Epidemiology of Sepsis-3 in a Sub-District of Beijing: Secondary Analysis of a Population-Based Database
Sepsis remains a critical global health challenge, with evolving definitions shaping its epidemiological understanding. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), introduced in 2016, redefined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. This definition emphasizes organ dysfunction quantified by a ≥2-point increase in the Sequential Organ Failure Assessment (SOFA) score. While high-income countries have reported Sepsis-3 epidemiology, data from middle-income regions like China remain limited. This study addresses this gap by analyzing the incidence, mortality, and clinical characteristics of Sepsis-3 in Yuetan sub-district, Beijing, providing insights into China’s sepsis burden.
Study Design and Methodology
The retrospective cohort study reviewed medical records of all adult residents (≥18 years) hospitalized between July 1, 2012, and June 30, 2014, in Yuetan sub-district. Using Beijing’s Public Health Information System, 21,191 patients were identified, excluding 1,361 due to missing records or institutional refusal. Three experienced ICU physicians independently reviewed records, resolving discrepancies through consensus.
Sepsis-3 was diagnosed using SOFA score criteria, while severe sepsis/septic shock followed the 1992 American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) definitions. Infections were classified as microbiologically or clinically documented. Data included demographics, comorbidities (assessed via Charlson index), infection sources, pathogens, and outcomes. Statistical analyses used Wilcoxon rank-sum tests for continuous variables and chi-square tests for categorical data. Incidence and mortality rates were standardized to China’s 2010 census and extrapolated nationally.
Key Findings
Demographic and Clinical Characteristics
Among 21,191 patients, 3,449 had infections, with 935 (27.1%) meeting Sepsis-3 criteria and 498 (14.4%) classified as severe sepsis/septic shock. Sepsis-3 patients were predominantly male (61.4% vs. 52.3% non-sepsis infections), older (median age: 81 vs. 78 years), and had higher comorbidity burdens (Charlson index: 2 vs. 1). Common comorbidities included cerebrovascular disease (38.3%), coronary heart disease (36.8%), and chronic lung disease (25.1%). Lower respiratory tract infections (47.4%) were the most frequent infection source, followed by intra-abdominal (16.9%) and urogenital infections (12.9%).
Notably, 33.6% of Sepsis-3 cases had microbiologically confirmed pathogens, dominated by Acinetobacter baumannii (18.9%), Pseudomonas aeruginosa (14.1%), and Klebsiella pneumoniae (12.5%). Sepsis-3 patients had longer hospital stays (median 20 vs. 14 days) and higher ICU admission rates (24.9% vs. 0.2%) than non-sepsis infections.
Incidence and Mortality Rates
The crude annual incidence of Sepsis-3 was 363 cases per 100,000 population, standardizing to 236 after age-sex adjustment. Extrapolated nationally, this corresponds to ~2.5 million annual cases. Men had significantly higher incidence (458 vs. 274/100,000) and mortality rates (143 vs. 90/100,000) than women. Incidence escalated with age: 20/100,000 (<50 years) to 10,305/100,000 (≥90 years). Seasonal variation peaked in winter (December–February).
In-hospital mortality for Sepsis-3 was 32.0%, rising to 53.4% for severe sepsis/septic shock. Mortality increased with age (11.1% in <50 years to 40.7% in ≥90 years). The standardized population mortality rate was 67/100,000, projecting ~700,437 annual deaths in China.
Comparative Analysis with Severe Sepsis/Septic Shock
Patients meeting ACCP/SCCM severe sepsis criteria differed significantly from Sepsis-3 cases:
- Higher prevalence of immunosuppression (21.7% vs. 9.5%)
- More ultimately fatal comorbidities (20.9% vs. 12.0%)
- Greater ICU utilization (38.8% vs. 24.9%)
- Elevated case fatality (53.4% vs. 32.0%)
These differences highlight Sepsis-3’s broader inclusion of less severely ill patients, underscoring definitional impacts on epidemiological estimates.
Discussion
Epidemiological Implications
This study provides the first population-based Sepsis-3 data from China, revealing lower incidence than high-income countries (e.g., 580/100,000 in the U.S.). Discrepancies arise from methodological variations, including retrospective vs. prospective designs and SOFA score application windows. The male predominance aligns with global trends, attributed to higher-risk behaviors (e.g., smoking) and comorbidities. Age-related incidence spikes reflect immunosenescence and multimorbidity in elderly populations.
Clinical and Pathogen Insights
The predominance of Gram-negative pathogens, particularly Acinetobacter baumannii, contrasts with Western studies where Staphylococcus aureus and Escherichia coli are more common. This may reflect regional antibiotic resistance patterns or healthcare practices. Lower respiratory infections as the primary source mirror global data, emphasizing the need for targeted prevention strategies.
Definitional Impact on Research and Practice
Sepsis-3’s inclusion of milder organ dysfunction (e.g., thrombocytopenia, hypoxemia) captures earlier disease stages compared to ACCP/SCCM criteria. This affects clinical trial design, as enrolling less severe cases may reduce statistical power to detect mortality benefits. Conversely, earlier identification could improve intervention timeliness, potentially reducing progression to severe sepsis.
Limitations and Future Directions
The retrospective design and single-subdistrict data limit generalizability. Underreporting of lactate levels in general wards precluded septic shock analysis. Future multi-center studies across diverse regions are needed to validate national estimates. Prospective cohorts incorporating Sepsis-3 biomarkers (e.g., lactate) could refine incidence and outcome assessments.
Conclusion
This study delineates Sepsis-3’s substantial burden in China, with ~2.5 million annual cases and >700,000 deaths. Male predominance, age-related susceptibility, and seasonal trends highlight high-risk populations for targeted interventions. The findings underscore the need for standardized global surveillance and adaptation of sepsis management protocols to regional pathogen profiles. By aligning definitions with pathophysiological insights, Sepsis-3 offers a framework for earlier detection and improved outcomes, though its epidemiological implications require continued evaluation.
doi:10.1097/CM9.0000000000000392
Was this helpful?
0 / 0