Epidemiology and Trends of Sepsis in Young Adults Aged 20-44 Years: A Nationwide Population-Based Study

Abstract

BACKGROUND: While sepsis may have especially marked impacts in young adults, there is limited population-based information on its epidemiology and trends. METHODS: Population-based longitudinal study on sepsis in adults aged 20-44 years using the 2006-2015 Spanish national hospital discharge database. Cases are identified by an ICD-9-CM coding strategy. Primary endpoints are incidence and in-hospital mortality. Trends are assessed for annual percentage change (AAPC) in rates using Joinpoint regression models. RESULTS: 28,351 cases are identified, representing 3.06‱ of all-cause hospitalisations and a crude incidence of 16.4 cases/100,000 population aged 20-44. The mean age is 36 years, 58% of cases are men, and around 60% have associated comorbidities. Seen in one third of cases, the source of infection is respiratory. Single organ dysfunction is recorded in 45% of cases. In-hospital mortality is 24% and associated with age, comorbidity and extent of organ dysfunction. Incidence rates increase over time in women (AAPC: 3.8% (95% CI: 2.1, 5.5)), whereas case-fatality decline with an overall AAPC of -5.9% (95% CI -6.6, -5.2). Our results indicate that sepsis is common in young adults and associated with high in-hospital mortality, though it shows a decreasing trend. The substantial increase in incidence rates in women needs further research.