Long-term Mortality Among Hospitalized Adults with Sepsis in Uganda: a Prospective Cohort Study

Abstract

BackgroundTwelve-month mortality in sepsis survivors has not been previously characterized in sub-Saharan Africa.MethodsHospitalized adults with ≥ 2 modified systemic inflammatory response syndrome (SIRS) criteria (temperature < 36°C or > 38°C, heart rate ≥ 90 beats per minute, or respiratory rate ≥ 20 breaths per minute) were enrolled at a tertiary care centre from October 2017 to August 2022. Multiple clinical blood and respiratory molecular and antigen assays were used to identify infectious etiologies. Baseline demographics were evaluated for risk of death by 1 month and 12 months using Cox proportional hazards regression.ResultsAmong 435 participants, the median age was 45.0 years (interquartile range [IQR]: 28.0, 60.0) years, 57.6% were female, and 31.7% were living with HIV. Malaria (17.7%) followed by tuberculosis (4.7%), and bacteremia (4.6%) were the most common detected causes of illness. Overall, 49 (11.3%) participants died, and 24 participants died between one month and one year (49.0% of deaths and 5.5% of the cohort). Female participants had a decreased risk of death by 12-months (unadjusted hazard ratio [HR]: 0.37; 95% confidence interval [CI]: 0.21 to 0.66).ConclusionsThe burden of sepsis may be underestimated in sub-Saharan Africa due to limited long-term follow-up.