Intensive Care Med (2018) 44:1071–1080
Sepsis-related mortality in China: a
, Xin‑ying Zeng
, Peng Yin
, Li‑jun Wang
, Chun‑yao Wang
, Wei Jiang
, Mai‑geng Zhou
for the China Critical Care Clinical Trials Group (CCC CTG )
© 2018 Springer‑Verlag GmbH Germany, part of Springer Nature and ESICM
Purpose: A population‑level description and analysis of sepsis‑related mortality in China is key to the planning and
assessment of interventional strategies.
Methods: Retrospective analysis of multiple cause of death (MCOD) recorded in the population‑based national mor‑
tality surveillance system (NMSS) of China. All sepsis‑related deaths occurring in 605 disease surveillance points (DSPs)
covering 323.8 million population across China were included in our study. Age‑standardized mortality and national
estimate of sepsis‑related deaths were estimated using the census population in 2010 and 2015, respectively.
Results: In 2015, a total of 1,937,299 deaths occurring in any of the 605 DSPs and standardized sepsis‑related mortal‑
ity rate was 66.7 (95% conﬁdence interval [CI] 66.4–67.0) deaths per 100,000 population. This produced a national
estimate of 1,025,997 sepsis‑related deaths. Sepsis‑related mortality rates exhibited signiﬁcant geographic variation.
In multilevel analysis, male sex (rate ratio [RR] 1.582, 95% CI 1.570–1.595), increasing age (RR 1.914 for 5‑year group,
95% CI 1.910–1.917), and presence of comorbidity (RR 2.316, 95% CI 2.298–2.335) were independently associated with
increased sepsis‑related mortality. Higher disposable income (RR 0.717 for the fourth interquartile range vs. the ﬁrst
interquartile range, 95% CI 0.515–0.978) and mean years of education (RR 0.808 for the fourth interquartile range vs.
the ﬁrst interquartile range, 95% CI 0.684–0.955) were negatively associated with sepsis‑related mortality. However,
population‑based hospital doctors were not signiﬁcantly associated with sepsis‑related mortality.
Conclusions: The standardized sepsis‑related mortality rate in China was high and varied according to socioeco‑
nomic indices, even though some uncertainty remained.
Keywords: Sepsis, Epidemiology, Mortality, China
Sepsis remains the most common cause of death in criti-
cally ill patients, which causes or contributes to between
one-third and one-half of all deaths in hospitals in the
USA . While there are no approved speciﬁc molecu
lar therapies for sepsis, management of these critically ill
patients relies on early recognition, appropriate antibiot
ics, and supportive care.
Global and national data on the epidemiology of sep
sis are an important prerequisite to develop appropri-
ate healthcare policy and to allocate limited healthcare
resources, as well as to reduce the disease burden of sep
sis. Recently, on the basis of a systematic review, Fleis-
chmann and colleagues estimated the global annual
incidence as up to 31 million cases of sepsis, including
19.4 million cases of severe sepsis, with about 6 million
*Correspondence: firstname.lastname@example.org; email@example.com
Medical Intensive Care Unit, Peking Union Medical College Hospital,
Peking Union Medical College Hospital and Chinese Academy of Medical
Sciences, 1 Shuai Fu Yuan, Beijing 100730, China
National Center for Chronic and Noncommunicable Disease Control
and Prevention, Chinese Center for Disease Control and Prevention, 27
Nanwei Road, Beijing 100050, China
Full author information is available at the end of the article
Li Weng, Xin‑ying Zeng, and Peng Yin contributed equally to the work.
The members of CCC CTG Group are listed in the Acknowledgements