Outcomes of patients with severe sepsis after the first 6 hours of resuscitation at a regional referral hospital in Uganda

详细信息    查看全文

• 作者：Abdallah Amir ; MBChB ; MMed^a ; ^{dr.amir83@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Kacie J. Saulters ; MD^b ; ¹ ; ^{kaciesaulters@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Sam Olum ; MBChB ; MMed^a ; ^{soketokeny@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Kelly Pitts ; MD^b ; ^{kp7dq@virginia.edu" class="auth_mail" title="E-mail the corresponding author} ; Andrew Parsons ; MD ; MPH^b ; ^{asp5c@virginia.edu" class="auth_mail" title="E-mail the corresponding author} ; Cristina Churchill ; MD^b ; ^{cc8qg@virginia.edu" class="auth_mail" title="E-mail the corresponding author} ; Kabanda Taseera ; MBChB ; MMed^a ; ^{kabtash@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Rose Muhindo ; MBChB ; MMed^a ; ^{drmuhindo@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Christopher C. Moore ; MD^a ; ^b ; ^{ccm5u@virginia.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Severe sepsis ; Resuscitation ; Monitoring ; Mortality ; Uganda ; Africa
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：33
• 期：Complete
• 页码：78-83
• 全文大小：228 K

文摘

The optimal resuscitation strategy for patients with severe sepsis in resource-limited settings is unknown. Therefore, we determined the association between intravenous fluids, changes in vital signs and lactate after the first 6 hours of resuscitation from severe sepsis, and in-hospital mortality at a hospital in Uganda.

Materials and methods

We enrolled patients admitted with severe sepsis to Mbarara Regional Referral Hospital and obtained vital signs and point-of-care blood lactate concentration at admission and after 6 hours of resuscitation. We used logistic regression to determine predictors of in-hospital mortality.

Results

We enrolled 218 patients and had 6 hour postresuscitation data for 202 patients. The median (interquartile range) age was 35 (26-50) years, 49% of patients were female, and 57% were HIV infected. The in-hospital mortality was 32% and was associated with admission Glasgow Coma Score (adjusted odds ratio [aOR], 0.749; 95% confidence interval [CI], 0.642-0.875; P < .001), mid-upper arm circumference (aOR, 0.876; 95% CI, 0.797-0.964; P = .007), and 6-hour systolic blood pressure (aOR, 0.979; 95% CI, 0.963-0.995; P = .009) but not lactate clearance of 10% or greater (aOR, 1.2; 95% CI, 0.46-3.10; P = .73).

Conclusions

In patients with severe sepsis in Uganda, obtundation and wasting were more closely associated with in-hospital mortality than lactate clearance of 10% or greater.