Epidemiology, Management, and Outcomes of Sepsis in Intensive Care Units Among Countries of Differing National Wealth Across Asia.

Rationale - Directly comparative data on sepsis epidemiology and sepsis bundle implementation in countries of differing national wealth remain sparse. Objectives - To evaluate across countries/regions of differing income status in Asia (a) the prevalence, causes, and outcomes of sepsis as a reason for ICU admission and (b) sepsis bundle (antibiotics administration, blood culture and lactate measurement) compliance and its association with hospital mortality. Methods - Prospective point-prevalence study among 386 adult intensive care units (ICU) from 22 Asian countries/regions. Adult ICU participants admitted for sepsis on four separate days (representing the seasons of 2019) were recruited. Measurements and Main Results - Overall prevalence of sepsis in ICU was 22.4% [20.9% vs 24.5% vs 21.3% in low-income/lower-middle-income (LICs/LMICs), upper-middle-income (UMICs), and high-income countries/regions (HICs) respectively, p<0.001]. Patients were younger and had lower severity of illness in LICs/LMICs. Hospital mortality was 32.6%, and marginally significantly higher in LICs/LMICs than HICs on multivariable generalized mixed model analysis [adjusted odds ratio (AOR) 1.84 (95% CI 1.00-3.37), p=0.049]. Sepsis bundle compliance was 21.5% at 1 hour (26.0% vs 22.1% vs 16.2% in LICs/LMICs, UMICs, and HICs respectively, p<0.001), and 36.6% at 3 hours (39.3% vs 32.8% vs 38.5% respectively, p=0.001). Delaying antibiotics administration beyond 3 hours was the only element independently associated with increased mortality [AOR 2.53 (95% CI 2.07-3.08), p<0.001]. Conclusions - Sepsis is a common cause of admission to Asian ICUs. Mortality remains high, and is higher in LICs/LMICs after controlling for confounders. Sepsis bundle compliance remains low. Delaying antibiotics administration beyond three hours from diagnosis is associated with increased mortality.