Departamento de Anestesiologia, Dor e Terapia Intensiva. Universidade Federal de São Paulo, São Paulo, SP, Brazil.
PLoS One. 2013 Jun 6;8(6):e64790. doi: 10.1371/journal.pone.0064790. Print 2013.
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.
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.
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.
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.
先前的研究表明，与其他发达国家或发展中国家相比，巴西的脓毒症死亡率更高。此外，另一项试验表明，与巴西的私立医院相比，公立医院的死亡率更高。这些发现的原因可能包括公共设施中脓毒症的识别延迟和治疗不足。我们设计了这项研究，以评估在巴西一个公私机构网络中入住重症监护病房的脓毒症患者的死亡相关因素。
这是一项对巴西 19 家私立和公立医院脓毒症患者的前瞻性队列进行的回顾性分析。我们分析了原始数据库中的数据，并收集了额外的数据，以评估治疗指南的遵守情况，并确定从器官功能障碍开始到医疗团队诊断脓毒症的时间。
共分析了 396 名患者。公立医院的患者年龄较小，基线时器官功能障碍的数量较多，且有较低的机会在器官功能障碍开始后两小时内被诊断为脓毒症。私立医院更能遵守乳酸和血培养采样以及血糖控制的要求。多变量分析表明，年龄、基线时的疾病严重程度以及在公立医院治疗是死亡的独立危险因素。脓毒症诊断延迟超过两小时仅与公共环境中的死亡率相关。
我们证实了该网络中私立医院的脓毒症死亡率较低。在公立医院接受治疗是死亡的独立因素。在公立医院中，脓毒症的识别延迟更为常见，这可能与更高的死亡率有关。提高脓毒症的识别和早期诊断可能是公立医院的重要目标。
