epidemiology
Epidemiology and
impact of sepsis
Sepsis and septic shock are the leading cause of death in adult
intensive care units. Comparison of epidemiological studies is challenged
by the complex pathophysiology and varying data resources
Herwig Gerlach
MD PhD MBA MSc
Department for
Anaesthesia, Intensive
Care Medicine and Pain
Management, Vivantes
– Klinikum Neukoelln,
Berlin, Germany
Currently, sepsis and septic shock with
subsequent multi-organ failure are the leading
causes of death in adult intensive care units
(ICUs). The high prevalence of sepsis, as well as
its association with high healthcare costs have
led to the development of several projects in the
past two decades, intended to allow for better
recognition and more accurate description of the
course of the disease. 1 Does this mean that sepsis
is a modern disease? The answer is clearly “no”!
Sepsis is one of the oldest described illnesses. The
term “sepsis” is derived from the ancient Greek
term “σῆψις“ (“make rotten”) and was used by
Hippocrates around 400 BC to describe the
natural process through which meat decays,
swamps release decomposing gases, but also
through which infected wounds become
purulent. 2 After this recognition, it took over 2000
years until the hypothesis was established that it
is not the pathogen itself, but rather the host
response that is responsible for the symptoms
seen in sepsis. 3
If epidemiological data of a disease are
gathered and described in the medical field, there
are always two major issues that have to be kept
in mind: definitions and data resources. First,
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clear definitions are of great importance,
particularly in emergency and intensive care
medicine; however, this is not always simple.
The synonym of sepsis, that is, ‘blood poisoning’,
which has been used for centuries and is still
popular among the non-medical population,
is an inadequate term for intensive care
specialists. The challenge of a clear definition
of sepsis is that this syndrome is based on highly
complex pathophysiological pathways that may
show varying clinical signs and symptoms.
Second, it is crucial to take the data resources
into consideration. The two major approaches
for epidemiology studies are prospective,
protocol-based observations on the one hand, and
retrospective analyses of existing administrative
data bases from hospitals, insurances, and/or
statistical institutes on the other. Therefore, this
article will start with a quick overview of the
varying sepsis definitions, followed by an example
for the comparison of data received either by
analysis of pre-existing administrative data,
or by using a prospective, observational approach
with standardised protocols. A multinational
comparison of sepsis epidemiology data is
following, and the review will end with a short