The Variation in Outcomes of Septic Patients: A Dual-Centre Comparative Study

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Abstract

Introduction Despite significant advances in the field of medicine, sepsis is constantly growing as a major public health concern. The global epidemic of sepsis imposes a significant economic burden on healthcare systems world-over. Furthermore, its high prevalence in society is inevitably paralleled by an excessive mortality rate, with approximately six million deaths reported every year. The primary aim of this study was to evaluate and compare, the management of acutely septic patients against outcomes in a tertiary teaching institution in Pakistan versus a similar one in the United Kingdom. Methods This study was a dual-centred, retrospective comparative analysis comparing all patients admitted through the emergency department at the respective tertiary centres. Patient details were collected and compared across the two sites to evaluate the effect of individual characteristics on prognosis. The outcomes of these presentations were analysed by comparing rates of in-hospital mortality, admission to the ICU or discharge. Results The total number of patients identified as having sepsis was 60 in the Pakistan cohort, and 92 in the Aberdeen cohort. No significant difference was found when comparing genders, and the results of basic observations were largely similar at presentation. Twenty-five per cent (25%) (n=38) of the total study population were deemed to have a poor outcome at 3 days, but 50% of the Pakistan cohort was deemed to have a poor outcome. Conclusion Managing sepsis has developed significantly in recent years, but most of this development was implemented in high-income countries. There was a significant delay in time to resuscitate septic patients in Pakistan, with significantly raised three-day morbidity and mortality. There is a need for further comparative studies of the management of sepsis in Pakistan and other low-income countries to identify the problems and tackle obstacles on every level of the healthcare system.

Keywords: global health policy; health education & awareness; mortality rate in sepsis; resource-poor setting; surviving sepsis guidelines.

Conflict of interest statement

The authors have declared that no competing interests exist.


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References

  1.  
    1. Assessment of global incidence and mortality of hospital-treated sepsis current estimates and limitations. Fleischmann C, Scherag A, Adhikari NK, et al. Am J Respir Crit Care Med. 2016;193:259–272. - PubMed
  2.  
    1. World Health Organization. Global Report on the Epidemiology and Burden of Sepsis: Current Evidence, Identifying Gaps and Future Directions. Geneva, CH: World Health Organisation; 2020. Current evidence, identifying gaps and future directions GLOBAL REPORT ON THE EPIDEMIOLOGY AND BURDEN OF SEPSIS [Internet]
  3.  
    1. A "three delays" model for severe sepsis in resource-limited countries. Papali A, McCurdy MT, Calvello EJ. J Crit Care. 2015;30:861–814. - PubMed
  4.  
    1. Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit. Vincent JL, Marshall JC, Ñamendys-Silva SA, et al. Lancet Respir Med. 2014;2:380–386. - PubMed
  5.  
    1. Critical care and the global burden of critical illness in adults. Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Lancet. 2010;376:1339–1346. - PMC - PubMed
  6.  
    1. Raising concerns about the Sepsis-3 definitions. Sartelli M, Kluger Y, Ansaloni L, et al. World J Emerg Surg. 2018;13:6. - PMC - PubMed
  7.  
    1. New clinical criteria for septic shock: serum lactate level as new emerging vital sign. Lee SM, An WS. J Thorac Dis. 2016;8:1388–1390. - PMC - PubMed
  8.  
    1. Sepsis and septic shock: current treatment strategies and new approaches. Polat G, Ugan RA, Cadirci E, Halici Z. Eurasian J Med. 2017;49:53–58. - PMC - PubMed
  9.  
    1. Pathophysiology of sepsis. Remick DG. Am J Pathol. 2007;170:1435–1444. - PMC - PubMed
  10.  
    1. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Bone RC, Balk RA, Cerra FB, et al. Chest. 1992;101:1644–1655. - PubMed
  11.  
    1. United Kingdom Sepsis Trust. Survive Sepsis. Birmingham, UK: Sutton Coldfield; 2014. Survive sepsis.
  12.  
    1. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Daniels R, Nutbeam T, McNamara G, Galvin C. Emerg Med J. 2011;28:507–512. - PubMed
  13.  
    1. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Levy MM, Dellinger RP, Townsend SR, et al. Crit Care Med. 2010;38:367–374. - PubMed
  14.  
    1. Frequency of vital signs monitoring and its association with mortality among adults with severe sepsis admitted to a general medical ward in Uganda. Asiimwe SB, Okello S, Moore CC. PLoS One. 2014;9:0. - PMC - PubMed
  15.  
    1. The impact of early monitored management on survival in hospitalized adult Ugandan patients with severe sepsis: a prospective intervention study*. Jacob ST, Banura P, Baeten JM, et al. Crit Care Med. 2012;40:2050–2058. - PMC - PubMed
  16.  
    1. Epidemiology of severe sepsis in the emergency department and difficulties in the initial assistance. Rezende E, Silva JM Jr, Isola AM, Campos EV, Amendola CP, Almeida SL. Clinics (Sao Paulo) 2008;63:457–464. - PMC - PubMed
  17.  
    1. Epidemiology and outcome of sepsis in a tertiary-care hospital in a developing country. Tanriover MD, Guven GS, Sen D, Unal S, Uzun O. Epidemiol Infect. 2006;134:315–322. - PMC - PubMed
  18.  
    1. Scottish Trauma Audit Group. Sepsis Management in Scotland. Edinburgh, UK: NHS; 2010.
  19.  
    1. The Sepsis Six: helping patients to survive sepsis. Robson W, Daniel R. Br J Nurs. 2013;17:1. - PubMed