Differences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Study

Conde, Katia Aparecida Pessoa; Silva, Eliezer; Silva, Carla Oliveira; Ferreira, Elaine Maria; Freitas, Flávio Geraldo Rezende; Castro, Isac de; Réa-Neto, Álvaro; Grion, Cíntia Magalhães Carvalho; Moura, Anselmo Dornas; Lobo, Suzana Margareth; Azevedo, Luciano César Pontes; Machado, Flávia Ribeiro

doi:10.1371/journal.pone.0064790

Cited by 69 publications

(80 citation statements)

References 27 publications

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“…Old Brazilian sepsis data from private and public ICU have shown higher mortality rates than in the present study [21], [30]. More recent data still shows a higher mortality rate in Brazil [5] than that reported in some studies conducted in developed countries [2]–[4].…”

Section: Discussioncontrasting

confidence: 58%

Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock

et al. 2014

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IntroductionThe growing number of renal transplant recipients in a sustained immunosuppressive state is a factor that can contribute to increased incidence of sepsis. However, relatively little is known about sepsis in this population. The aim of this single-center study was to evaluate the factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit (ICU) with severe sepsis and septic shock.MethodsPatient demographics and transplant-related and ICU stay data were retrospectively collected. Multiple logistic regression was conducted to identify the independent risk factors associated with hospital mortality.ResultsA total of 190 patients were enrolled, 64.2% of whom received kidneys from deceased donors. The mean patient age was 51±13 years (males, 115 [60.5%]), and the median APACHE II was 20 (16–23). The majority of patients developed sepsis late after the renal transplantation (2.1 [0.6–2.3] years). The lung was the most common infection site (59.5%). Upon ICU admission, 16.4% of the patients had ≤1 systemic inflammatory response syndrome criteria. Among the patients, 61.5% presented with ≥2 organ failures at admission, and 27.9% experienced septic shock within the first 24 hours of ICU admission. The overall hospital mortality rate was 38.4%. In the multivariate analysis, the independent determinants of hospital mortality were male gender (OR = 5.9; 95% CI, 1.7–19.6; p = 0.004), delta SOFA 24 h (OR = 1.7; 95% CI, 1.2–2.3; p = 0.001), mechanical ventilation (OR = 30; 95% CI, 8.8–102.2; p<0.0001), hematologic dysfunction (OR = 6.8; 95% CI, 2.0–22.6; p = 0.002), admission from the ward (OR = 3.4; 95% CI, 1.2–9.7; p = 0.02) and acute kidney injury stage 3 (OR = 5.7; 95% CI,1.9–16.6; p = 0.002).ConclusionsHospital mortality in renal transplant patients with severe sepsis and septic shock was associated with male gender, admission from the wards, worse SOFA scores on the first day and the presence of hematologic dysfunction, mechanical ventilation or advanced graft dysfunction.

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Section: Discussioncontrasting

confidence: 58%

Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock

et al. 2014

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“…This leads to the delays in care and lack of recognition or misdiagnosis of sepsis, hence resulting in increased morbidity and mortality. A multicenter observational study evaluated the factors associated with mortality in 396 septic patients admitted to ICUs in 19 public and private institutions in Brazil in 2013 [11]. The authors observed that private hospitals had a higher chance of diagnosing sepsis within two hours of the onset of organ dysfunction in addition to having more compliance implementing the treatment protocol [11].…”

Section: Optimizing Management Of Sepsis In Developing Countriesmentioning

confidence: 99%

“…A multicenter observational study evaluated the factors associated with mortality in 396 septic patients admitted to ICUs in 19 public and private institutions in Brazil in 2013 [11]. The authors observed that private hospitals had a higher chance of diagnosing sepsis within two hours of the onset of organ dysfunction in addition to having more compliance implementing the treatment protocol [11]. Delayed recognition of sepsis and inadequate treatment of sepsis due to lack of access to emergency departments and intensive-care units, shortage of resources, and limited beds in public hospitals may contribute to its higher sepsis mortality rate.…”

