Differences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Study
Autor(a) principal: | |
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Data de Publicação: | 2013 |
Outros Autores: | , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://repositorio.unifesp.br/handle/11600/36422 http://dx.doi.org/10.1371/journal.pone.0064790 |
Resumo: | 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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Conde, Katia Aparecida Pessoa [UNIFESP]Silva, EliezerSilva, Carla OliveiraFerreira, ElaineFreitas, Flavio Geraldo Rezende [UNIFESP]Castro, IsacRea-Neto, AlvaroCarvalho Grion, Cintia MagalhaesMoura, Anselmo DornasLobo, Suzana MargarethPontes Azevedo, Luciano Cesar [UNIFESP]Machado, Flavia Ribeiro [UNIFESP]Universidade Federal de São Paulo (UNIFESP)Latin Amer Sepsis InstCtr Estudos & Pesquisas Terapia Intens CEPETIHosp Univ LondrinaHosp Mater DeiUniversidade de São Paulo (USP)2016-01-24T14:31:53Z2016-01-24T14:31:53Z2013-06-06Plos One. San Francisco: Public Library Science, v. 8, n. 6, 11 p., 2013.1932-6203http://repositorio.unifesp.br/handle/11600/36422http://dx.doi.org/10.1371/journal.pone.0064790WOS000321099000022.pdf10.1371/journal.pone.0064790WOS:000321099000022Background: 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.Eli LillyLatin America Sepsis InstituteUniversidade Federal de São Paulo, Dept Anestesiol Dor & Terapia Intens, São Paulo, BrazilLatin Amer Sepsis Inst, São Paulo, BrazilCtr Estudos & Pesquisas Terapia Intens CEPETI, Curitiba, Parana, BrazilHosp Univ Londrina, Div Terapia Intens, Londrina, PR, BrazilHosp Mater Dei, Intens Care Unit, Belo Horizonte, MG, BrazilHosp Base, Fac Med Sao Jose Rio Preto, Serv Terapia Intens, Sao Jose Do Rio Preto, SP, BrazilUniversidade Federal de São Paulo, Dept Anestesiol Dor & Terapia Intens, São Paulo, BrazilWeb of Science11engPublic Library SciencePlos OneDifferences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Studyinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESPORIGINALWOS000321099000022.pdfapplication/pdf683364${dspace.ui.url}/bitstream/11600/36422/1/WOS000321099000022.pdf54f907bc8c745290e77ab9775c34804eMD51open accessTEXTWOS000321099000022.pdf.txtWOS000321099000022.pdf.txtExtracted texttext/plain49731${dspace.ui.url}/bitstream/11600/36422/2/WOS000321099000022.pdf.txt5bb29a89be3626b13d1ef954a20328efMD52open access11600/364222022-06-02 09:02:14.943open accessoai:repositorio.unifesp.br:11600/36422Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652022-06-02T12:02:14Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.en.fl_str_mv |
Differences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Study |
title |
Differences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Study |
spellingShingle |
Differences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Study Conde, Katia Aparecida Pessoa [UNIFESP] |
title_short |
Differences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Study |
title_full |
Differences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Study |
title_fullStr |
Differences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Study |
title_full_unstemmed |
Differences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Study |
title_sort |
Differences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Study |
author |
Conde, Katia Aparecida Pessoa [UNIFESP] |
author_facet |
Conde, Katia Aparecida Pessoa [UNIFESP] Silva, Eliezer Silva, Carla Oliveira Ferreira, Elaine Freitas, Flavio Geraldo Rezende [UNIFESP] Castro, Isac Rea-Neto, Alvaro Carvalho Grion, Cintia Magalhaes Moura, Anselmo Dornas Lobo, Suzana Margareth Pontes Azevedo, Luciano Cesar [UNIFESP] Machado, Flavia Ribeiro [UNIFESP] |
author_role |
author |
author2 |
Silva, Eliezer Silva, Carla Oliveira Ferreira, Elaine Freitas, Flavio Geraldo Rezende [UNIFESP] Castro, Isac Rea-Neto, Alvaro Carvalho Grion, Cintia Magalhaes Moura, Anselmo Dornas Lobo, Suzana Margareth Pontes Azevedo, Luciano Cesar [UNIFESP] Machado, Flavia Ribeiro [UNIFESP] |
author2_role |
author author author author author author author author author author author |
dc.contributor.institution.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) Latin Amer Sepsis Inst Ctr Estudos & Pesquisas Terapia Intens CEPETI Hosp Univ Londrina Hosp Mater Dei Universidade de São Paulo (USP) |
dc.contributor.author.fl_str_mv |
Conde, Katia Aparecida Pessoa [UNIFESP] Silva, Eliezer Silva, Carla Oliveira Ferreira, Elaine Freitas, Flavio Geraldo Rezende [UNIFESP] Castro, Isac Rea-Neto, Alvaro Carvalho Grion, Cintia Magalhaes Moura, Anselmo Dornas Lobo, Suzana Margareth Pontes Azevedo, Luciano Cesar [UNIFESP] Machado, Flavia Ribeiro [UNIFESP] |
description |
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. |
publishDate |
2013 |
dc.date.issued.fl_str_mv |
2013-06-06 |
dc.date.accessioned.fl_str_mv |
2016-01-24T14:31:53Z |
dc.date.available.fl_str_mv |
2016-01-24T14:31:53Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
Plos One. San Francisco: Public Library Science, v. 8, n. 6, 11 p., 2013. |
dc.identifier.uri.fl_str_mv |
http://repositorio.unifesp.br/handle/11600/36422 http://dx.doi.org/10.1371/journal.pone.0064790 |
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1932-6203 |
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WOS000321099000022.pdf |
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10.1371/journal.pone.0064790 |
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Plos One. San Francisco: Public Library Science, v. 8, n. 6, 11 p., 2013. 1932-6203 WOS000321099000022.pdf 10.1371/journal.pone.0064790 WOS:000321099000022 |
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http://repositorio.unifesp.br/handle/11600/36422 http://dx.doi.org/10.1371/journal.pone.0064790 |
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