Factors relating to mortality in septic patients in Vietnamese intensive care units from a subgroup analysis of MOSAICS II study

Abstract

Sepsis is the most common cause of in-hospital deaths, especially from low-income and lower-middle-income countries (LMICs). This study aimed to investigate the mortality rate and associated factors from sepsis in intensive care units (ICUs) in an LMIC. We did a multicenter cross-sectional study of septic patients presenting to 15 adult ICUs throughout Vietnam on the 4 days representing the different seasons of 2019. Of 252 patients, 40.1% died in hospital and 33.3% died in ICU. ICUs with accredited training programs (odds ratio, OR: 0.309; 95% confidence interval, CI 0.122–0.783) and completion of the 3-h sepsis bundle (OR: 0.294; 95% CI 0.083–1.048) were associated with decreased hospital mortality. ICUs with intensivist-to-patient ratio of 1:6 to 8 (OR: 4.533; 95% CI 1.621–12.677), mechanical ventilation (OR: 3.890; 95% CI 1.445–10.474) and renal replacement therapy (OR: 2.816; 95% CI 1.318–6.016) were associated with increased ICU mortality, in contrast to non-surgical source control (OR: 0.292; 95% CI 0.126–0.678) which was associated with decreased ICU mortality. Improvements are needed in the management of sepsis in Vietnam such as increasing resources in critical care settings, making accredited training programs more available, improving compliance with sepsis bundles of care, and treating underlying illness and shock optimally in septic patients.

Performance Assessment of the Universal Vital Assessment Score vs Other Illness Severity Scores for Predicting Risk of In-Hospital Death Among Adult Febrile Inpatients in Northern Tanzania, 2016-2019

“… 3 , 5 , 6 Furthermore, severe febrile illness outcomes likely differ owing to patterns of comorbidities and the availability of intensive care. 11 It is unsurprising that studies of existing illness severity scores derived in high-income countries have shown mixed results for predictive performance for adverse outcomes in LMICs. 12 , 13 , 14 , 15 , 16 …”

Sequential Organ Failure Assessment (SOFA) score for predicting mortality in patients with sepsis in Vietnamese intensive care units: A multicentre, cross-sectional study

“…(4, 36) In our study, however, the hospital and ICU mortality rates are higher than that reported in the international Extended Study on Prevalence of Infection in Intensive Care (EPIC III) study (30.3% [2404/7936] and 23.6% [1870/7936], respectively). (37) These differences might be because the EPIC III included ICU-acquired infection and not specifically sepsis,(37) and also might be because the patients, pathogens, and clinical capacity to manage sepsis differ considerably between HIC and LMIC settings(7, 33, 37).…”

“…This multicentre observational, cross-sectional, point prevalence study is part of the Management of Severe sepsis in Asia’s Intensive Care unitS II (MOSAICS II) study,(32, 33) which collects data on the management of sepsis in Asia. In this study, we used only data from Vietnam.…”

“…Other factors were independently associated with the risk of the hospital and ICU mortalities, as shown in Table 3 and Tables S17 and S18 (as shown in Supplementary file 3). 37) and also might be because the patients, pathogens, and clinical capacity to manage sepsis differ considerably between HIC and LMIC settings (7,33,37).…”

Sepsis Management in Southeast Asia: A Review and Clinical Experience

“…The conventional treatment for sepsis involves antibiotics, plasma, oxygen and other blood products to help with thromboembolic complications, and vasoactive medications and intravenous fluids for stabilizing the blood circulation and maintaining blood pressure [9]. There have been various sepsis studies in the Southeast Asia including Bangladesh [10,11], India [11][12][13], Indonesia [14,15], Nepal [6,11,16,17], Pakistan [7], Sri Lanka [18,19], Thailand [14,20] and Vietnam [14,21]. Appropriate management of sepsis is required, especially in Southeast Asian countries where the mortality rate is high [9].…”