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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.

ObjectivesTo compare the accuracy of the SOFA and APACHE II scores in predicting mortality among ICU patients with sepsis in an LMIC.DesignA multicentre, cross-sectional study.SettingA total of 15 adult ICUs throughout Vietnam.ParticipantsWe included all patients aged ≥ 18 years who were admitted to ICUs for sepsis and who were still in ICUs from 00:00 hour to 23:59 hour of the specified study days (i.e., 9thJanuary, 3rdApril, 3rdJuly, and 9thOctober of the year 2019).Primary and secondary outcome measuresThe primary outcome was hospital all-cause mortality (hospital mortality). We also defined the secondary outcome as all-cause deaths in the ICU (ICU mortality).ResultsOf 252 patients, 40.1% died in hospitals, and 33.3% died in ICUs. SOFA (AUROC: 0.688 [95% CI: 0.618-0.758]; cut-off value ≥ 7.5; PAUROCAUROCAUROCAUROCConclusionsIn this study, SOFA and APACHE II scores were worthwhile in predicting mortality among ICU patients with sepsis. However, due to better discrimination for predicting ICU mortality, the SOFA was preferable to the APACHE II score in predicting mortality.Clinical trials registry – India: CTRI/2019/01/016898Strengths and limitations of this studyAn advantage of the present study was data from multi centres, which had little missing data.Due to the absence of a national registry of intensive care units (ICUs) to allow systematic recruitment of units, we used a snowball method to identify suitable units, which might have led to the selection of centres with a greater interest in sepsis management.Due to the study’s real-world nature, we did not make a protocol for microbiological investigations. Moreover, we mainly evaluated resources utilized in ICUs; therefore, the data detailing the point-of-care testing and life-sustaining treatments were not available. Additionally, to improve the feasibility of conducting the study in busy ICUs, we opted not to collect data on antibiotic resistance and appropriateness.Due to our independent variables (e.g., SOFA score that was greater than or equal to the cut-off value) that might be associated with primary outcome only measured upon ICU admission, the mixed-effects logistic regression model could not be used to predict discrete outcome variables measured at two different times, i.e., inside and outside the ICU settings.Although the sample size was large enough, the confidence interval was slightly wide (±6.03%), which might influence the normal distribution of the sample.

Background The simple scoring systems for predicting the outcome of sepsis in intensive care units (ICUs) are few, especially for limited-resource settings. Therefore, this study aimed to evaluate the accuracy of the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score in predicting the mortality of ICU patients with sepsis in Vietnam. Methods We did a multicenter cross-sectional study of patients with sepsis (≥18 years old) presenting to 15 adult ICUs throughout Vietnam on the specified days (i.e., 9th January, 3rd April, 3rd July, and 9th October) representing the different seasons of 2019. The primary and secondary outcomes were the hospital and ICU all-cause mortalities, respectively. The area under the receiver operating characteristic curve (AUROC) was calculated to determine the discriminatory ability of the qSOFA score for deaths in the hospital and ICU. The cut-off value of the qSOFA scores was determined by the receiver operating characteristic curve analysis. Upon ICU admission, factors associated with the hospital and ICU mortalities were assessed in univariable and multivariable logistic models. Results Of 252 patients, 40.1% died in the hospital, and 33.3% died in the ICU. The qSOFA score had a poor discriminatory ability for both the hospital (AUROC: 0.610 [95% CI: 0.538 to 0.681]; cut-off value: ≥2.5; sensitivity: 34.7%; specificity: 84.1%; PAUROC = 0.003) and ICU (AUROC: 0.619 [95% CI: 0.544 to 0.694]; cutoff value: ≥2.5; sensitivity: 36.9%; specificity: 83.3%; PAUROC = 0.002) mortalities. However, multivariable logistic regression analyses show that the qSOFA score of 3 was independently associated with the increased risk of deaths in both the hospital (adjusted odds ratio, AOR: 3.358; 95% confidence interval, CI: 1.756 to 6.422) and the ICU (AOR: 3.060; 95% CI: 1.651 to 5.671). Conclusion In our study, despite having a poor discriminatory value, the qSOFA score seems worthwhile in predicting mortality in ICU patients with sepsis in limited-resource settings. Clinical trial registration Clinical trials registry–India: CTRI/2019/01/016898