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

Son Ngoc ,Bryan Mcnally ,Jason Phua,Cuong Van Bui,Nga T T Nguyen ,Vuong Hung Le ,Thuy Thi Phuong Le ,Nhan Duc Le ,Thao Thi Ngoc Pham ,Yen Hai Vu ,Tuan Dang Nguyen ,Ha Nhat Bui ,Co Xuan Dao,Giang Thi Huong Bui ,Nguyen Minh Nguyen ,Phuoc Thien Duong ,Hue Thi Hoang ,Trang Huyen Tran ,My Ha Nguyen ,Tam Van Bui,Chi Van Nguyen,Giang Thi Tra Pham ,Trung Le ,Dai Quang Huynh ,Quoc Trong Ai Hoang ,Lien Thi Bao Nguyen ,Hung T Nguyen ,Duy Khanh Pham ,Hai Bui Hoang ,Chinh Quoc Luong ,Thang Quang Nguyen ,Thang Dinh Vu ,Anh Dat Nguyen

doi:10.1038/s41598-021-98165-8

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.

Highlights

Sepsis is the most common cause of in-hospital deaths, especially from low-income and lower-middleincome countries (LMICs)
More than a third of them (39.3%; 99/252) were from university-affiliated hospitals, four-fifths (80.2%; 202/252) were from intensive care units (ICUs) with accredited training programs, low rate of patients was from ICUs with the nurse-to-patient ratio of 1 or more:[1] (2.8%; 7/252) or the ratio of 1:2 (74.2%; 187/252), only 65.5% (165/252) of patients were from ICUs with the intensivist-to-patient ratio of 1:5 or fewer and 29.8% (75/252) were from ICUs with the intensivist-to-patient ratio of 1:6 to 8
The characteristics, severity of illness, sites of infection and microbiology, compliance with sepsis bundle elements, and life-sustaining treatments during ICU stay were compared between patients who survived and patients who died in the hospital, as shown in Tables 2, 3, 4, 5, and 6

Summary

Introduction

Sepsis is the most common cause of in-hospital deaths, especially from low-income and lower-middleincome countries (LMICs). This study aimed to investigate the mortality rate and associated factors from sepsis in intensive care units (ICUs) in an LMIC. 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. In Southeast Asia, a multinational multicenter cross-sectional study of community-acquired sepsis and severe sepsis shows that sepsis is caused by a wide range of known and emerging pathogens, and is associated with substantial death rates (mortality rates of 1.8% [14/763] in pediatric and 13.3% [108/815] in adult patients), of which bacteremia was commonly observed in both age groups in the study p opulation[18]

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