Rising rates of sepsis in England: an ecological study

Abstract

Purpose: Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major cause of morbidity and mortality. A contemporary overview of sepsis epidemiology in England is long overdue. This study provides an update on the incidence of sepsis-coded hospital admissions and mortality following the COVID-19 pandemic, focusing on the relative contribution of different bacterial pathogens to sepsis-coded admissions.

Methods: We undertook a descriptive study of all hospital admissions from April 1998 to March 2024 using routinely collected health data. Information on sepsis admission episodes, causative pathogens, age, sex, length-of-stay and mortality were collected.

Results: Sepsis-coded hospital admissions increased from 27.9 admissions per 100,000 in 1998 to 210.4 in 2023, a 7.5-fold increase. The incidence of sepsis-coded admissions due to most pre-specified pathogens of interest increased. The largest increases were seen for sepsis due to Enterococci, Streptococcus pyogenes, gram-negative bacteria, Streptococcus agalactiae, Staphylococcus aureus and Listeria spp. Sepsis due to meningococcus decreased. The percentage of patients aged ≥ 75 years admitted with sepsis increased from 32.4 to 52.5% of sepsis cases. Median length-of-stay was 6.1 days. Sepsis-coded admissions and mortality decreased during the COVID-19 pandemic. These have now returned to pre-pandemic levels.

Conclusion: The recorded incidence of sepsis-coded hospital admissions has risen. This may have been impacted by coding changes and improved disease recognition. The decrease in meningococcal sepsis may reflect the success of vaccination campaigns. Further research is needed to explore concurrent trends in sepsis severity, predict who is at greatest risk and improve prevention efforts.

Keywords: Incidence; Length of stay; Public health; Routinely collected health data; Sepsis.