Differences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Study

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dc.contributor.authorConde, Katia Aparecida Pessoa [UNIFESP]
dc.contributor.authorSilva, Eliezer
dc.contributor.authorSilva, Carla Oliveira
dc.contributor.authorFerreira, Elaine
dc.contributor.authorFreitas, Flavio Geraldo Rezende [UNIFESP]
dc.contributor.authorCastro, Isac
dc.contributor.authorRea-Neto, Alvaro
dc.contributor.authorCarvalho Grion, Cintia Magalhaes
dc.contributor.authorMoura, Anselmo Dornas
dc.contributor.authorLobo, Suzana Margareth
dc.contributor.authorPontes Azevedo, Luciano Cesar [UNIFESP]
dc.contributor.authorMachado, Flavia Ribeiro [UNIFESP]
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionLatin Amer Sepsis Inst
dc.contributor.institutionCtr Estudos & Pesquisas Terapia Intens CEPETI
dc.contributor.institutionHosp Univ Londrina
dc.contributor.institutionHosp Mater Dei
dc.contributor.institutionUniversidade de São Paulo (USP)
dc.date.accessioned2016-01-24T14:31:53Z
dc.date.available2016-01-24T14:31:53Z
dc.date.issued2013-06-06
dc.description.abstractBackground: 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.en
dc.description.affiliationUniversidade Federal de São Paulo, Dept Anestesiol Dor & Terapia Intens, São Paulo, Brazil
dc.description.affiliationLatin Amer Sepsis Inst, São Paulo, Brazil
dc.description.affiliationCtr Estudos & Pesquisas Terapia Intens CEPETI, Curitiba, Parana, Brazil
dc.description.affiliationHosp Univ Londrina, Div Terapia Intens, Londrina, PR, Brazil
dc.description.affiliationHosp Mater Dei, Intens Care Unit, Belo Horizonte, MG, Brazil
dc.description.affiliationHosp Base, Fac Med Sao Jose Rio Preto, Serv Terapia Intens, Sao Jose Do Rio Preto, SP, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Dept Anestesiol Dor & Terapia Intens, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipEli Lilly
dc.description.sponsorshipLatin America Sepsis Institute
dc.format.extent11
dc.identifierhttp://dx.doi.org/10.1371/journal.pone.0064790
dc.identifier.citationPlos One. San Francisco: Public Library Science, v. 8, n. 6, 11 p., 2013.
dc.identifier.doi10.1371/journal.pone.0064790
dc.identifier.fileWOS000321099000022.pdf
dc.identifier.issn1932-6203
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/36422
dc.identifier.wosWOS:000321099000022
dc.language.isoeng
dc.publisherPublic Library Science
dc.relation.ispartofPlos One
dc.rightsinfo:eu-repo/semantics/openAccess
dc.titleDifferences in Sepsis Treatment and Outcomes between Public and Private Hospitals in Brazil: A Multicenter Observational Studyen
dc.typeinfo:eu-repo/semantics/article
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