Factors relating to mortality in septic patients in Vietnamese intensive care units from a subgroup analysis of MOSAICS II study

doi:10.1038/s41598-021-98165-8

Observational Study

. 2021 Sep 23;11(1):18924.

doi: 10.1038/s41598-021-98165-8.

Factors relating to mortality in septic patients in Vietnamese intensive care units from a subgroup analysis of MOSAICS II study

Son Ngoc Do^#^{1

2

3}, Chinh Quoc Luong^#^{4

5

6}, Dung Thi Pham⁷, My Ha Nguyen⁸, Nga Thi Nguyen⁹, Dai Quang Huynh^{10

11}, Quoc Trong Ai Hoang¹², Co Xuan Dao^{2

13}, Trung Minh Le¹⁴, Ha Nhat Bui¹⁵, Hung Tan Nguyen¹⁶, Hai Bui Hoang^{2

17}, Thuy Thi Phuong Le¹⁸, Lien Thi Bao Nguyen¹⁹, Phuoc Thien Duong²⁰, Tuan Dang Nguyen²¹, Yen Hai Vu^{16

22}, Giang Thi Tra Pham²³, Tam Van Bui⁹, Thao Thi Ngoc Pham^{10

11}, Hanh Trong Hoang^{24

25}, Cuong Van Bui¹³, Nguyen Minh Nguyen¹⁷, Giang Thi Huong Bui^{2

13}, Thang Dinh Vu¹⁴, Nhan Duc Le¹⁶, Trang Huyen Tran¹⁷, Thang Quang Nguyen²¹, Vuong Hung Le²², Chi Van Nguyen^{1

2}, Bryan Francis McNally^{26

27}, Jason Phua^{28

29}, Anh Dat Nguyen^{1

2}

Affiliations

¹ Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.
² Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, 100000, Vietnam.
³ Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, 100000, Vietnam.
⁴ Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam. luongquocchinh@gmail.com.
⁵ Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, 100000, Vietnam. luongquocchinh@gmail.com.
⁶ Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, 100000, Vietnam. luongquocchinh@gmail.com.
⁷ Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, 410000, Vietnam.
⁸ Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, 410000, Vietnam.
⁹ Department of Intensive Care and Poison Control, Vietnam-Czechoslovakia Friendship Hospital, Hai Phong, 180000, Vietnam.
¹⁰ Intensive Care Department, Cho Ray Hospital, Ho Chi Minh City, 700000, Vietnam.
¹¹ Department of Critical Care, Emergency Medicine and Clinical Toxicology, Faculty of Medicine, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, 700000, Vietnam.
¹² Emergency Department, Hue Central General Hospital, Hue City, Thua Thien Hue, 530000, Vietnam.
¹³ Department of Intensive Care, Bach Mai Hospital, Hanoi, 100000, Vietnam.
¹⁴ Intensive Care Unit, 115 People's Hospital, Ho Chi Minh City, 700000, Vietnam.
¹⁵ Intensive Care Unit, Bai Chay General Hospital, Quang Ninh, 200000, Vietnam.
¹⁶ Intensive Care Unit, Da Nang Hospital, Da Nang, 550000, Vietnam.
¹⁷ Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, 100000, Vietnam.
¹⁸ Intensive Care Unit, Dong Da General Hospital, Hanoi, 100000, Vietnam.
¹⁹ Intensive Care Unit, Saint Paul General Hospital, Hanoi, 100000, Vietnam.
²⁰ Intensive Care Unit, Can Tho Central General Hospital, Can Tho, 900000, Vietnam.
²¹ Intensive Care Unit, Vinmec Times City International Hospital, Hanoi, 100000, Vietnam.
²² Intensive Care Unit, Thai Nguyen Central General Hospital, Thai Nguyen, 250000, Vietnam.
²³ Emergency Department, Thanh Nhan General Hospital, Hanoi, 100000, Vietnam.
²⁴ Intensive Care Unit, Hue Central General Hospital, Hue City, Thua Thien Hue, 530000, Vietnam.
²⁵ Department of Emergency and Critical Care Medicine, Faculty of Medicine, Hue University of Medicine and Pharmacy, Hue City, Thua Thien Hue, 530000, Vietnam.
²⁶ Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA.
²⁷ Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA.
²⁸ FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore, 159964, Singapore.
²⁹ Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Health System, Singapore, 119228, Singapore.

^# Contributed equally.

PMID: 34556710
PMCID: PMC8460806
DOI: 10.1038/s41598-021-98165-8

Observational Study

Factors relating to mortality in septic patients in Vietnamese intensive care units from a subgroup analysis of MOSAICS II study

Son Ngoc Do et al. Sci Rep. 2021.

. 2021 Sep 23;11(1):18924.

doi: 10.1038/s41598-021-98165-8.

