Otavio T Ranzani1,2, Manu Shankar-Hari1,3,4, David A Harrison1, Lígia S Rabello5, Jorge I F Salluh5, Kathryn M Rowan1, Marcio Soares5. 1. Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom. 2. Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. 3. Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom. 4. School of Immunology & Microbial Sciences, Kings College London, London, United Kingdom. 5. Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education - IDOR, Rio De Janeiro, Brazil.
Abstract
OBJECTIVES: To test whether differences in both general and sepsis-specific patient characteristics explain the observed differences in sepsis mortality between countries, using two national critical care (ICU) databases. DESIGN: Cohort study. SETTING: We analyzed 62 and 164 ICUs in Brazil and England, respectively. PATIENTS: Twenty-two-thousand four-hundred twenty-six adult ICU admissions from January 2013 to December 2013. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: After harmonizing relevant variables, we merged the first ICU episode of adult medical admissions from Brazil (ORganizational CHaractEeriSTics in cRitical cAre study) and England (Intensive Care National Audit & Research Centre Case Mix Programme). Sepsis-3 definition was used, and the primary outcome was hospital mortality. We used multilevel logistic regression models to evaluate the impact of country (Brazil vs England) on mortality, after adjustment for general (age, sex, comorbidities, functional status, admission source, time to admission) and sepsis-specific (site of infection, organ dysfunction type and number) patient characteristics. Of medical ICU admissions, 13.2% (4,505/34,150) in Brazil and 30.7% (17,921/58,316) in England met the sepsis definition. The Brazil cohort was older, had greater prevalence of severe comorbidities and dependency compared with England. Respiratory was the most common infection site in both countries. The most common organ dysfunction was cardiovascular in Brazil (41.2%) and respiratory in England (85.8%). Crude hospital mortality was similar (Brazil 41.4% vs England 39.3%; odds ratio, 1.12 [0.98-1.30]). After adjusting for general patient characteristics, there was an important change in the point-estimate of the odds ratio (0.88 [0.75-1.02]). However, after adjusting for sepsis-specific patient characteristics, the direction of effect reversed again with Brazil having higher risk-adjusted mortality (odds ratio, 1.22 [1.05-1.43]). CONCLUSIONS: Patients with sepsis admitted to ICUs in Brazil and England have important differences in general and sepsis-specific characteristics, from source of admission to organ dysfunctions. We show that comparing crude mortality from sepsis patients admitted to the ICU between countries, as currently performed, is not reliable and that the adjustment for both general and sepsis-specific patient characteristics is essential for valid international comparisons of mortality amongst sepsis patients admitted to critical care units.
OBJECTIVES: To test whether differences in both general and sepsis-specific patient characteristics explain the observed differences in sepsis mortality between countries, using two national critical care (ICU) databases. DESIGN: Cohort study. SETTING: We analyzed 62 and 164 ICUs in Brazil and England, respectively. PATIENTS: Twenty-two-thousand four-hundred twenty-six adult ICU admissions from January 2013 to December 2013. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: After harmonizing relevant variables, we merged the first ICU episode of adult medical admissions from Brazil (ORganizational CHaractEeriSTics in cRitical cAre study) and England (Intensive Care National Audit & Research Centre Case Mix Programme). Sepsis-3 definition was used, and the primary outcome was hospital mortality. We used multilevel logistic regression models to evaluate the impact of country (Brazil vs England) on mortality, after adjustment for general (age, sex, comorbidities, functional status, admission source, time to admission) and sepsis-specific (site of infection, organ dysfunction type and number) patient characteristics. Of medical ICU admissions, 13.2% (4,505/34,150) in Brazil and 30.7% (17,921/58,316) in England met the sepsis definition. The Brazil cohort was older, had greater prevalence of severe comorbidities and dependency compared with England. Respiratory was the most common infection site in both countries. The most common organ dysfunction was cardiovascular in Brazil (41.2%) and respiratory in England (85.8%). Crude hospital mortality was similar (Brazil 41.4% vs England 39.3%; odds ratio, 1.12 [0.98-1.30]). After adjusting for general patient characteristics, there was an important change in the point-estimate of the odds ratio (0.88 [0.75-1.02]). However, after adjusting for sepsis-specific patient characteristics, the direction of effect reversed again with Brazil having higher risk-adjusted mortality (odds ratio, 1.22 [1.05-1.43]). CONCLUSIONS:Patients with sepsis admitted to ICUs in Brazil and England have important differences in general and sepsis-specific characteristics, from source of admission to organ dysfunctions. We show that comparing crude mortality from sepsispatients admitted to the ICU between countries, as currently performed, is not reliable and that the adjustment for both general and sepsis-specific patient characteristics is essential for valid international comparisons of mortality amongst sepsispatients admitted to critical care units.
Authors: Hallie C Prescott; Theodore J Iwashyna; Bronagh Blackwood; Thierry Calandra; Linda L Chlan; Karen Choong; Bronwen Connolly; Paul Dark; Luigi Ferrucci; Simon Finfer; Timothy D Girard; Carol Hodgson; Ramona O Hopkins; Catherine L Hough; James C Jackson; Flavia R Machado; John C Marshall; Cheryl Misak; Dale M Needham; Pinaki Panigrahi; Konrad Reinhart; Sachin Yende; Ross Zafonte; Kathryn M Rowan; Derek C Angus Journal: Am J Respir Crit Care Med Date: 2019-10-15 Impact factor: 21.405
Authors: Son Ngoc Do; Chinh Quoc Luong; Dung Thi Pham; My Ha Nguyen; Nga Thi Nguyen; Dai Quang Huynh; Quoc Trong Ai Hoang; Co Xuan Dao; Trung Minh Le; Ha Nhat Bui; Hung Tan Nguyen; Hai Bui Hoang; Thuy Thi Phuong Le; Lien Thi Bao Nguyen; Phuoc Thien Duong; Tuan Dang Nguyen; Yen Hai Vu; Giang Thi Tra Pham; Tam Van Bui; Thao Thi Ngoc Pham; Hanh Trong Hoang; Cuong Van Bui; Nguyen Minh Nguyen; Giang Thi Huong Bui; Thang Dinh Vu; Nhan Duc Le; Trang Huyen Tran; Thang Quang Nguyen; Vuong Hung Le; Chi Van Nguyen; Bryan Francis McNally; Jason Phua; Anh Dat Nguyen Journal: Sci Rep Date: 2021-09-23 Impact factor: 4.379
Authors: Peter Bank Pedersen; Daniel Pilsgaard Henriksen; Mikkel Brabrand; Annmarie Touborg Lassen Journal: BMJ Open Date: 2019-10-30 Impact factor: 2.692