Machado FR, et al. - Researchers here investigated incidence, prevalence, and mortality of sepsis in adult Brazilian intensive care units (ICUs) and association of ICU organisational factors with outcome. Findings revealed a high incidence, prevalence, and mortality of ICU-treated sepsis in Brazil. They observed that outcome varied markedly and was associated with access to adequate resources and treatment. The burden of sepsis was identified in resource-limited settings, highlighting the need to establish programmes aiming for sepsis prevention, early diagnosis, and adequate treatment.

Methods

• In a nationally representative pseudo-random sample, a 1-day point prevalence study with follow-up of patients in ICU with sepsis was performed.
• Initially stratified by geographical region, a sampling frame was produced.
• Then, stratification was performed of each stratum by hospitals' main source of income (serving general public vs privately insured individuals) and ICU size (ten or fewer beds vs more than ten beds), finally generating 40 strata.
• In each stratum, a random sample of ICUs was selected so as to enroll the total required beds in 1690 Brazilian adult ICUs.
• Follow up of patients was performed until hospital discharge censored at 60 days.
• Incidence was estimated from prevalence and length of stay, and national estimates were generated.
• Mortality prognostic factors were assessed using random-effects logistic regression models.

Results

• On Feb 27, 2014, data on 2,632 patients was provided by 227 (72%) of selected 317 ICUs.
• Of 2632 patients, 794 had sepsis (30.2 septic patients per 100 ICU beds, 95% CI 28.4–31.9).
• Researchers observed the ICU sepsis incidence of 36.3 per 1000 patient-days (95% CI 29.8–44.0) and mortality in 439 (55.7%) of 788 patients (95% CI 52.2–59.2).
• They identified an independent association of low availability of resources (odds ratio [OR] 1.67, 95% CI 1.02–2.75, p=0.045) and adequacy of treatment (OR 0.56, 0.37–0.84, p=0.006) with mortality.
• Observations revealed the projected incidence rate of 290 per 100,000 population (95% CI 237.9–351.2) of adult cases of ICU-treated sepsis per year, which yields about 420,000 cases annually, of whom 230,000 die in hospital.