dc.contributor.author | Jacob, Shevin T. | |
dc.contributor.author | Banura, Patrick | |
dc.contributor.author | Moore, Christopher C. | |
dc.contributor.author | Pinkerton, Relana | |
dc.contributor.author | Meya, David | |
dc.contributor.author | Opendi, Pius | |
dc.contributor.author | Reynolds, Steven J. | |
dc.contributor.author | Kenya-Mugisha, Nathan | |
dc.contributor.author | Mayanja-Kizza, Harriet | |
dc.contributor.author | Scheld, Michael W. | |
dc.date.accessioned | 2012-12-04T12:36:06Z | |
dc.date.available | 2012-12-04T12:36:06Z | |
dc.date.issued | 2009-11-11 | |
dc.identifier.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) | en_US |
dc.identifier.issn | 1932-6203 | |
dc.identifier.uri | http://hdl.handle.net/10570/908 | |
dc.description | Pfizer Initiative in International Health, Division of Intramural Research, NIAID/NIH | en_US |
dc.description.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. | en_US |
dc.language.iso | en | en_US |
dc.publisher | Public Library of Science | en_US |
dc.subject | Sepsis syndrome | en_US |
dc.subject | Sub-Saharan Africa | en_US |
dc.subject | Mortality | en_US |
dc.subject | Epidemiology | en_US |
dc.subject | Thrombocytopenia | en_US |
dc.subject | HIV-infected patients | en_US |
dc.subject | Uganda | en_US |
dc.subject | Data management | en_US |
dc.subject | Infectious disease | en_US |
dc.subject | HIV/AIDS | en_US |
dc.subject | CD4 cell count | en_US |
dc.title | Severe sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected population | en_US |
dc.type | Journal article, peer reviewed | en_US |