Section: Optimizing Management Of Sepsis In Developing Countriesmentioning

confidence: 99%

“…Delayed recognition of sepsis and inadequate treatment of sepsis due to lack of access to emergency departments and intensive-care units, shortage of resources, and limited beds in public hospitals may contribute to its higher sepsis mortality rate. Becker et al [9,11] proposed a possible solution to this issue by recommending that developing countries should establish a systematic approach to create an efficient triage in order to improve access to emergency care and intensive care services [4]. This would enable the healthcare providers to identify critically ill patients and provide them with basic interventions without any delay to reaching definitive care.…”

Section: Optimizing Management Of Sepsis In Developing Countriesmentioning

confidence: 99%

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Optimizing Quality of Care for Septic Patients in Developing Countries

Saleh¹

2015

SOJAPM

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Open Access Opiniondeveloping countries. Although data on the burden of sepsis in developing countries is lacking in the published literature, the incidence and mortality are likely to be disproportionally high in developing countries compared to developed countries [4][5][6][7][8][9][10]. The Brazilian Sepsis Epidemiological Study has confirmed this conclusion by evaluating 1383 patients who were admitted to five different intensive care units. The investigators discovered that the incidence of sepsis, severe sepsis, and septic shock were 61.4, 35.6, and 30.0 per 1000 days, respectively [6]. The mortality of patients with sepsis, severe sepsis, and septic shock were 34.7%, 47.3%, and 52.2%, respectively [6]. These high incidences and mortalities of sepsis in developing countries may be caused by their quality of healthcare, lack of access to healthcare and educational efforts targeting sepsis, and shortage of resources.It is also important to note that severe sepsis is likely to complicate malnutrition, malaria, maternal conditions, and chronic illnesses, including HIV/AIDS, diabetes, and cancer in developing countries [4][5]8]. For instance, Bane et al. [7] Evaluated HIV-positive patients who were admitted to an Ethiopian hospital and noticed that sepsis and septic shock were among the most common causes of mortality due to their immunosuppressant [4,7]. Sani et al. [4,8]. Reviewed the causes of death among patients with AIDS over 4 years in a Nigerian hospital As a result of their calculations, 455 of 4574 patients (9.9%) were admitted due to their HIV/AIDS-related diagnoses, which caused 176 deaths (38.7%) over the period [4,8]. The most common causes of these deaths were tuberculosis (33.4%) and sepsis (23.8%). This indicates that immunosuppressant secondary to acute illnesses and chronic conditions in developing countries may thus potentially significantly increase the incidence and mortality of sepsis in developing countries [4].similarly, a large prospective study evaluating 1,235 Brazilian patients admitted to 90 Brazilian icus demonstrated that there was a clear association between infection and mortality [10]. Furthermore, the overall ICU mortality rate was 28.4% with the higher rate in the infected patients than in non-infected patients (37.6% vs 13.2%) [10]. Likewise, the in-hospital mortality rate was 34.2%, with 44.2% in the infected patients and 17.7% in non-infected patients. The authors performed a multivariate analysis and concluded that the significant factors associated with the incidence of infection were emergency surgery (OR 2.89), mechanical ventilation (OR AbstractSepsis is a major cause of morbidity and mortality in intensive care units. It affects millions of people worldwide annually, causing hundreds of thousands deaths and health-care expenditure of at least $16.7 billion per year. This highlights the significance of diagnosing and treating septic patients emergently. Unfortunately, developing countries are struggling with limited resources, lack of educational efforts targeting se...

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“…The pioneering studies of Amato et al [4] and Pálizas et al [5] opened up new approaches to ARDS management and perfusion monitoring. Highly relevant epidemiological studies have provided fundamental data for the international community on ARDS [6], sepsis [7], intra-abdominal hypertension [8], as well as ICU organizational factors and patient outcomes [9]. Elegant clinical physiological studies which have contributed to universal knowledge, especially in the area of septic shock or tissue perfusion monitoring, have also been performed in the region [10][11][12][13][14].…”

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confidence: 99%