Sepsis carries a high mortality among hospitalised adults in Malawi in the era of antiretroviral therapy scale-up: A longitudinal cohort study.
J Infect. 2014 Jul 17;
Authors: Waitt PI, Mukaka M, Goodson P, SimuKonda FD, Waitt CJ, Feasey N, Allain TJ, Downie P, Heyderman RS
Abstract
OBJECTIVE: To assess mortality risk among adults presenting to an African teaching hospital with sepsis and severe sepsis in a setting of high HIV prevalence and widespread ART uptake.
METHODS: Prospective cohort study of adults (age ≥16 years) admitted with clinical suspicion of severe infection between November 2008 and January 2009 to Queen Elizabeth Central Hospital, a 1250-bed government-funded hospital in Blantyre, Malawi. Demographic, clinical and laboratory information, including blood and cerebrospinal fluid cultures were obtained on admission.
RESULTS: Data from 213 patients (181 with sepsis and 32 with severe sepsis; M:F = 2:3) were analysed. 161 (75.6%) patients were HIV-positive. Overall mortality was 22%, rising to 50% amongst patients with severe sepsis. The mortality of all sepsis patients commenced on antiretroviral therapy (ART) within 90 days was 11/28(39.3%) compared with 7/42 (16.7%) among all sepsis patients on ART for greater than 90 days (p=0.050). Independent associations with death were hypoxia (OR=2.4; 95% CI, 1.1-5.1) and systolic hypotension (OR 7.0; 95% CI: 2.4-20.4).
CONCLUSIONS: Sepsis and severe sepsis carry high mortality among hospitalised adults in Malawi. Measures to reduce this, including early identification and targeted intervention in high-risk patients, especially HIV-positive individuals recently commenced on ART, are urgently required.
PMID: 25043393 [PubMed - as supplied by publisher]