Sepsis carries a high mortality among hospitalised adults in Malawi in the era of antiretroviral therapy scale-up: A longitudinal cohort study
Sepsis carries a high mortality among hospitalised adults in Malawi in the era of antiretroviral therapy scale-up: A longitudinal cohort study
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DOI：
10.1016/j.jinf.2014.07.004
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发表时间：
2015-01-01
影响因子：
28.2
通讯作者：
Heyderman, Robert S.
中科院分区：
文献类型：
--
作者：
Waitt, Peter I.;Mukaka, Mavuto;Heyderman, Robert S.
目的：评估在HIV高流行率和ART广泛流行的环境下，在非洲教学医院就诊的成人中患有脓毒症和严重脓毒症的死亡风险。方法：对2008年11月至2009年1月在马拉维布兰太尔的伊丽莎白女王中心医院接受临床怀疑严重感染的成年人(年龄=16岁)进行前瞻性队列研究，该医院有1250张床位。入院时获取包括血液和脑脊液培养在内的人口学、临床和实验室信息。结果：分析了213例患者的资料，其中败血症181例，严重败血症32例，男：女=2：3。HIV阳性161例(75.6%)。总死亡率为22%，在严重脓毒症患者中上升至50%。所有在90天内开始接受抗逆转录病毒治疗(ART)的脓毒症患者的死亡率为11/28(39.3%)，而接受抗逆转录病毒治疗(ART)90天以上的脓毒症患者的死亡率为7/42(16.7%)(p=0.050)。与死亡相关的独立因素是缺氧(OR=2.4；95%CI，1.1-5.1)和收缩期低血压(OR 7.0；95%CI：2.4-20.4)。结论：在马拉维，败血症和严重脓毒症的住院成人死亡率很高。迫切需要采取措施减少这种情况，包括对高危患者，特别是最近开始接受抗逆转录病毒治疗的艾滋病毒阳性患者进行早期识别和有针对性的干预。(C)2014年提交人。由爱思唯尔有限公司代表英国感染协会出版。
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 anti-retroviral 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. (C) 2014 The Authors. Published by Elsevier Ltd on behalf of the The British Infection Association.