Abstract
PurposeFew studies have assessed the presentation, management, and outcomes of sepsis in low-income countries (LICs). We sought to characterize these aspects of sepsis and to assess mortality predictors in sepsis in two referral hospitals in Rwanda.Materials and methodsThis was a retrospective cohort study in two public academic referral hospitals in Rwanda. Data was abstracted from paper medical records of adult patients who met our criteria for sepsis.ResultsOf the 181 subjects who met eligibility criteria, 111 (61.3%) met our criteria for sepsis without shock and 70 (38.7%) met our criteria for septic shock. Thirty-five subjects (19.3%) were known to be HIV positive. The vast majority of septic patients (92.7%) received intravenous fluid therapy (median = 1.0 L within 8 hours), and 94.0% received antimicrobials. Vasopressors were administered to 32.0% of the cohort and 46.4% received mechanical ventilation. In-hospital mortality for all patients with sepsis was 51.4%, and it was 82.9% for those with septic shock. Baseline characteristic mortality predictors were respiratory rate, Glasgow Coma Scale score, and known HIV seropositivity.ConclusionsSeptic patients in two public tertiary referral hospitals in Rwanda are young (median age = 40, IQR = 29, 59) and experience high rates of mortality. Predictors of mortality included baseline clinical characteristics and HIV seropositivity status. The majority of subjects were treated with intravenous fluids and antimicrobials. Further work is needed to understand clinical and management factors that may help improve mortality in septic patients in LICs.
Highlights
Sepsis is a dysregulated host response to infection that results in life-threatening organ dysfunction [1]
Vasopressors were administered to 32.0% of the cohort and 46.4% received mechanical ventilation
Based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, an estimated 48.9 million people worldwide experienced sepsis in 2017, with 11.0 million deaths [2]. This burden is high in low-income countries (LICs), with an estimated 16.7 million cases of sepsis occurring annually in sub-Saharan Africa [2]
Summary
Sepsis is a dysregulated host response to infection that results in life-threatening organ dysfunction [1]. Based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, an estimated 48.9 million people worldwide experienced sepsis in 2017, with 11.0 million deaths [2] This burden is high in low-income countries (LICs), with an estimated 16.7 million cases of sepsis occurring annually in sub-Saharan Africa [2]. In a referral hospital in the capital city of Haiti, the most common sources of infection in patients with sepsis were lung and intra-abdominal [8] Management at this facility consisted of intravenous fluid resuscitation in 80% of patients with severe sepsis, and 54.6% of patients with severe sepsis received antimicrobials within 24 hours, with the most commonly used antimicrobials being ceftriaxone and chloroquine
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