Although the ADRENAL trial was a multicenter, international study, the lion's share of the participants were in Australia (~70%). Moreover, the APROCCHS trial only studied patients in France. Both of these trials took a remarkable coordination effort, yielded intriguing findings, and were monumental accomplishments. However, are their results generalizable to the rest of the world?

Recently, there have been a few key articles highlighting our current understanding of the global burden of sepsis. Unfortunately, it showed we know a lot about the burden in high-income countries, but have almost no data on the epidemiology of sepsis in low and middle-income countries [1, 2]. These countries likely suffer a high burden of disease. Fortunately, sepsis is now being recognized as a global health priority by the WHO with new resolutions underway (3). Do you think the results of these trials be generalizable to low and middle-income countries?

1. Fleischmann et al. (2016). Assessment of global incidence and mortality of hospital-treated sepsis. current estimates and limitations. American Journal of Respiratory and Critical Care Medicine, 193(3), 259-272. doi:10.1164/rccm.201504-0781OC [doi]

2. Finfer, S., & Machado, F. R. (2016). The global epidemiology of sepsis. does it matter that we know so little? American Journal of Respiratory and Critical Care Medicine, 193(3), 228-230. doi:10.1164/rccm.201510-1976ED [doi]

3. Reinhart et al. Recognizing sepsis as a global health priority — A WHO resolution. NEJM.