Sepsis is a life-threatening illness caused by an abnormal response of the body to an infection. To estimate the sepsis burden in the entire Hong Kong population, The Chinese University of Hong Kong’s (CUHK) Faculty of Medicine (CU Medicine) conducted big data analysis using electronic health record-based (EHR) data from over 13 million adult public hospital episodes between 2009 and 2018. The results showed that one in four of all adult deaths in Hong Kong were attributable to sepsis. Over the decade, adult sepsis incidence and mortality increased by an average annual 2.8% and 1.9% respectively.

The research team hopes that the study results can raise public awareness of sepsis and facilitate early treatment. Details of the study have been published in the international medical journal Clinical Infectious Diseases. 

CU Medicine conducted an analysis using electronic health record-based (EHR) data from over 13 million adult public hospital episodes between 2009 and 2018. The results showed that one in four of all adult deaths in Hong Kong were attributable to sepsis. Local sepsis morbidity and mortality in adults have continued to increase over the past decade.

Featured in the photo are (from left) Professor Anna Lee; Dr Lowell Ling, Assistant Professor; and Mr Jack Zhang, PhD student; from the Department of Anaesthesia and Intensive Care at CU Medicine. 

Half of sepsis patients with multiorgan dysfunction die

Sepsis is a significant problem in Hong Kong, affecting one in 1,000 adults in the local population per year. The disease can affect vital organs such as the lungs, kidneys and liver, and its mortality rate can be greater than 47% in patients with multiorgan dysfunction.

Dr Lowell Ling states that the local sepsis situation is worrying, as sepsis is an increasing cause of death and its outcomes have not improved much over the last 10 years. He hopes the study results can raise public awareness of sepsis and facilitate early treatment.

Most epidemiologic studies of sepsis use administrative codes from hospital discharge databases or death certificates, but these suffer from poor sensitivity and imperfect specificity. This may lead to misleading sepsis incidence rates or mortality trends. To overcome these shortcomings, CU Medicine’s team used EHR-based data to estimate the adult sepsis burden in Hong Kong. Using this method, adult sepsis was defined as clinical evidence of presumed infection, including clinical cultures and antibiotic treatment, and concurrent acute organ dysfunction.

 

Mr Jack Zhang Zhen-he, PhD student from the Department of Anaesthesia and Intensive Care at CU Medicine, commented, “This is the first study in the world outside the United States to use a population EHR-based surveillance definition to estimate adult sepsis levels. This is a highly accurate, objective method for demonstrating the trends in population-level standardised adult sepsis incidence and mortality.”

Findings underscore the high burden of sepsis, with timely treatment key to combating it

The research team studied over 13 million hospital episodes, including all adult public hospitals admissions in Hong Kong between 2009 and 2018. It found that:

• Sepsis incidence increased 2.8% per year, from 624 per 100,000 in 2009 to 759 per 100,000 in 2018.
• Sepsis mortality increased 1.9% per year, from 142 per 100,000 in 2009 to 156 per 100,000 in 2018.
• Sepsis accounted for an increasing proportion of all deaths during the study period, with an annual increase of 3.9%. In 2018, 27.8% of all adult deaths in Hong Kong were attributable to sepsis.
• The respiratory, urinary and gastrointestinal systems were the top three common sites of infection among adult sepsis patients.

First author and corresponding author of the study, Dr Lowell Ling, Assistant Professor at CU Medicine’s Department of Anaesthesia and Intensive Care, concluded, “Our findings underscore the high burden of sepsis in Hong Kong. This is worrying, as sepsis is an increasing cause of death and the outcomes of patients with sepsis have not improved much over the last 10 years. As timely treatment is key to combating sepsis, the public should be aware of sepsis symptoms, such as symptoms of infection like fever with cough and sputum and pain or burning sensation when urinating, in combination with shivering, confusion, severe shortness of breath, reduced urination, light-headedness and skin discolouration, and seek medical care as early as possible.”

Mr. Ching, who has recovered from sepsis, says that he had suffered from pneumonia earlier and delayed seeking medical care for about half a month. His condition then became so severe that he developed multiorgan dysfunction. Fortunately, he can now return to work and exercise after treatment.

The project was supported by the Health and Medical Research Fund, the Health Bureau, The Government of the Hong Kong Special Administrative Region.