Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case–control study
Abstract Background Nosocomial sepsis is a major healthcare issue, but there are few data on estimates of its attributable mortality. We aimed to estimate attributable mortality fraction (AF) due to nosocomial sepsis. Methods Matched 1:1 case–control study in 37 hospitals in Brazil. Hospitalized pat...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-04-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-023-01123-y |
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| author | Fernando G. Zampieri Alexandre B. Cavalcanti Leandro U. Taniguchi Thiago C. Lisboa Ary Serpa-Neto Luciano C. P. Azevedo Antonio Paulo Nassar Tamiris A. Miranda Samara P. C. Gomes Meton S. de Alencar Filho Rodrigo T. Amancio da Silva Fabio Holanda Lacerda Viviane Cordeiro Veiga Airton Leonardo de Oliveira Manoel Rodrigo S. Biondi Israel S. Maia Wilson J. Lovato Claudio Dornas de Oliveira Felipe Dal Pizzol Milton Caldeira Filho Cristina P. Amendola Glauco A. Westphal Rodrigo C. Figueiredo Eliana B. Caser Lanese M. de Figueiredo Flávio Geraldo R. de Freitas Sergio S. Fernandes Andre Luiz N. Gobatto Jorge Luiz R. Paranhos Rodrigo Morel V. de Melo Michelle T. Sousa Guacyra Margarita B. de Almeida Bianca R. Ferronatto Denise M. Ferreira Fernando J. S. Ramos Marlus M. Thompson Cintia M. C. Grion Renato Hideo Nakagawa Santos Lucas P. Damiani Flavia R. Machado for the MAPA investigators, the BRICNet |
| author_facet | Fernando G. Zampieri Alexandre B. Cavalcanti Leandro U. Taniguchi Thiago C. Lisboa Ary Serpa-Neto Luciano C. P. Azevedo Antonio Paulo Nassar Tamiris A. Miranda Samara P. C. Gomes Meton S. de Alencar Filho Rodrigo T. Amancio da Silva Fabio Holanda Lacerda Viviane Cordeiro Veiga Airton Leonardo de Oliveira Manoel Rodrigo S. Biondi Israel S. Maia Wilson J. Lovato Claudio Dornas de Oliveira Felipe Dal Pizzol Milton Caldeira Filho Cristina P. Amendola Glauco A. Westphal Rodrigo C. Figueiredo Eliana B. Caser Lanese M. de Figueiredo Flávio Geraldo R. de Freitas Sergio S. Fernandes Andre Luiz N. Gobatto Jorge Luiz R. Paranhos Rodrigo Morel V. de Melo Michelle T. Sousa Guacyra Margarita B. de Almeida Bianca R. Ferronatto Denise M. Ferreira Fernando J. S. Ramos Marlus M. Thompson Cintia M. C. Grion Renato Hideo Nakagawa Santos Lucas P. Damiani Flavia R. Machado for the MAPA investigators, the BRICNet |
| author_sort | Fernando G. Zampieri |
| collection | DOAJ |
| description | Abstract Background Nosocomial sepsis is a major healthcare issue, but there are few data on estimates of its attributable mortality. We aimed to estimate attributable mortality fraction (AF) due to nosocomial sepsis. Methods Matched 1:1 case–control study in 37 hospitals in Brazil. Hospitalized patients in participating hospitals were included. Cases were hospital non-survivors and controls were hospital survivors, which were matched by admission type and date of discharge. Exposure was defined as occurrence of nosocomial sepsis, defined as antibiotic prescription plus presence of organ dysfunction attributed to sepsis without an alternative reason for organ failure; alternative definitions were explored. Main outcome measurement was nosocomial sepsis-attributable fractions, estimated using inversed-weight probabilities methods using generalized mixed model considering time-dependency of sepsis occurrence. Results 3588 patients from 37 hospitals were included. Mean age was 63 years and 48.8% were female at birth. 