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Lancet Infect Dis. 2017 Nov;17(11):1180-1189. doi: 10.1016/S1473-3099(17)30322-5. Epub 2017 Aug 17.

The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study.

Collaborators (640)

Zajac SR, Bley MV, Bley MV, Scazufca A, Rosateli P, Reis T, Junior AN, Neto PAN, Filho ILS, Lima H, Vieira M, Zanchet M, Ferreira I, Miguita R, Petisco GM, Westphal GA, Santos JRP, Damasceno V, Dos Santos JT, Fernandes F, Almeida EP, Lemos M, Lima MFA, Camacho R, Ribeiro A, Douglas MOG, Mattei GA, Junior EA, Ferreira P, Rabelo HRMP, Pinto SPS, Fontes LE, Machado D, Guitzel M, Lucio M, Conceição CNP, Barros A, Salgado D, Veiga VC, Rojas SSO, Veiga VC, Rojas SSO, de Paula KM, Hatum R, Fraenkel L, Viana WN, Santos APG, Rabello L, Tanaka L, Uchoa M, Moura MD, Gneco H, Buarque MF, Monteiro K, Nassar AP Jr, Koterba E, Teixeira MJ, Falcão ALE, Pinto VGS, Junior JMM, Gut AL, Stefano LM, Damasceno M, Lontra MV, Cozzani C, Sobrinho EB, Lage SG, Kopel L, Youssef NCM, Sanches LC, Amendola CP, Kmohan C, Silva CB, Schifelbain L, Bellotto E, Viecili P, Azevedo L, Monteiro L, Vieira S, Abrão AM, Moraes AP, Insaurrale H, Gadelha M, Marisa D, Diniz RN, Romano ER, Luzzi S, Rezende E, Filho MC, Martins RHFC, Carvalho FB, Moreira GC, Paula J, Fernandes F, Haag F Jr, Lucena FS, Machado RS, Filho WO, Cavalcante LO, Filho HC, Lima GS, Trombka JN, Machado EC, Bainy MP, Ramos CH, Hoppe C, Luckmeyer GD, Vogas C, Thompson MM, Sousa RK, Fernandes R, Lourenço E, Peixoto GL, Mocelin A, Silva MML, Neto JSA, Villela C, Mendonça SL, Prado SC, Goulart R, Duarte JJL, Junior HAO, Andrade JN, Souza LF, Fernandes L, Neto ML, Fernandes SS, Amâncio F, Versiani JC, Pitanga F, Alcantara MB, Reiff CC, Rosenblat R, Nobrega MS, Nobrega MLFS, Costa G, Assunção N, Almeida EP, Neder L, Almeida R, Fuck J, Souza RM, Ribeiro AG, Alves AAG, Carvalho SHC, Arbex M, Oliveira EC, Carvalho FB, Melo RS, Conde K, Abreu NQ, Melo CLT, Carvalho AA, Filho MC, Lannes R, Missaka H, Furtado AH Jr, Peixoto AA Jr, Maia I, Pincelli MP, Camacho R, Yunes MP, Pessoa AN, Figueiredo S, Botoni FA, Cunha CT, Olson FA, Franco R, Bemfica AF, Nobrega MS, Junior ADF, Ferreira ELA, Messeder O, Passos R, Lira JA, Vilela CA, Junior SMD, Ferreira CS, Muller OPJA, Dos Santos RP, Rubini P, Monteiro D, Rodrigues LE, Ruivo GF, Gomes MC, Egito E, Assef MG, Lima MAM, Borges AF, Gadelha M, Jezler S, Mendes C, Gottardo PC, Lima R, Filho CMF, Campagnucci VP, Solino I, Lorca AP, Lorca AP, Rodrigues GM, Gerent KB, Barbosa O, Filho GTH, Troncoso E, Ventura A, Silva MA, Houly JG, Pimentel JPM, Ramos RA, Gianini F, Casemiro B, Pinto EM, Silva GA, Sebold M, Vieira E, Ferreira R, Gomes LA, Lovato WJ, Dantas W, Ishy L, Dantas W, Ishy L, Moreira J, Gagliardi I, Goes LO, Vendrame LS, Guimarães HP, Gois A, Machado FR, Rodrigues M Jr, Vieira PCB, Bittencourt W, Melnick E, Schneider M, Rezegue L, Nogueira NJM, Azevedo L, Godinho EP, Mazza BF, Paciencia LE, Ferraz S, Imamura CRA, Tavares J, Santos JC, Vale E, Filho JM, Tannous LA, João PGD, Geral CTI, Salgado D, Matera AP, Matsui M, Neto EE, Pinheiro BV, Carvalho EV, Matos H, Lippi M, Campos AL, Albuquerque DC, Monteiro D, Castiglioni D, Silva GS, Cunha S, Novello E, Silva MEB, Grion C, Festti J, Grion C, Festti J, Souza CRA, Mecatti GC, Junqueira EB, Dutra RS, Mirachi GB, Mendes DA, Moura EMF, Silva IF, Mota MGP, Carneiro T, Celso A, Réa-Neto A, Oliveira MC, Japiassú A, Castro PP, Costa HJM, Rolim AV, Rocha D, Righy C, Righy C, Santos V, Fernandino B, Pereira AL, Rego VLD, Silva MML, Melo LA, Guilherme L, Ferro HC, Silva FJL, Carrasco HVCJ, El-Fakouri S, Alvarez J, de Castro D, Shiavetto PM, Gallate SR, Filho ET, Veneziano SG, Filho WO, Antoniazzi P, Filho