The increase of sepsis-related mortality in Italy: a nationwide study, 2003–2015

  • Enrico GrandeEmail author
  • Francesco Grippo
  • Luisa Frova
  • Annalisa Pantosti
  • Patrizio Pezzotti
  • Ugo Fedeli
Original Article


The true burden of sepsis is largely unknown. Conventional underlying cause of death (UCoD) statistics largely underestimates sepsis-related mortality. This study aims to analyze all the conditions mentioned in the death certificates (multiple causes of death—MCoD) to estimate the nationwide burden of sepsis-related mortality in Italy, to investigate time trends and main comorbidities in sepsis-related deaths. All death certificates mentioning sepsis from 2003 to 2015 were analyzed. Age-standardized mortality rates were calculated for sepsis as both UCoD and MCoD, by gender and broad age groups. The ratio of the age-standardized proportions of any mention of sepsis in the presence/absence of associated chronic diseases (ASPR) was computed. The number of certificates reporting sepsis increased from 18,939 in 2003 to 49,010 in 2015 (from 3 to 8% of all deaths). The increase in sepsis mortality rates was larger for UCoD (males, + 200%; females, + 175%) than for MCoD-based figures (+ 100%; + 90%); MCoD rates remained noticeably higher than UCoD rates (2015, 87.3 per 100,000 vs. 16.3 for males; 54.9 vs. 11.8 for females). The largest increase was observed among the very elderly. The association between sepsis and chronic diseases was stronger for subjects aged less than 75 years. The increased awareness within the medical community in addition to the growing susceptible elderly population and the spread of antimicrobial resistance could have contributed to the sepsis-related mortality increase. MCoD statistics could help in recognizing sepsis not only as a clinical challenge, but also as a major public health issue.


Sepsis Mortality Multiple causes of death Italy 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. Mortality data are routinely collected by the National Institute of Statistics. All analyses were carried out on aggregated data without any possibility of identification of individuals; therefore, the study was exempt from institutional review board approval.

Informed consent

Since analyses were carried out on retrospective, routinely collected aggregated data, the informed consent was not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Enrico Grande
    • 1
    Email author
  • Francesco Grippo
    • 1
  • Luisa Frova
    • 1
  • Annalisa Pantosti
    • 2
  • Patrizio Pezzotti
    • 2
  • Ugo Fedeli
    • 3
  1. 1.Integrated System for Health, Social Assistance, Welfare and JusticeNational Institute of StatisticsRomeItaly
  2. 2.Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
  3. 3.Epidemiological DepartmentAzienda Zero, Veneto RegionPadovaItaly

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