470 sepsis episodes occurred in 388 patients (311 in cases and 77 in control group), with pneumonia being the most common source of infection (44.3%). Average AF for sepsis mortality was 0.076 (95% CI 0.068–0.084) for medical admissions; 0.043 (95% CI 0.032–0.055) for elective surgical admissions; and 0.036 (95% CI 0.017–0.055) for emergency surgeries. In a time-dependent analysis, AF for sepsis rose linearly for medical admissions, reaching close to 0.12 on day 28; AF plateaued earlier for other admission types (0.04 for elective surgery and 0.07 for urgent surgery). Alternative sepsis definitions yield different estimates. Conclusion The impact of nosocomial sepsis on outcome is more pronounced in medical admissions and tends to increase over time. The results, however, are sensitive to sepsis definitions. |
| first_indexed | 2024-04-09T15:06:01Z |
| format | Article |
| id | doaj.art-3a55ad45c5694717a134c78ab3147b85 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-09T15:06:01Z |
| publishDate | 2023-04-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-3a55ad45c5694717a134c78ab3147b852023-04-30T11:28:10ZengSpringerOpenAnnals of Intensive Care2110-58202023-04-0113111310.1186/s13613-023-01123-yAttributable mortality due to nosocomial sepsis in Brazilian hospitals: a case–control studyFernando G. Zampieri0Alexandre B. Cavalcanti1Leandro U. Taniguchi2Thiago C. Lisboa3Ary Serpa-Neto4Luciano C. P. Azevedo5Antonio Paulo Nassar6Tamiris A. Miranda7Samara P. C. Gomes8Meton S. de Alencar Filho9Rodrigo T. Amancio da Silva10Fabio Holanda Lacerda11Viviane Cordeiro Veiga12Airton Leonardo de Oliveira Manoel13Rodrigo S. Biondi14Israel S. Maia15Wilson J. Lovato16Claudio Dornas de Oliveira17Felipe Dal Pizzol18Milton Caldeira Filho19Cristina P. Amendola20Glauco A. Westphal21Rodrigo C. Figueiredo22Eliana B. Caser23Lanese M. de Figueiredo24Flávio Geraldo R. de Freitas25Sergio S. Fernandes26Andre Luiz N. Gobatto27Jorge Luiz R. Paranhos28Rodrigo Morel V. de Melo29Michelle T. Sousa30Guacyra Margarita B. de Almeida31Bianca R. Ferronatto32Denise M. Ferreira33Fernando J. S. Ramos34Marlus M. Thompson35Cintia M. C. Grion36Renato Hideo Nakagawa Santos37Lucas P. Damiani38Flavia R. Machado39for the MAPA investigators, the BRICNetHCor Research Institute, Rua Desembargador Eliseu GuilhermeHCor Research Institute, Rua Desembargador Eliseu GuilhermeIntensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloHCor Research Institute, Rua Desembargador Eliseu GuilhermeDepartment of Critical Care Medicine, Hospital Israelita Albert EinsteinIntensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloIntensive Care Unit, AC Camargo Cancer CenterHCor Research Institute, Rua Desembargador Eliseu GuilhermeHCor Research Institute, Rua Desembargador Eliseu GuilhermeHospital Maternidade São Vicente de PauloHospital Federal dos Servidores do EstadoHospital da LuzBP-A Beneficência Portuguesa de São PauloHospital PaulistanoInstituto de Cardiologia do Distrito FederalHCor Research Institute, Rua Desembargador Eliseu GuilhermeHospital das Clínicas da Faculdade de Medicina de Ribeirão PretoSanta Casa de Misericórdia Belo HorizonteHospital São JoséHospital Dona HelenaHospital de Amor-Fundação PIO XIICentro Hospitalar UnimedHospital Maternidade São JoséHospital Unimed VitóriaHospital Distrital Evandro Ayres de Moura Antônio BezerraHospital e Maternidade SepacoHospital Japones Santa CruzHospital da CidadeSanta Casa de Misericórdia de São João Del ReiHospital Ana NeryFundação São Francisco de AssisHospital Regional Dr. Clodolfo Rodrigues de MeloHospital Erasto GaertnerHospital das Clínicas da Universidade Federal de GoiásBP-A Beneficência Portuguesa de São PauloHospital Evangélico de Cachoeiro de ItapemirimHospital Universitário Regional do Norte do ParanáHCor Research Institute, Rua Desembargador Eliseu GuilhermeHCor Research Institute, Rua Desembargador Eliseu GuilhermeDepartment of Anesthesiology, Pain and Critical Care-Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de