WH, Sadala P, Balbino C, Moreno G, Dias MSF, Lopez RP, Rodrigues ML, Terceiro J, Serpa MF, Santos L, Filho WO, Lippi MM, Zajac SR, Bley MV, Bley MV, Scazufca A, Rosateli P, Reis T, Junior AN, Neto PAN, Filho ILS, Lima H, Vieira M, Zanchet M, Ferreira I, Miguita R, Petisco GM, Westphal GA, Santos JRP, Damasceno V, Dos Santos JT, Fernandes F, Almeida EP, Lemos M, Lima MFA, Camacho R, Ribeiro A, Douglas MOG, Mattei GA, Junior EA, Ferreira P, Rabelo HRMP, Pinto SPS, Fontes LE, Machado D, Guitzel M, Lucio M, Conceição CNP, Barros A, Salgado D, Veiga VC, Rojas SSO, Veiga VC, Rojas SSO, de Paula KM, Hatum R, Fraenkel L, Viana WN, Santos APG, Rabello L, Tanaka L, Uchoa M, Moura MD, Gneco H, Buarque MF, Monteiro K, Nassar AP Jr, Koterba E, Teixeira MJ, Falcão ALE, Pinto VGS, Junior JMM, Gut AL, Stefano LM, Damasceno M, Lontra MV, Cozzani C, Sobrinho EB, Lage SG, Kopel L, Youssef NCM, Sanches LC, Amendola CP, Kmohan C, Silva CB, Schifelbain L, Bellotto E, Viecili P, Azevedo L, Monteiro L, Vieira S, Abrão AM, Moraes AP, Insaurrale H, Gadelha M, Marisa D, Diniz RN, Romano ER, Luzzi S, Rezende E, Filho MC, Martins RHFC, Carvalho FB, Moreira GC, Paula J, Fernandes F, Haag F Jr, Lucena FS, Machado RS, Filho WO, Cavalcante LO, Filho HC, Lima GS, Trombka JN, Machado EC, Bainy MP, Ramos CH, Hoppe C, Luckmeyer GD, Vogas C, Thompson MM, Sousa RK, Fernandes R, Lourenço E, Peixoto GL, Mocelin A, Silva MML, Neto JSA, Villela C, Mendonça SL, Prado SC, Goulart R, Duarte JJL, Junior HAO, Andrade JN, Souza LF, Fernandes L, Neto ML, Fernandes SS, Amâncio F, Versiani JC, Pitanga F, Alcantara MB, Reiff CC, Rosenblat R, Nobrega MS, Nobrega MLFS, Costa G, Assunção N, Almeida EP, Neder L, Almeida R, Fuck J, Souza RM, Ribeiro AG, Alves AAG, Carvalho SHC, Arbex M, Oliveira EC, Carvalho FB, Melo RS, Conde K, Abreu NQ, Melo CLT, Carvalho AA, Filho MC, Lannes R, Missaka H, Furtado AH Jr, Peixoto AA Jr, Maia I, Pincelli MP, Camacho R, Yunes MP, Pessoa AN, Figueiredo S, Botoni FA, Cunha CT, Olson FA, Franco R, Bemfica AF, Nobrega MS, Junior ADF, Ferreira ELA, Messeder O, Passos R, Lira JA, Vilela CA, Junior SMD, Ferreira CS, Muller OPJA, Dos Santos RP, Rubini P, Monteiro D, Rodrigues LE, Ruivo GF, Gomes MC, Egito E, Assef MG, Lima MAM, Borges AF, Gadelha M, Jezler S, Mendes C, Gottardo PC, Lima R, Filho CMF, Campagnucci VP, Solino I, Lorca AP, Lorca AP, Rodrigues GM, Gerent KB, Barbosa O, Filho GTH, Troncoso E, Ventura A, Silva MA, Houly JG, Pimentel JPM, Ramos RA, Gianini F, Casemiro B, Pinto EM, Silva GA, Sebold M, Vieira E, Ferreira R, Gomes LA, Lovato WJ, Dantas W, Ishy L, Dantas W, Ishy L, Moreira J, Gagliardi I, Goes LO, Vendrame LS, Guimarães HP, Gois A, Machado FR, Rodrigues M Jr, Vieira PCB, Bittencourt W, Melnick E, Schneider M, Rezegue L, Nogueira NJM, Azevedo L, Godinho EP, Mazza BF, Paciencia LE, Ferraz S, Imamura CRA, Tavares J, Santos JC, Vale E, Filho JM, Tannous LA, João PGD, Geral CTI, Salgado D, Matera AP, Matsui M, Neto EE, Pinheiro BV, Carvalho EV, Matos H, Lippi M, Campos AL, Albuquerque DC, Monteiro D, Castiglioni D, Silva GS, Cunha S, Novello E, Silva MEB, Grion C, Festti J, Grion C, Festti J, Souza CRA, Mecatti GC, Junqueira EB, Dutra RS, Mirachi GB, Mendes DA, Moura EMF, Silva IF, Mota MGP, Carneiro T, Celso A, Réa-Neto A, Oliveira MC, Japiassú A, Castro PP, Costa HJM, Rolim AV, Rocha D, Righy C, Righy C, Santos V, Fernandino B, Pereira AL, Rego VLD, Silva MML, Melo LA, Guilherme L, Ferro HC, Silva FJL, Carrasco HVCJ, El-Fakouri S, Alvarez J, de Castro D, Shiavetto PM, Gallate SR, Filho ET, Veneziano SG, Filho WO, Antoniazzi P, Filho WH, Sadala P, Balbino C, Moreno G, Dias MSF, Lopez RP, Rodrigues ML, Terceiro J, Serpa MF, Santos L, Filho WO, Lippi MM.

