Comparative analysis between high- and low-resource hospitals to identify factors associated with sepsis-related mortality.

OBJECTIVE

To compare sepsis-related mortality between a limited-resource setting in South America and a high-resource setting in North America, and examine differences in early sepsis management processes.

METHODS

This retrospective review included adult patients presenting to 2 tertiary emergency departments (EDs) from June 1st, 2021 through May 31st, 2022, with a diagnosis of sepsis or septic shock. Sepsis mortality and ED time metrics relevant to early sepsis identification and management were evaluated as associations with the type of hospital rather than causal relationships. A 2:1 propensity score matching approach was used for the analysis. Logistic regression was performed to assess the effect of the hospital system on mortality after adjustment for significant confounders.

RESULTS

A total of 297 patients were diagnosed with sepsis, of whom 68 (23%) exhibited septic shock. Overall, 198 patients (67%) were treated in the high-resource ED and 99 (33%) in the limited-resource ED. In-hospital mortality was substantially lower in the high-resource setting (6.1% vs 42.4%; P < .001). After adjustment for lactate levels, the odds of death were 13.61 and 7.69 times higher for patients with sepsis and septic shock, respectively, treated in the limited-resource setting (P < .001). Time to antibiotic administration (119 vs 200 minutes; P < .001) and time to IV fluid administration (23 vs 54 minutes, P < .001) were both significantly shorter in the high-resource setting. The median length of the ICU stay was 2.53 days in the high-resource setting vs 6 days in the limited-resource setting (P = .007).

CONCLUSIONS

The high-resource ED demonstrated lower mortality, a shorter length of the ICU stay, and shorter times to antibiotic and IV fluid administration vs the limited-resource ED. However, causal inferences cannot be drawn due to baseline differences in illness severity and the retrospective study design.