The Burden of Sepsis and Septic Shock in the Intensive Care Unit
Luigi La Via, Antonino Maniaci, Mario Lentini, Giuseppe Cuttone, Salvatore Ronsivalle, Simona Tutino, Francesca Maria Rubulotta, Giuseppe Nunnari, Andrea Marıno
Abstract
This narrative review synthesizes our current understanding of sepsis and septic shock burden in intensive care units (ICUs) worldwide. Based on a comprehensive but non-systematic literature search from 2000 to 2025, this review synthesizes our current understanding across eight key domains: epidemiology, pathophysiology, diagnostics, management strategies, long-term outcomes, disparities, and future directions. The global burden of sepsis, especially in the developed and developing world, is great: over 48 million cases per year, with mortality rates at the ICU level in the range of 30 to 50%, depending on geography and resources. The pathophysiological progression from an initial hyper-inflammatory state to immune paralysis underlies organ failure and complicates therapeutic targeting. Diagnostic approaches, including clinical scoring systems, biomarkers (e.g., procalcitonin, MR-proADM), and emerging AI tools, offer improved early detection but face challenges in reliability and accessibility. Management in the ICU remains anchored in timely antimicrobial administration, hemodynamic stabilization with balanced fluids and vasopressors, source control, and organ support, including lung-protective ventilation and kidney replacement therapy. Novel adjuncts, such as immunomodulators and extracorporeal therapies, show promise but demand further validation. Importantly, survivors face significant long-term sequelae-post-intensive care syndrome (PICS)-encompassing physical, cognitive, and psychological impairments, which require structured rehabilitation and follow-up. The future of sepsis care lies in integrating precision medicine-through molecular diagnostics, individualized immunotherapy, and AI-supported monitoring-with scalable, equitable implementation strategies that bridge the gap between high- and low-income settings. Addressing disparities and expanding rehabilitation services are essential to improving survival and long-term quality of life in sepsis survivors.