A twenty-year retrospective analysis on sepsis and septic shock incidence and mortality

Abstract Sepsis and septic shock are major causes of global mortality. Analyzing trends in incidence, in-hospital mortality (IHM), and length of stay (LOS) is critical to improve patient outcomes. This retrospective study examined the impact of sepsis on patients admitted to St. Anna University Hospital in Ferrara, Italy, from 2003 to 2022. Inclusion criteria were patients aged ≥ 18, admitted through the Emergency Department with a confirmed diagnosis of sepsis or septic shock. We evaluated trends in incidence, IHM, LOS, sepsis etiology, and changes during the SARS-CoV-2 pandemic, assessing mortality correlations with underlying causes across age groups. Among 461,241 patients, 15,238 (3.3%) developed sepsis or septic shock. Sepsis incidence ( p < 0.001), IHM ( p < 0.001), and LOS ( p < 0.001) significantly increased over time. Respiratory etiology was most common, followed by urinary, abdominal, indeterminate, and other causes. Respiratory and indeterminate etiologies were associated with higher mortality ( p < 0.001). Both IHM and 21-day mortality rose significantly during the SARS-CoV-2 pandemic ( p < 0.001). Sepsis incidence and mortality increased substantially over the study period, especially during the pandemic. Respiratory and indeterminate etiologies were linked to poorer outcomes, underscoring the need for improved diagnostic and therapeutic strategies to address the growing sepsis burden.