Epidemiology, Management, and Outcomes of Sepsis in ICUs among Countries of Differing National Wealth across Asia

Li A. Ling L. Qin H. Arabi Y.M. Myatra S.N. Egi M. Kim J.H. Nor M.B.M. Son D.N. Fang W.-F. Wahyuprajitno B. Hashmi M. Faruq M.O. Patjanasoontorn B. Al Bahrani M.J. Shrestha B.R. Shrestha U. Nafees K.M.K. Sann K.K. Palo J.E.M. Mendsaikhan N. Konkayev A. Detleuxay K. Chan Y.H. Du B. Divatia J.V. Koh Y. Gomersall C.D. Phua J.
1 November 2022 American Thoracic Society

American Journal of Respiratory and Critical Care Medicine
2022 #206 Issue 9 1107 - 1116 pp.

Rationale: Directly comparative data on sepsis epidemiology and sepsis bundle implementation in countries of differing national wealth remain sparse. Objectives: To evaluate across countries/regions of differing income status in Asia I) the prevalence, causes, and outcomes of sepsis as a reason for ICU admission and 2) sepsis bundle (antibiotic administration, blood culture, and lactate measurement) compliance and its association with hospital mortality. Methods: A prospective point prevalence study was conducted among 386 adult ICUs from 22 Asian countries/regions. Adult ICU participants admitted for sepsis on four separate days (representing the seasons of 2019) were recruited. Measurements and Main Results: The overall prevalence of sepsis in ICUs was 22.4% (20.9%, 24.5%, and 21.3% in low-income countries/regions [LICsj/lower middle-income countries/regions [LMICs], upper middle-income countries/regions, and high-income countries/regions [HICs], respectively; P < 0.001). Patients were younger and had lower severity of illness in LICs/LMICs. Hospital mortality was 32.6% and marginally significantly higher in LICs/LMICs than HICs on multivariable generalized mixed model analysis (adjusted odds ratio, 1.84; 95% confidence interval, 1.00-3.37 P = 0.049). Sepsis bundle compliance was 21.5% at 1 hour (26.0%, 22.1%, and 16.2% in LICs/LMICs, upper middle-income countries/regions, and HICs, respectively; P< 0.001) and 36.6% at 3 hours (39.3%, 32.8%, and 38.5%, respectively; P = 0.001). Delaying antibiotic administration beyond 3 hours was the only element independently associated with increased mortality (adjusted odds ratio, 2.53; 95% confidence interval, 2.07-3.08; P< 0.001). Conclusions: Sepsis is a common cause of admission to Asian ICUs. Mortality remains high and is higher in LICs/LMICs after controlling for confounders. Sepsis bundle compliance remains low. Delaying antibiotic administration beyond 3 hours from diagnosis is associated with increased mortality. Copyright

epidemiology , mortality , sepsis , sepsis bundle

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Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
Department of Intensive Care Medicine, Woodlands Health, Singapore, Singapore
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
State Key Laboratory of Complex, Severe and Rare Disease, Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
Department of Anesthesiology and Intensive Care Medicine, Kobe University Hospital, Kobe, Japan
Department of Critical Care Medicine, Korea University Ansan Hospital, Ansan, South Korea
International Islamic University, Malaysia Medical Centre, Kuantan, Malaysia
Critical Care Unit, Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Airlangga, Intensive Care Unit, Dr. Soetomo General Hospital, Surabaya, Indonesia
Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
General Intensive Care Unit, Emergency Department, United Hospital Ltd., Dhaka, Bangladesh
Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman
Department of Anesthesia and Intensive Care, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei Darussalam
Department of Anaesthesiology, Intensive Care Unit, Yangon General Hospital, University of Medicine 1, Yangon, Myanmar
Acute and Critical Care Institute, The Medical City, Pasig City, Philippines
Anaesthesia and Critical Care Department, Mongolian National University of Health Science, Ulaanbaatar, Mongolia
Anaesthesiology and Intensive Care Department, Astana Medical University, Nur-Sultan, Kazakhstan
Anaesthesia and Intensive Care Unit Department, Institution of Traumatology and Orthopedics, Nur-Sultan, Kazakhstan
Adult Intensive Care Unit, Mahosot Hospital, Vientiane, Laos
Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore, Singapore

Division of Respiratory and Critical Care Medicine
Department of Intensive Care Medicine
Department of Anaesthesia and Intensive Care
State Key Laboratory of Complex
King Saud Bin Abdulaziz University for Health Sciences
Department of Anaesthesia
Department of Anesthesiology and Intensive Care Medicine
Department of Critical Care Medicine
International Islamic University
Critical Care Unit
Division of Pulmonary and Critical Care Medicine
Department of Respiratory Care
Department of Anesthesiology and Reanimation
Department of Anaesthesiology
General Intensive Care Unit
Division of Respiratory and Critical Care Medicine
Department of Anesthesia and Critical Care
Department of Anesthesia and Intensive Care
Raja Isteri Pengiran Anak Saleha Hospital
Department of Anaesthesiology
Acute and Critical Care Institute
Anaesthesia and Critical Care Department
Anaesthesiology and Intensive Care Department
Anaesthesia and Intensive Care Unit Department
Adult Intensive Care Unit
Biostatistics Unit
Department of Pulmonary and Critical Care Medicine
FAST and Chronic Programmes

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