Sepsis carries a high mortality among hospitalised adults in Malawi in the era of antiretroviral therapy scale-up: A longitudinal cohort study



Waitt, Peter I, Mukaka, Mavuto, Goodson, Patrick, SimuKonda, Felanji D, Waitt, Catriona J ORCID: 0000-0003-0134-5855, Feasey, Nick, Allain, Theresa J, Downie, Paul and Heyderman, Robert S
(2014) Sepsis carries a high mortality among hospitalised adults in Malawi in the era of antiretroviral therapy scale-up: A longitudinal cohort study. Journal of Infection, 70 (1). 11 - 19.

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Abstract

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 antiretroviral 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.

Item Type: Article
Uncontrolled Keywords: Adults, Africa, Antiretroviral therapy, Bacteraemia, HIV, Sepsis
Depositing User: Symplectic Admin
Date Deposited: 16 Dec 2014 14:37
Last Modified: 22 Nov 2020 00:14
DOI: 10.1016/j.jinf.2014.07.004
Publisher's Statement : © 2014 The Authors. Published by Elsevier Ltd on behalf of the The British Infection Association. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/3.0/).
Related URLs:
URI: http://livrepository.liverpool.ac.uk/id/eprint/2003722