Volume 85, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We evaluated the association between severity of sepsis and in-hospital mortality in 150 patients with non-surgical sepsis at a regional referral hospital in Uganda. In-hospital mortality occurred in 5 of 52 (9.6%) patients with sepsis, 24 of 71 (33.8%) patients with severe sepsis, and 16 of 27 (59.3%) patients with septic shock. In the multivariate analysis, the identification of severe sepsis (adjusted hazard ratio [AHR] = 2.9, 95% confidence interval [CI] = 1.0–8.2, = 0.04), septic shock (AHR = 5.7, 95% CI = 1.6–20.3, = 0.007), and dysfunction of three or more organs (AHR = 2.9, 95% CI = 1.1–7.3, = 0.03) increased the risk of in-hospital mortality. Adding aggregate organ dysfunction to the multivariate equation that included the sepsis category statistically significantly improved the model, but the opposite did not. Predictors of mortality were easily measurable and could be used to risk stratify critically ill patients in resource-constrained settings.


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  1. World Health Organization, 2008. The Global Burden of Disease (2004 Update). Geneva, Switzerland: World Health Organization.
  2. Cheng AC, West TE, Limmathurotsakul D, Peacock SJ, , 2008. Strategies to reduce mortality from bacterial sepsis in adults in developing countries. PLoS Med 5: e175.[Crossref]
  3. Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD, , 2010. Critical care and the global burden of critical illness in adults. Lancet 376: 13391346.[Crossref]
  4. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, , 2003. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31: 12501256.[Crossref]
  5. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ, , 1995. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 23: 16381652.[Crossref]
  6. Vincent JL, Moreno R, Takala J, Willatts S, De MA, Bruining H, Reinhart CK, Suter PM, Thijs LG, , 1996. The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22: 707710.[Crossref]
  7. Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW, , 2003. Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule. Crit Care Med 31: 670675.[Crossref]
  8. Jacob ST, Moore CC, Banura P, Pinkerton R, Meya D, Opendi P, Reynolds SJ, Kenya-Mugisha N, Mayanja-Kizza H, Scheld WM, , 2009. Severe sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected population. PLoS One 4: e7782.[Crossref]
  9. Reddy EA, Shaw AV, Crump JA, , 2010. Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis. Lancet Infect Dis 10: 417432.[Crossref]
  10. Moore CC, Jacob ST, Pinkerton R, Banura P, Meya DB, Reynolds SJ, Kenya-Mugisha N, Mayanja-Kizza H, Scheld WM, , 2009. Treatment of severe sepsis with artemether-lumefantrine is associated with decreased mortality in Ugandan patients without malaria. Am J Trop Med Hyg 80: 723728.
  11. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL, , 2008. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36: 296327.[Crossref]
  12. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Kumar A, Cheang M, , 2006. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34: 15891596.[Crossref]
  13. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, , 2001. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345: 13681377.[Crossref]
  14. Petti CA, Polage CR, Quinn TC, Ronald AR, Sande MA, , 2006. Laboratory medicine in Africa: a barrier to effective health care. Clin Infect Dis 42: 377382.[Crossref]
  15. Kiragga AK, Ocama P, Reynolds SJ, Kambugu A, Ojiambo H, Castelnuovo B, , 2008. Validation of a portable hand-held lactate analyzer for determination of blood lactate in patients on antiretroviral therapy in Uganda. J Acquir Immune Defic Syndr 49: 564566.[Crossref]
  16. Moore CC, Jacob ST, Pinkerton R, Meya DB, Mayanja-Kizza H, Reynolds SJ, Scheld WM, , 2008. Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1-infected patient population in Uganda. Clin Infect Dis 46: 215222.[Crossref]
  17. Perez EH, Dawood H, Chetty U, Esterhuizen TM, Bizaare M, , 2008. Validation of the Accutrend lactate meter for hyperlactatemia screening during antiretroviral therapy in a resource-poor setting. Int J Infect Dis 12: 553556.[Crossref]
  18. van Griensven J, Atte EF, Reid T, , 2008. Symptomatic hyperlactatemia: lessons learned using a point-of-care device in a health care center- and nurse-based antiretroviral program in Rwanda. Clin Infect Dis 46: 320322.[Crossref]
  19. Martin GS, Mannino DM, Eaton S, Moss M, , 2003. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348: 15461554.[Crossref]
  20. Shapiro N, Howell MD, Bates DW, Angus DC, Ngo L, Talmor D, , 2006. The association of sepsis syndrome and organ dysfunction with mortality in emergency department patients with suspected infection. Ann Emerg Med 48: 583590.[Crossref]
  21. Duke T, Graham SM, Cherian MN, Ginsburg AS, English M, Howie S, Peel D, Enarson PM, Wilson IH, Were W, , 2010. Oxygen is an essential medicine: a call for international action. Int J Tuberc Lung Dis 14: 13621368.
  22. Mrus JM, Braun L, Yi MS, Linde-Zwirble WT, Johnston JA, , 2005. Impact of HIV/AIDS on care and outcomes of severe sepsis. Crit Care 9: R623R630.[Crossref]
  23. Wachter RM, Luce JM, Hopewell PC, , 1992. Critical care of patients with AIDS. JAMA 267: 541547.[Crossref]
  24. Yende S, Angus DC, , 2007. Long-term outcomes from sepsis. Curr Infect Dis Rep 9: 382386.[Crossref]
  25. Shapiro NI, Howell MD, Talmor D, Donnino M, Ngo L, Bates DW, , 2007. Mortality in Emergency Department Sepsis (MEDS) score predicts 1-year mortality. Crit Care Med 35: 192198.[Crossref]
  26. World Health Organization, 2004. Integrated Management of Adolescent and Adult Illness (Revision 3). Geneva, Switzerland: World Health Organization.

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  • Received : 03 Dec 2010
  • Accepted : 13 Jun 2011

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