Revised Understanding of Sepsis Incidence: A Norwegian Study

A thorough research effort originating from Norway has revealed a higher incidence of sepsis than previously documented. Specifically, 250 out of every 100,000 individuals in Norway are afflicted with sepsis each year. The study dismantles prior assumptions about reporting increases, highlights a significant reduction in mortality rates associated with sepsis in hospitals, and underlines the uptick in recurrent sepsis, particularly among the aging population.

The primary factor contributing to the increasing number of sepsis cases is recurrent episodes of the condition, rather than fatalities upon initial onset.

Though colloquially referred to as blood poisoning, sepsis is a critical medical situation that leads to the death of about 3,000 people each year in Norwegian medical facilities. The condition is not a form of poisoning per se, but occurs due to an exaggerated immune response to an infection, which could be bacterial, viral, fungal, or parasitic. This overreactive immune response results in damage to the organs, culminating in organ failure.

The investigation, which analyzed 300,000 sepsis hospital admissions, found that the condition is more widespread than once believed. Moreover, an increased survival rate was noted, largely due to patients experiencing multiple episodes of sepsis rather than succumbing to the condition upon its first occurrence.

According to Lise Tuset Gustad, a researcher at the Norwegian University of Science and Technology (NTNU), Nord University, and Levanger Hospital, 250 out of every 100,000 Norwegians develop sepsis for the first time each year. The incidence rates, adjusted for age, remained constant throughout the research period and were found to be higher than previously indicated.

The study was carried out by the research group at NTNU’s Central Norwegian Centre for Sepsis Research and examined data from 2008 through 2021. The findings were published in the British Medical Journal, BMJ Open.

The quality of the data is robust, as the research was conducted using national registry studies, and is the first nationwide sepsis investigation extending over a lengthy timeframe. It includes data from all hospitalized patients, not just those in intensive care. A total of 317,705 hospital admissions for sepsis were recorded during this period, of which 222,832 were first-time sepsis patients.

Mortality rates have declined significantly during this period, dropping by 43 percent for those admitted with sepsis for the first time. Overall, hospital mortality rates declined by one-third, irrespective of whether patients were experiencing sepsis for the first time or had prior episodes.

During the initial two years of the Covid-19 pandemic, a decline in first-time sepsis cases was noted, possibly attributable to social distancing measures. There was also a marked increase in hospital mortality rates from sepsis during the pandemic, particularly in 2021.

The pandemic increased awareness about sepsis, particularly that caused by viral infections. Of the 30,000 people admitted with sepsis in 2020 and 2021, around 10 percent were cases of Covid-19 sepsis, with a higher mortality rate compared to other causes of sepsis.

The study also highlighted an increasing trend in recurrent sepsis, particularly among those above 60 years of age. In individuals older than 80, the rate of recurring sepsis more than quintupled in 2021 compared to 2008.

Contrary to prior professional opinions, the increase in sepsis cases is not attributable to changes in diagnostic coding regulations. The study employed consistent coding throughout the research period, ensuring the validity of the observed changes.

The findings have implications for healthcare professionals, policymakers, and health planning authorities. The research contradicts earlier beliefs about the incidence and nature of sepsis, emphasizing the need for preventive measures, particularly for those who are at risk of recurrent sepsis.

The study received funding from the collaborative body NTNU/Central Norway Health Region and from the Nord-Trøndelag HF Health Authority.

Reference: “Long-term temporal trends in incidence rate and case fatality of sepsis and COVID-19-related sepsis in Norwegian hospitals, 2008–2021: a nationwide registry study” by Nina Vibeche Skei et al., published on 1 August 2023, in BMJ Open. DOI: 10.1136/bmjopen-2023-071846.

Frequently Asked Questions (FAQs) about Sepsis in Norway

More about Sepsis in Norway

• Norwegian University of Science and Technology (NTNU) Sepsis Research
• British Medical Journal (BMJ Open) Publication
• Nord-Trøndelag HF Health Authority
• Norwegian Central Registry for Health Research
• Sepsis and COVID-19
• Levanger Hospital Research