Differences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Study
Open Access
- 6 June 2013
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 8 (6), e64790
- https://doi.org/10.1371/journal.pone.0064790
Abstract
Background: Previous studies showed higher sepsis mortality rates in Brazil compared to other developed or developing countries. Moreover, another trial demonstrated an increased mortality rate in public hospitals compared to private hospitals in Brazil. the reasons for these findings may include delayed recognition and inadequate treatment of sepsis in public facilities. We designed this study to evaluate the factors associated with mortality in septic patients admitted to intensive care units in a network of public and private institutions.Materials and Methods: This study is a retrospective analysis of a prospective cohort of sepsis patients in 19 private and public institutions in Brazil. We analyzed data from the original database and collected additional data to assess compliance to the treatment guidelines and to determine the time from the onset of organ dysfunction and the sepsis diagnosis by the healthcare team.Results: A total of 396 patients were analyzed. Patients in public hospitals were younger, had a greater number of dysfunctional organs at baseline and a lower chance to have sepsis diagnosed within two hours of the onset of organ dysfunction. Private hospitals had a better compliance to lactate and blood culture sampling and maintenance of glycemic control. the multivariate analysis showed that age, disease severity at baseline and being treated at a public hospital were independent risk factors for mortality. A delay in the sepsis diagnosis of longer than two hours was associated with mortality only in the public setting.Conclusions: We confirmed a lower sepsis mortality rate in the private hospitals of this network. Being treated in a public hospital was an independent factor for mortality. Delayed recognition of sepsis was more frequent in public institutions and this might have been associated with a higher mortality. Improving sepsis recognition and early diagnosis may be important targets in public institutions.Eli LillyLatin America Sepsis InstituteUniversidade Federal de São Paulo, Dept Anestesiol Dor & Terapia Intens, São Paulo, BrazilLatin Amer Sepsis Inst, São Paulo, BrazilCtr Estudos & Pesquisas Terapia Intens CEPETI, Curitiba, Parana, BrazilHosp Univ Londrina, Div Terapia Intens, Londrina, PR, BrazilHosp Mater Dei, Intens Care Unit, Belo Horizonte, MG, BrazilHosp Base, Fac Med Sao Jose Rio Preto, Serv Terapia Intens, Sao Jose Do Rio Preto, SP, BrazilUniversidade Federal de São Paulo, Dept Anestesiol Dor & Terapia Intens, São Paulo, BrazilWeb of SciencKeywords
This publication has 28 references indexed in Scilit:
- Decreasing Mortality in Severe Sepsis and Septic Shock Patients by Implementing a Sepsis Bundle in a Hospital SettingPLOS ONE, 2011
- An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational StudiesMultivariate Behavioral Research, 2011
- The implications of propensity score variable selection strategies in pharmacoepidemiology: an empirical illustrationPharmacoepidemiology and Drug Safety, 2011
- Reduced mortality after the implementation of a protocol for the early detection of severe sepsisJournal of Critical Care, 2011
- Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort studyCritical Care, 2011
- The Surviving Sepsis Campaign: Results of an international guideline-based performance improvement program targeting severe sepsis*Critical Care Medicine, 2010
- Key Process Indicators of Mortality in the Implementation of Protocol-driven Therapy for Severe SepsisJournal of the Formosan Medical Association, 2009
- Variable Selection for Propensity Score ModelsAmerican Journal of Epidemiology, 2006
- The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failureIntensive Care Medicine, 1996
- The central role of the propensity score in observational studies for causal effectsBiometrika, 1983