Epidemiological trends in sepsis in Spain: incidence, in-hospital mortality, and healthcare burden (2017-2022)

OBJECTIVES: To describe trends in incidence, in-hospital mortality, clinical characteristics, infection sources, and healthcare burden of sepsis in Spain from 2017 to 2022, while assessing the impact of COVID-19. METHODS: We conducted a nationwide, population-based retrospective study using the Spanish Minimum Basic Data Set. Sepsis was identified by concurrent infection and organ dysfunction codes based on Angus criteria adapted for ICD-10-CM. Age-adjusted incidence, in-hospital mortality, healthcare costs, and a non-COVID-19 sepsis cohort were analyzed. RESULTS: Among 1187,393 sepsis hospitalizations, annual cases increased from 183,971 in 2017 to 226,884 in 2022. Age-adjusted incidence changed from a baseline of approximately 4.0 per 1000 inhabitants in 2017 to reach 4.65 per 1000 inhabitants in 2022. In-hospital mortality increased from an initial19.4% in 2017, peaked at 23.7% in 2020, and stabilized at 20.8% in 2022. Patients were predominantly older adults, with a mean age of 74.3 years and a high metabolic and respiratory comorbidity burden. Respiratory and genitourinary infections were the leading sources. Costs peaked during the pandemic and remained substantial. CONCLUSION: Sepsis epidemiology in Spain was strongly influenced by COVID-19, but the burden remained concentrated among older, multimorbid patients. Stable non-COVID-19 trends highlight a persistent healthcare challenge, underscoring the need for adequate resource planning and clinical management adapted to high-risk population.