Skip to main content

Advertisement

SpringerLink
Log in

The increase of sepsis-related mortality in Italy: a nationwide study, 2003–2015

  • Original Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The true burden of sepsis is largely unknown. Conventional underlying cause of death (UCoD) statistics largely underestimates sepsis-related mortality. This study aims to analyze all the conditions mentioned in the death certificates (multiple causes of death—MCoD) to estimate the nationwide burden of sepsis-related mortality in Italy, to investigate time trends and main comorbidities in sepsis-related deaths. All death certificates mentioning sepsis from 2003 to 2015 were analyzed. Age-standardized mortality rates were calculated for sepsis as both UCoD and MCoD, by gender and broad age groups. The ratio of the age-standardized proportions of any mention of sepsis in the presence/absence of associated chronic diseases (ASPR) was computed. The number of certificates reporting sepsis increased from 18,939 in 2003 to 49,010 in 2015 (from 3 to 8% of all deaths). The increase in sepsis mortality rates was larger for UCoD (males, + 200%; females, + 175%) than for MCoD-based figures (+ 100%; + 90%); MCoD rates remained noticeably higher than UCoD rates (2015, 87.3 per 100,000 vs. 16.3 for males; 54.9 vs. 11.8 for females). The largest increase was observed among the very elderly. The association between sepsis and chronic diseases was stronger for subjects aged less than 75 years. The increased awareness within the medical community in addition to the growing susceptible elderly population and the spread of antimicrobial resistance could have contributed to the sepsis-related mortality increase. MCoD statistics could help in recognizing sepsis not only as a clinical challenge, but also as a major public health issue.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Singer M, Deutschman CS, Warren Seymour C et al (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315(8):801–810

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Klompas M, Rhee C (2016) Sepsis and the theory of relativity: measuring a moving target with a moving measuring stick. Crit Care 20:396

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rudd KE, Delaney A, Finfer S (2017) Counting sepsis, an imprecise but improving science. JAMA 318(13):1228–1229

    Article  PubMed  Google Scholar 

  4. Rhee C, Dantes R, Epstein L et al (2017) Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. JAMA 318(13):1241–1249

    Article  PubMed  PubMed Central  Google Scholar 

  5. Epstein L, Dantes R, Magill S et al (2016) Varying estimates of sepsis mortality using death certificates and administrative codes--United States, 1999-2014. MMWR Morb Mortal Wkly Rep 65:342–345

    Article  PubMed  Google Scholar 

  6. Reinhart K, Daniels R, Kissoon N et al (2017) Recognizing sepsis as a global health priority - a WHO resolution. N Engl J Med 377:414–417

    Article  Google Scholar 

  7. Govindan S, Shapiro L, Langa KM et al (2014) Death certificates underestimate infections as proximal causes of death in the U.S. PLoS One 9(5):e97714

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Désesquelles A, Demuru E, Pappagallo M et al (2015) After the epidemiologic transition: a reassessment of mortality from infectious diseases among over-65s in France and Italy. Int J Public Health 60:961–967

    Article  PubMed  Google Scholar 

  9. El Bcheraoui C, Naghavi M, Murray CJL (2018) Sepsis as a cause of infectious disease mortality-reply. JAMA 320(8):837

    Article  PubMed  Google Scholar 

  10. Melamed A, Sorvillo FJ (2009) The burden of sepsis-associated mortality in the United States from 1999 to 2005: an analysis of multiple-cause-of-death data. Crit Care 13:R28

    Article  PubMed  PubMed Central  Google Scholar 

  11. McPherson D, Griffiths C, Williams M et al (2013) Sepsis-associated mortality in England: an analysis of multiple cause of death data from 2001 to 2010. BMJ Open 3(8):e002586

    Article  PubMed  PubMed Central  Google Scholar 

  12. Taniguchi LU, Bierrenbach AL, Toscano CM et al (2014) Sepsis-related deaths in Brazil: an analysis of the national mortality registry from 2002 to 2010. Crit Care 18:608

    Article  PubMed  PubMed Central  Google Scholar 

  13. Pechholdová M (2017) Sepsis-related mortality in the Czech Republic: multiple causes of death analysis. Epidemiol Mikrobiol Imunol 66:73–79

    PubMed  Google Scholar 

  14. Fedeli U, Piccinni P, Schievano E et al (2016) Growing burden of sepsis-related mortality in northeastern Italy: a multiple causes of death analysis. BMC Infect Dis 16:330

    Article  PubMed  PubMed Central  Google Scholar 

  15. National Institute of Statistics: Vital statistics on causes of death (2019). http://siqual.istat.it/SIQual/visualizza.do?id=5000131. Accessed 18 Feb 2019

  16. World Health Organization (1992) International statistical classification of diseases and related health problems, tenth revision (ICD-10). World Health Organization, Geneva