Abstract

BACKGROUND:

The sepsis burden on acute care services in middle-income countries is a cause for concern. We estimated incidence, prevalence, and mortality of sepsis in adult Brazilian intensive care units (ICUs) and association of ICU organisational factors with outcome.

METHODS:

We did a 1-day point prevalence study with follow-up of patients in ICU with sepsis in a nationally representative pseudo-random sample. We produced a sampling frame initially stratified by geographical region. Each stratum was then stratified by hospitals' main source of income (serving general public vs privately insured individuals) and ICU size (ten or fewer beds vs more than ten beds), finally generating 40 strata. In each stratum we selected a random sample of ICUs so as to enrol the total required beds in 1690 Brazilian adult ICUs. We followed up patients until hospital discharge censored at 60 days, estimated incidence from prevalence and length of stay, and generated national estimates. We assessed mortality prognostic factors using random-effects logistic regression models.

FINDINGS:

On Feb 27, 2014, 227 (72%) of 317 ICUs that were randomly selected provided data on 2632 patients, of whom 794 had sepsis (30·2 septic patients per 100 ICU beds, 95% CI 28·4-31·9). The ICU sepsis incidence was 36·3 per 1000 patient-days (95% CI 29·8-44·0) and mortality was observed in 439 (55·7%) of 788 patients (95% CI 52·2-59·2). Low availability of resources (odds ratio [OR] 1·67, 95% CI 1·02-2·75, p=0·045) and adequacy of treatment (OR 0·56, 0·37-0·84, p=0·006) were independently associated with mortality. The projected incidence rate is 290 per 100 000 population (95% CI 237·9-351·2) of adult cases of ICU-treated sepsis per year, which yields about 420 000 cases annually, of whom 230 000 die in hospital.

INTERPRETATION:

The incidence, prevalence, and mortality of ICU-treated sepsis is high in Brazil. Outcome varies considerably, and is associated with access to adequate resources and treatment. Our results show the burden of sepsis in resource-limited settings, highlighting the need to establish programmes aiming for sepsis prevention, early diagnosis, and adequate treatment.

FUNDING:

Fundação de Apoio a Pesquisa do Estado de São Paulo (FAPESP).

PMID:
28826588
DOI:
10.1016/S1473-3099(17)30322-5
[Indexed for MEDLINE]

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