Sao PauloAbstract Background Nosocomial sepsis is a major healthcare issue, but there are few data on estimates of its attributable mortality. We aimed to estimate attributable mortality fraction (AF) due to nosocomial sepsis. Methods Matched 1:1 case–control study in 37 hospitals in Brazil. Hospitalized patients in participating hospitals were included. Cases were hospital non-survivors and controls were hospital survivors, which were matched by admission type and date of discharge. Exposure was defined as occurrence of nosocomial sepsis, defined as antibiotic prescription plus presence of organ dysfunction attributed to sepsis without an alternative reason for organ failure; alternative definitions were explored. Main outcome measurement was nosocomial sepsis-attributable fractions, estimated using inversed-weight probabilities methods using generalized mixed model considering time-dependency of sepsis occurrence. Results 3588 patients from 37 hospitals were included. Mean age was 63 years and 48.8% were female at birth. 470 sepsis episodes occurred in 388 patients (311 in cases and 77 in control group), with pneumonia being the most common source of infection (44.3%). Average AF for sepsis mortality was 0.076 (95% CI 0.068–0.084) for medical admissions; 0.043 (95% CI 0.032–0.055) for elective surgical admissions; and 0.036 (95% CI 0.017–0.055) for emergency surgeries. In a time-dependent analysis, AF for sepsis rose linearly for medical admissions, reaching close to 0.12 on day 28; AF plateaued earlier for other admission types (0.04 for elective surgery and 0.07 for urgent surgery). Alternative sepsis definitions yield different estimates. Conclusion The impact of nosocomial sepsis on outcome is more pronounced in medical admissions and tends to increase over time. The results, however, are sensitive to sepsis definitions.https://doi.org/10.1186/s13613-023-01123-ySepsisAttributable mortalityEpidemiology |
| spellingShingle | Fernando G. Zampieri Alexandre B. Cavalcanti Leandro U. Taniguchi Thiago C. Lisboa Ary Serpa-Neto Luciano C. P. Azevedo Antonio Paulo Nassar Tamiris A. Miranda Samara P. C. Gomes Meton S. de Alencar Filho Rodrigo T. Amancio da Silva Fabio Holanda Lacerda Viviane Cordeiro Veiga Airton Leonardo de Oliveira Manoel Rodrigo S. Biondi Israel S. Maia Wilson J. Lovato Claudio Dornas de Oliveira Felipe Dal Pizzol Milton Caldeira Filho Cristina P. Amendola Glauco A. Westphal Rodrigo C. Figueiredo Eliana B. Caser Lanese M. de Figueiredo Flávio Geraldo R. de Freitas Sergio S. Fernandes Andre Luiz N. Gobatto Jorge Luiz R. Paranhos Rodrigo Morel V. de Melo Michelle T. Sousa Guacyra Margarita B. de Almeida Bianca R. Ferronatto Denise M. Ferreira Fernando J. S. Ramos Marlus M. Thompson Cintia M. C. Grion Renato Hideo Nakagawa Santos Lucas P. Damiani Flavia R. Machado for the MAPA investigators, the BRICNet Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case–control study Annals of Intensive Care Sepsis Attributable mortality Epidemiology |
| title | Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case–control study |
| title_full | Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case–control study |
| title_fullStr | Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case–control study |
| title_full_unstemmed | Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case–control study |
| title_short | Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case–control study |
| title_sort | attributable mortality due to nosocomial sepsis in brazilian hospitals a case control study |
| topic | Sepsis Attributable mortality Epidemiology |
| url | https://doi.org/10.1186/s13613-023-01123-y |
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