Authors

Affiliations

¹ Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.
² Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, 100000, Vietnam.
³ Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, 100000, Vietnam.
⁴ Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam. luongquocchinh@gmail.com.
⁵ Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, 100000, Vietnam. luongquocchinh@gmail.com.
⁶ Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, 100000, Vietnam. luongquocchinh@gmail.com.
⁷ Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, 410000, Vietnam.
⁸ Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, 410000, Vietnam.
⁹ Department of Intensive Care and Poison Control, Vietnam-Czechoslovakia Friendship Hospital, Hai Phong, 180000, Vietnam.
¹⁰ Intensive Care Department, Cho Ray Hospital, Ho Chi Minh City, 700000, Vietnam.
¹¹ Department of Critical Care, Emergency Medicine and Clinical Toxicology, Faculty of Medicine, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, 700000, Vietnam.
¹² Emergency Department, Hue Central General Hospital, Hue City, Thua Thien Hue, 530000, Vietnam.
¹³ Department of Intensive Care, Bach Mai Hospital, Hanoi, 100000, Vietnam.
¹⁴ Intensive Care Unit, 115 People's Hospital, Ho Chi Minh City, 700000, Vietnam.
¹⁵ Intensive Care Unit, Bai Chay General Hospital, Quang Ninh, 200000, Vietnam.
¹⁶ Intensive Care Unit, Da Nang Hospital, Da Nang, 550000, Vietnam.
¹⁷ Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, 100000, Vietnam.
¹⁸ Intensive Care Unit, Dong Da General Hospital, Hanoi, 100000, Vietnam.
¹⁹ Intensive Care Unit, Saint Paul General Hospital, Hanoi, 100000, Vietnam.
²⁰ Intensive Care Unit, Can Tho Central General Hospital, Can Tho, 900000, Vietnam.
²¹ Intensive Care Unit, Vinmec Times City International Hospital, Hanoi, 100000, Vietnam.
²² Intensive Care Unit, Thai Nguyen Central General Hospital, Thai Nguyen, 250000, Vietnam.
²³ Emergency Department, Thanh Nhan General Hospital, Hanoi, 100000, Vietnam.
²⁴ Intensive Care Unit, Hue Central General Hospital, Hue City, Thua Thien Hue, 530000, Vietnam.
²⁵ Department of Emergency and Critical Care Medicine, Faculty of Medicine, Hue University of Medicine and Pharmacy, Hue City, Thua Thien Hue, 530000, Vietnam.
²⁶ Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA.
²⁷ Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA.
²⁸ FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore, 159964, Singapore.
²⁹ Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Health System, Singapore, 119228, Singapore.

^# Contributed equally.

PMID: 34556710
PMCID: PMC8460806
DOI: 10.1038/s41598-021-98165-8

Abstract

Sepsis is the most common cause of in-hospital deaths, especially from low-income and lower-middle-income countries (LMICs). This study aimed to investigate the mortality rate and associated factors from sepsis in intensive care units (ICUs) in an LMIC. We did a multicenter cross-sectional study of septic patients presenting to 15 adult ICUs throughout Vietnam on the 4 days representing the different seasons of 2019. Of 252 patients, 40.1% died in hospital and 33.3% died in ICU. ICUs with accredited training programs (odds ratio, OR: 0.309; 95% confidence interval, CI 0.122-0.783) and completion of the 3-h sepsis bundle (OR: 0.294; 95% CI 0.083-1.048) were associated with decreased hospital mortality. ICUs with intensivist-to-patient ratio of 1:6 to 8 (OR: 4.533; 95% CI 1.621-12.677), mechanical ventilation (OR: 3.890; 95% CI 1.445-10.474) and renal replacement therapy (OR: 2.816; 95% CI 1.318-6.016) were associated with increased ICU mortality, in contrast to non-surgical source control (OR: 0.292; 95% CI 0.126-0.678) which was associated with decreased ICU mortality. Improvements are needed in the management of sepsis in Vietnam such as increasing resources in critical care settings, making accredited training programs more available, improving compliance with sepsis bundles of care, and treating underlying illness and shock optimally in septic patients.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Figure 1**
Flowchart of the study design, patient enrollment and follow up. *ICU* intensive care unit.

See this image and copyright information in PMC

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References

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[1] Singer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA. 2016;315:801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed

[2] Singer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA. 2016;315:801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed

[3] Rudd KE, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: Analysis for the Global Burden of Disease Study. Lancet. 2020;395:200–211. doi: 10.1016/s0140-6736(19)32989-7. - DOI - PMC - PubMed

[4] Rudd KE, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: Analysis for the Global Burden of Disease Study. Lancet. 2020;395:200–211. doi: 10.1016/s0140-6736(19)32989-7. - DOI - PMC - PubMed

[5] Liu V, et al. Hospital deaths in patients with sepsis from two independent cohorts. JAMA. 2014;312:90–92. doi: 10.1001/jama.2014.5804. - DOI - PubMed

[6] Liu V, et al. Hospital deaths in patients with sepsis from two independent cohorts. JAMA. 2014;312:90–92. doi: 10.1001/jama.2014.5804. - DOI - PubMed

[7] Torio, C. M. & Moore, B. J. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013: Statistical Brief #204. in Healthcare Cost and Utilization Project (HCUP) Statistical Briefs (ed Knutson, D.) (Agency for Healthcare Research and Quality (US), Rockville (MD), 2006).

[8] Torio, C. M. & Moore, B. J. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013: Statistical Brief #204. in Healthcare Cost and Utilization Project (HCUP) Statistical Briefs (ed Knutson, D.) (Agency for Healthcare Research and Quality (US), Rockville (MD), 2006).

[9] Sakr Y, et al. Sepsis in intensive care unit patients: Worldwide data from the intensive care over nations audit. Open Forum Infect. Diseases. 2018;5:ofy313. doi: 10.1093/ofid/ofy313. - DOI - PMC - PubMed

[10] Sakr Y, et al. Sepsis in intensive care unit patients: Worldwide data from the intensive care over nations audit. Open Forum Infect. Diseases. 2018;5:ofy313. doi: 10.1093/ofid/ofy313. - DOI - PMC - PubMed

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Factors relating to mortality in septic patients in Vietnamese intensive care units from a subgroup analysis of MOSAICS II study

Affiliations

Factors relating to mortality in septic patients in Vietnamese intensive care units from a subgroup analysis of MOSAICS II study

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