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Differences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study.

Conde KA, Silva E, Silva CO, Ferreira E, Freitas FG, Castro I, Rea-Neto A, Grion CM, Moura AD, Lobo SM, Azevedo LC, Machado FR - PLoS ONE (2013)

Bottom Line: Private hospitals had a better compliance to lactate and blood culture sampling and maintenance of glycemic control.The multivariate analysis showed that age, disease severity at baseline and being treated at a public hospital were independent risk factors for mortality.Being treated in a public hospital was an independent factor for mortality.

View Article: PubMed Central - PubMed

Affiliation: Departamento de Anestesiologia, Dor e Terapia Intensiva. Universidade Federal de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Background: Previous studies showed higher sepsis mortality rates in Brazil compared to other developed or developing countries. Moreover, another trial demonstrated an increased mortality rate in public hospitals compared to private hospitals in Brazil. The reasons for these findings may include delayed recognition and inadequate treatment of sepsis in public facilities. We designed this study to evaluate the factors associated with mortality in septic patients admitted to intensive care units in a network of public and private institutions.

Materials and methods: This study is a retrospective analysis of a prospective cohort of sepsis patients in 19 private and public institutions in Brazil. We analyzed data from the original database and collected additional data to assess compliance to the treatment guidelines and to determine the time from the onset of organ dysfunction and the sepsis diagnosis by the healthcare team.

Results: A total of 396 patients were analyzed. Patients in public hospitals were younger, had a greater number of dysfunctional organs at baseline and a lower chance to have sepsis diagnosed within two hours of the onset of organ dysfunction. Private hospitals had a better compliance to lactate and blood culture sampling and maintenance of glycemic control. The multivariate analysis showed that age, disease severity at baseline and being treated at a public hospital were independent risk factors for mortality. A delay in the sepsis diagnosis of longer than two hours was associated with mortality only in the public setting.

Conclusions: We confirmed a lower sepsis mortality rate in the private hospitals of this network. Being treated in a public hospital was an independent factor for mortality. Delayed recognition of sepsis was more frequent in public institutions and this might have been associated with a higher mortality. Improving sepsis recognition and early diagnosis may be important targets in public institutions.

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Related in: MedlinePlus

Study flowchart.
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pone-0064790-g001: Study flowchart.

Mentions: We analyzed 396 patients out of 524 who were originally included in the COSTS study. Forty-two patients were not included because they had sepsis without organ dysfunction. Three of the original centers did not agree to participate in this study, two public and one private, totaling 47 patients. In addition, data were missing for 39 patients from the current participating sites. To summarize, a total of 86 patients with severe sepsis or septic shock were not included in the present study (Figure 1). Ultimately, we included patients from 18 of the 21 original sites. Of these sites, nine centers were characterized as public hospitals and nine as private hospitals. The participating centers are listed in Table S1.


Differences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study.

Conde KA, Silva E, Silva CO, Ferreira E, Freitas FG, Castro I, Rea-Neto A, Grion CM, Moura AD, Lobo SM, Azevedo LC, Machado FR - PLoS ONE (2013)

Study flowchart.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3675193&req=5

pone-0064790-g001: Study flowchart.
Mentions: We analyzed 396 patients out of 524 who were originally included in the COSTS study. Forty-two patients were not included because they had sepsis without organ dysfunction. Three of the original centers did not agree to participate in this study, two public and one private, totaling 47 patients. In addition, data were missing for 39 patients from the current participating sites. To summarize, a total of 86 patients with severe sepsis or septic shock were not included in the present study (Figure 1). Ultimately, we included patients from 18 of the 21 original sites. Of these sites, nine centers were characterized as public hospitals and nine as private hospitals. The participating centers are listed in Table S1.

Bottom Line: Private hospitals had a better compliance to lactate and blood culture sampling and maintenance of glycemic control.The multivariate analysis showed that age, disease severity at baseline and being treated at a public hospital were independent risk factors for mortality.Being treated in a public hospital was an independent factor for mortality.

View Article: PubMed Central - PubMed

Affiliation: Departamento de Anestesiologia, Dor e Terapia Intensiva. Universidade Federal de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Background: Previous studies showed higher sepsis mortality rates in Brazil compared to other developed or developing countries. Moreover, another trial demonstrated an increased mortality rate in public hospitals compared to private hospitals in Brazil. The reasons for these findings may include delayed recognition and inadequate treatment of sepsis in public facilities. We designed this study to evaluate the factors associated with mortality in septic patients admitted to intensive care units in a network of public and private institutions.

Materials and methods: This study is a retrospective analysis of a prospective cohort of sepsis patients in 19 private and public institutions in Brazil. We analyzed data from the original database and collected additional data to assess compliance to the treatment guidelines and to determine the time from the onset of organ dysfunction and the sepsis diagnosis by the healthcare team.

Results: A total of 396 patients were analyzed. Patients in public hospitals were younger, had a greater number of dysfunctional organs at baseline and a lower chance to have sepsis diagnosed within two hours of the onset of organ dysfunction. Private hospitals had a better compliance to lactate and blood culture sampling and maintenance of glycemic control. The multivariate analysis showed that age, disease severity at baseline and being treated at a public hospital were independent risk factors for mortality. A delay in the sepsis diagnosis of longer than two hours was associated with mortality only in the public setting.

Conclusions: We confirmed a lower sepsis mortality rate in the private hospitals of this network. Being treated in a public hospital was an independent factor for mortality. Delayed recognition of sepsis was more frequent in public institutions and this might have been associated with a higher mortality. Improving sepsis recognition and early diagnosis may be important targets in public institutions.

Show MeSH
Related in: MedlinePlus