10-year study: 1 in 4 adult deaths in HK related to sepsis

A 10-year population-level surveillance study by researchers from the Chinese University of Hong Kong (CUHK) has shown that sepsis is related to 27.8 percent of all adult deaths in Hong Kong.

The study also demonstrated an increasing proportion of sepsis-related deaths among all Hong Kong adult deaths, as well as increasing trends in the incidence of sepsis and sepsis-related mortality in 2009–2018. “These results indicate that sepsis is a substantial burden in Hong Kong, highlighting the need for timely treatment,” said first and corresponding author Dr Lowell Ling of the Department of Anaesthesia and Intensive Care, CUHK. [Clin Infect Dis 2023:doi:10.1093/cid/ciad491]

The CUHK researchers conducted an electronic health record–based sepsis surveillance with the Hospital Authority’s Clinical Data Analysis and Reporting System. Sepsis was defined as clinical evidence of both presumed infection (ie, positivity for microbiological culture and ≥4 days of antibiotic treatment initiated within ± 2 days from date of index culture) and concurrent acute organ dysfunction (ie, ≥2 point increase from baseline in estimated Sequential Organ Failure Assessment score during infection).

A total of 13,550,168 hospitalization episodes in 2,927,708 adult patients were identified between 1 April 2009 and 31 March 2019. Among these episodes, 3.6 percent (n=485,057) met the definition of sepsis. In the sepsis cohort (median age, 77 years; male, 58.8 percent), 23.9 percent of patients had dysfunction of one organ, 43.1 percent had dysfunction of two organs, 24.1 percent had dysfunction of three organs, and 8.9 percent had dysfunction of ≥4 organs. The most common sites of infections were the respiratory tract (35.0 percent), urinary tract (26.5 percent) and gastrointestinal tract (12.7 percent). The rate of ICU admission was 13.0 percent.

Mechanical ventilation and vasopressors were used in 20.0 percent and 9.3 percent of the sepsis patients, respectively. Among these patients, 62.8 percent were not admitted to ICU.

During the study period, sepsis incidence increased by 2.9 percent annually (624/100,000 in 2009 vs 759/100,000 in 2018; 95 percent confidence interval [CI], 2.0–3.8; p<0.001), and sepsis-related mortality increased by 1.9 percent annually (142/100,000 vs 156/100,000; 95 percent CI, 0.9–2.9; p=0.002).

Notably, there was an annual increase of 3.9 percent in the proportion of sepsis-related deaths among total adult deaths in Hong Kong (20.9 percent in 2009 vs 27.8 percent in 2018; 95 percent CI, 2.9–4.9; p<0.001).

The case fatality risk (CFR) of sepsis slightly declined by 0.5 percent annually (22.9 percent in 2009 vs 21.5 percent in 2018; 95 percent CI. -1.0 to -0.1; p=0.03). However, CFR was higher in patients with a greater number of dysfunctioning organs (1 organ, 15.1 percent; 2 organs, 18.3 percent; 3 organs, 27.8 percent; ≥4 organs, 47.2 percent). Among those requiring mechanical ventilation or vasopressors, mortality rate was higher when managed in general wards vs ICUs (46.4 percent vs 29.6 percent; p<0.001).

“Sepsis is an increasing cause of death [in Hong Kong], and timely admission to ICU may improve patients’ survival,” concluded the researchers. “Based on our results, there is a need to enhance critical care [services] for sepsis patients.”