    Google Scholar 

  17. EUROSTAT (2013) Revision of the European standard population. Report of Eurostat’s task force - 2013 edition. EUROSTAT Methodologies & Working papers. http://ec.europa.eu/eurostat/documents/3859598/5926869/KS-RA-13-028-EN.PDF/e713fa79-1add-44e8-b23d-5e8fa09b3f8f. Accessed 18 Feb 2019

  18. Désesquelles A, Salvatore MA, Frova L et al (2010) Revisiting the mortality of France and Italy with the multiple-cause-of-death approach. Demogr Res 23(28):771–806

    Article  Google Scholar 

  19. Grande E, Zucchetto A, Suligoi B et al (2017) Multiple cause-of-death data among people with AIDS in Italy: a nationwide cross-sectional study. Popul Health Metrics 15(1):19

    Article  Google Scholar 

  20. Molbak K, Espenhain L, Nielsen J, et al (2015) Excess mortality among the elderly in European countries, December 2014 to February 2015. EuroSurveill 20(11); pii: 21065

  21. Knoop ST, Skrede S, Langeland N et al (2017) Epidemiology and impact on all-cause mortality of sepsis in Norwegian hospitals: a national retrospective study. PLoS One 12(11):e0187990

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Magliano DJ, Harding JL, Cohen K et al (2015) Excess risk of dying from infectious causes in those with type 1 and type 2 diabetes. Diabetes Care 38(7):1274–1280

    Article  PubMed  Google Scholar 

  23. Wang HE, Gamboa C, Warnock DG et al (2011) Chronic kidney disease and risk of death from infection. Am J Nephrol 34(4):330–336

    Article  PubMed  PubMed Central  Google Scholar 

  24. Fedeli U, Schievano E (2017) Increase in Parkinson’s disease-related mortality among males in Northern Italy. Park Relat Disord 40:47–50

    Article  Google Scholar 

  25. Jinno S, Lu N, Jafarzadeh SR et al (2018) Trends of hospitalization for serious infections in patients with rheumatoid arthritis in the US between 1993 and 2013. Arthritis Care Res 70(4):652–658

    Article  Google Scholar 

  26. Cohen J, Vincent JL, Adhikari NK et al (2015) Sepsis: a roadmap for future research. Lancet Infect Dis 15(5):581–614

    Article  PubMed  Google Scholar 

  27. Regione Emilia-Romagna (2007) Progetto LaSER. Lotta alla sepsi in Emilia-Romagna. http://assr.regione.emilia-romagna.it/it/servizi/pubblicazioni/dossier/doss143. Accessed 20 May 2019

  28. Regione Toscana (2013) Percorso Sepsi - Gestione della Sepsi e dello Shock Settico, Identificazione e Trattamento - Percorso Diagnostico Terapeutico Assistenziale. https://www.ars.toscana.it/percorso-sepsi.html. Accessed 20 May 2019

  29. Gagliotti C, Buttazzi R, Moro ML, et al (2016) Sorveglianza dell’antibioticoresistenza e uso di antibiotici sistemici in Emilia-Romagna. Rapporto 2015 (Surveillance of antimicrobial resistance and consumption of systemic antibiotics in Emilia-Romagna. Report 2015). Regione Emilia Romagna, Servizio Sanitario Regionale. http://assr.regione.emilia-romagna.it/it/servizi/pubblicazioni/rapporti-documenti/antibioticoresistenza-2015. Accessed 18 Feb 2019

  30. European Centre for Disease Prevention and Control (2017) Antimicrobial resistance surveillance in Europe 2015. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: European Centre for Disease Prevention and Control

  31. Cantón R, Akóva M, Carmeli Y et al (2012) Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe. Clin Microbiol Infect 18(5):413–431

    Article  PubMed  Google Scholar 

  32. World Health Organization (2016) International statistical classification of diseases and related health problems, Tenth revision (ICD-10), Fifth edition. http://apps.who.int/classifications/icd10/browse/2016/en#/. Accessed 18 Feb 2019

Download references

Author information

Authors and Affiliations

  1. Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Viale Liegi 13, 00198, Rome, Italy

    Enrico Grande, Francesco Grippo & Luisa Frova

  2. Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy

    Annalisa Pantosti & Patrizio Pezzotti

  3. Epidemiological Department, Azienda Zero, Veneto Region, Padova, Italy

    Ugo Fedeli

Authors
  1. Enrico Grande
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Grippo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luisa Frova
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Annalisa Pantosti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrizio Pezzotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ugo Fedeli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Enrico Grande.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. Mortality data are routinely collected by the National Institute of Statistics. All analyses were carried out on aggregated data without any possibility of identification of individuals; therefore, the study was exempt from institutional review board approval.

Informed consent

Since analyses were carried out on retrospective, routinely collected aggregated data, the informed consent was not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grande, E., Grippo, F., Frova, L. et al. The increase of sepsis-related mortality in Italy: a nationwide study, 2003–2015. Eur J Clin Microbiol Infect Dis 38, 1701–1708 (2019). https://doi.org/10.1007/s10096-019-03601-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-019-03601-3

Keywords

Search

Navigation