The Lancet

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ISSN / EISSN : 01406736 / 1474547X
Current Publisher: Elsevier BV (10.1016)
Total articles ≅ 463,442
Google Scholar h5-index: 278
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Kristina E Rudd, Sarah Charlotte Johnson, Kareha M Agesa, Katya Anne Shackelford, Derrick Tsoi, Daniel Rhodes Kievlan, Danny V Colombara, Kevin S Ikuta, Niranjan Kissoon, Simon Finfer, et al.
Published: 18 January 2020
The Lancet, Volume 395, pp 200-211; doi:10.1016/s0140-6736(19)32989-7

Abstract:SummaryBackgroundSepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. It is considered a major cause of health loss, but data for the global burden of sepsis are limited. As a syndrome caused by underlying infection, sepsis is not part of standard Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimates. Accurate estimates are important to inform and monitor health policy interventions, allocation of resources, and clinical treatment initiatives. We estimated the global, regional, and national incidence of sepsis and mortality from this disorder using data from GBD 2017.MethodsWe used multiple cause-of-death data from 109 million individual death records to calculate mortality related to sepsis among each of the 282 underlying causes of death in GBD 2017. The percentage of sepsis-related deaths by underlying GBD cause in each location worldwide was modelled using mixed-effects linear regression. Sepsis-related mortality for each age group, sex, location, GBD cause, and year (1990–2017) was estimated by applying modelled cause-specific fractions to GBD 2017 cause-of-death estimates. We used data for 8·7 million individual hospital records to calculate in-hospital sepsis-associated case-fatality, stratified by underlying GBD cause. In-hospital sepsis-associated case-fatality was modelled for each location using linear regression, and sepsis incidence was estimated by applying modelled case-fatality to sepsis-related mortality estimates.FindingsIn 2017, an estimated 48·9 million (95% uncertainty interval [UI] 38·9–62·9) incident cases of sepsis were recorded worldwide and 11·0 million (10·1–12·0) sepsis-related deaths were reported, representing 19·7% (18·2–21·4) of all global deaths. Age-standardised sepsis incidence fell by 37·0% (95% UI 11·8–54·5) and mortality decreased by 52·8% (47·7–57·5) from 1990 to 2017. Sepsis incidence and mortality varied substantially across regions, with the highest burden in sub-Saharan Africa, Oceania, south Asia, east Asia, and southeast Asia.InterpretationDespite declining age-standardised incidence and mortality, sepsis remains a major cause of health loss worldwide and has an especially high health-related burden in sub-Saharan Africa.FundingThe Bill & Melinda Gates Foundation, the National Institutes of Health, the University of Pittsburgh, the British Columbia Children's Hospital Foundation, the Wellcome Trust, and the Fleming Fund.
Andrew Green
Published: 18 January 2020
The Lancet, Volume 395; doi:10.1016/s0140-6736(20)30063-5

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Published: 18 January 2020
The Lancet, Volume 395; doi:10.1016/s0140-6736(20)30039-8

The publisher has not yet granted permission to display this abstract.
Jean-Noel Vergnes, Marco Mazevet
Published: 18 January 2020
The Lancet, Volume 395; doi:10.1016/s0140-6736(19)33015-6

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Henry M Feder, William N Rezuke
Published: 18 January 2020
The Lancet, Volume 395; doi:10.1016/s0140-6736(19)32962-9

Fei Liang
Published: 18 January 2020
The Lancet, Volume 395; doi:10.1016/s0140-6736(19)32594-2

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Petra Zimmermann, Nigel Curtis
Published: 18 January 2020
The Lancet, Volume 395; doi:10.1016/s0140-6736(19)32632-7

Abstract:Marian Knight and colleagues1Knight M Chiocchia V Partlett C et al.Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial.Lancet. 2019; 393: 2395-2403Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar reported that antibiotics given after operative delivery (forceps or vacuum) significantly reduce maternal infection. Up to 40% of infants are exposed to antibiotics as a result of intrapartum antibiotic prophylaxis for maternal group B streptococcus colonisation or surgical prophylaxis for caesarean section.2Persaud RR Azad MB Chari RS et al.Perinatal antibiotic exposure of neonates in Canada and associated risk factors: a population-based study.J Matern Fetal Neonatal Med. 2015; 28: 1190-1195Crossref PubMed Google Scholar Adding antibiotic prophylaxis for women who need operative assistance during delivery would lead to an additional 2–15% of women and infants being exposed to antibiotics.
Miriam Orcutt, Reem Mussa, Lucinda Hiam, Apostolos Veizis, Sophie McCann, Elisavet Papadimitriou, Aurelie Ponthieu, Michael Knipper
Published: 13 January 2020
The Lancet; doi:10.1016/s0140-6736(19)33175-7

Enrico Coiera
Published: 7 January 2020
The Lancet; doi:10.1016/s0140-6736(19)32987-3

Corinna Hawkes, Marie T Ruel, Leah Salm, Bryony Sinclair, Francesco Branca
Published: 1 January 2020
The Lancet, Volume 395, pp 142-155; doi:10.1016/s0140-6736(19)32506-1

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