plans on this prevalent and deadly condition. If we don’t urgently take steps to slow antibiotic resistance and develop new agents, then even with improved healthcare, this death toll may begin to rise.”