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

Nina Vibeche Skei; Tom Ivar Lund Nilsen; Siri Tandberg Knoop; Hallie Prescott; Stian Lydersen; Randi Marie Mohus; Alen Brkic; Kristin Vardheim Liyanarachi; Erik Solligård; Jan Kristian Damås; Lise Tuset Gustad

doi:10.1136/bmjopen-2023-071846

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

BMJ Open. 2023 Aug 2;13(8):e071846. doi: 10.1136/bmjopen-2023-071846.

Authors

Nina Vibeche Skei^{1

2}, Tom Ivar Lund Nilsen³, Siri Tandberg Knoop^{4

5}, Hallie Prescott^{6

7}, Stian Lydersen⁸, Randi Marie Mohus^{2

9}, Alen Brkic^{10

11}, Kristin Vardheim Liyanarachi^{2

12}, Erik Solligård², Jan Kristian Damås^{2

12

13}, Lise Tuset Gustad^{2

14

15}

Affiliations

¹ Department of Anesthesia and Intensive Care, Nord-Trøndelag Hospital Trust, Levanger, Norway [email protected].
² Institute of Circulation and Medical Imaging, Mid-Norway Centre of Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
³ Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
⁴ Department of Microbiology, Haukeland University Hospital, Bergen, Norway.
⁵ Department of Clinical Science, University of Bergen, Bergen, Norway.
⁶ Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁷ VA Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, Michigan, USA.
⁸ Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
⁹ Clinic of Anaesthesia and Intensive Care, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway.
¹⁰ Research Department, Sørlandet Sykehus HF, Kristiansand, Norway.
¹¹ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
¹² Department of Infectious Diseases, St. Olav's University Hospital, Trondheim, Norway.
¹³ Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
¹⁴ Department of Medicine and Rehabilitation, Nord-Trondelag Hospital Trust, Levanger, Norway.
¹⁵ Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway.

Abstract

Objectives: To estimate temporal trends in incidence rate (IR) and case fatality during a 14-year period from 2008 to 2021, and to assess possible shifts in these trends during the COVID-19 pandemic.

Setting: All Norwegian hospitals 2008-2021.

Participants: 317 705 patients ≥18 year with a sepsis International Classification of Diseases 10th revision code retrieved from The Norwegian Patient Registry.

Primary and secondary measures: Annual age-standardised IRs with 95% CIs. Poisson regression was used to estimate changes in IRs across time, and logistic regression was used to estimate ORs for in-hospital death.

Results: Among 12 619 803 adult hospitalisations, a total of 317 705 (2.5%) hospitalisations in 222 832 (70.0%) unique patients met the sepsis criteria. The overall age-standardised IR of a first sepsis admission was 246/100 000 (95% CI 245 to 247), whereas the age-standardised IR of all sepsis admissions was 352/100 000 (95% CI 351 to 354). In the period 2009-2019, the annual IR for a first sepsis episode was stable (IR ratio (IRR) per year, 0.999; 95% CI 0.994 to 1.004), whereas for recurrent sepsis the IR increased (annual IRR, 1.048; 95% CI 1.037 to 1.059). During the COVID-19 pandemic, the IRR for a first sepsis was 0.877 (95% CI 0.829 to 0.927) in 2020 and 0.929 (95% CI 0.870 to 0.992) in 2021, and for all sepsis it was 0.870 (95% CI 0.810 to 0.935) in 2020 and 0.908 (95% CI 0.840 to 0.980) in 2021, compared with the previous 11-year period. Case fatality among first sepsis admissions declined in the period 2009-2019 (annual OR 0.954 (95% CI 0.950 to 0.958)), whereas case fatality increased during the COVID-19 pandemic in 2020 (OR 1.061 (95% CI 1.001 to 1.124) and in 2021 (OR 1.164 (95% CI 1.098 to 1.233)).

Conclusion: The overall IR of sepsis increased from 2009 to 2019, due to an increasing IR of recurrent sepsis, and indicates that sepsis awareness with updated guidelines and education must continue.

Keywords: COVID-19; INFECTIOUS DISEASES; INTENSIVE & CRITICAL CARE.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
COVID-19* / epidemiology
Hospital Mortality
Hospitals
Humans
Incidence
Norway / epidemiology
Pandemics
Registries
Sepsis* / epidemiology