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http://hdl.handle.net/123456789/1594
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| Title: | Severe sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected population |
| Authors: | Jacob, Shevin T.
Banura, Patrick
Moore, Christopher C.
Pinkerton, Relana
Meya, David
Opendi, Pius
Reynolds, Steven J.
Kenya-Mugisha, Nathan
Mayanja-Kizza, Harriet
Scheld, Michael W. |
| Keywords: | Sepsis syndrome
Sub-Saharan Africa
Mortality
Epidemiology
Thrombocytopenia
HIV-infected patients
Uganda
Data management
Infectious disease
HIV/AIDS
CD4 cell count |
| Issue Date: | Nov-2009 |
| Publisher: | Public Library of Science |
| Citation: | Jacob, S.T., Moore, C.C., Banura, P., Pinkerton, R., Meya, D., Opendi, P., Reynolds, S.J., Kenya-Mugisha, N., Mayanja-Kizza, H., Scheld, M.W. (2009). Severe sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected population. PLoS One 4(11) |
| Abstract: | Background: Sepsis likely contributes to the high burden of infectious disease morbidity and mortality in low income countries. Data regarding sepsis management in sub-Saharan Africa are limited. We conducted a prospective observational study reporting the management and outcomes of severely septic patients in two Ugandan hospitals. We describe their epidemiology, management, and clinical correlates for mortality.
Methodology/Results: Three-hundred eighty-two patients fulfilled enrollment criteria for a severe sepsis syndrome. Vital signs, Management and laboratory results were recorded. Outcomes measured included in-hospital and post-discharge mortality. Most patients were HIV-infected (320/377, 84.9%) with a median CD4+ T cell (CD4) count of 52 cells/mm3 (IQR, 16–131 cells/mm3). Overall mortality was 43.0%, with 23.7% in-hospital mortality (90/380) and 22.3% post-discharge mortality (55/247). Significant predictors of in-hospital mortality included admission Glasgow Coma Scale and Karnofsky Performance Scale (KPS), tachypnea, leukocytosis and thrombocytopenia. Discharge KPS and early fluid resuscitation were significant predictors of post-discharge mortality. Among HIV-infected patients, CD4 count was a significant predictor of post-discharge mortality. Median volume of fluid resuscitation within the first 6 hours of presentation was 500 mLs (IQR 250–1000 mls). Fifty-two different empiric antibacterial regimens were used during the study. Bacteremic patients were more likely to die in hospital than non-bacterium patients (OR 1.83, 95% CI = 1.01–3.33). Patients with Mycobacterium tuberculosis (MTB) bacteremia (25/249) had higher in-hospital mortality (OR 1.97, 95% CI = 1.19–327) and lower median CD4 counts (p = 0.001) than patients without MTB bacteremia.
Conclusion: Patients presenting with sepsis syndromes to two Ugandan hospitals had late stage HIV infection and high mortality. Bacteremia, especially from MTB, was associated with increased in-hospital mortality. Most clinical predictors of in hospital mortality were easily measurable and can be used for triaging patients in resource-constrained settings. Procurement of low cost and high impact treatments like intravenous fluids and empiric antibiotics may help decrease sepsis-associated mortality in resource-constrained settings. |
| URI: | http://hdl.handle.net/123456789/1594 |
| ISSN: | 1932-6203 |
| Appears in Collections: | Research Articles (Health-Sciences)
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| Banura-Chs-Res.pdf | | 229Kb | Adobe PDF | View/Open |
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