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Observational Study
. 2013 Jun 6;8(6):e64790.
doi: 10.1371/journal.pone.0064790. Print 2013.

Differences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study

Katia Aparecida Pessoa Conde  1 , Eliezer Silva, Carla Oliveira Silva, Elaine Ferreira, Flavio Geraldo Rezende Freitas, Isac Castro, Alvaro Rea-Neto, Cintia Magalhaes Carvalho Grion, Anselmo Dornas Moura, Suzana Margareth Lobo, Luciano Cesar Pontes Azevedo, Flavia Ribeiro Machado
Affiliations
Observational Study

Differences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study

Katia Aparecida Pessoa Conde et al. PLoS One. .

Abstract

Background: Previous studies showed higher sepsis mortality rates in Brazil compared to other developed or developing countries. Moreover, another trial demonstrated an increased mortality rate in public hospitals compared to private hospitals in Brazil. The reasons for these findings may include delayed recognition and inadequate treatment of sepsis in public facilities. We designed this study to evaluate the factors associated with mortality in septic patients admitted to intensive care units in a network of public and private institutions.

Materials and methods: This study is a retrospective analysis of a prospective cohort of sepsis patients in 19 private and public institutions in Brazil. We analyzed data from the original database and collected additional data to assess compliance to the treatment guidelines and to determine the time from the onset of organ dysfunction and the sepsis diagnosis by the healthcare team.

Results: A total of 396 patients were analyzed. Patients in public hospitals were younger, had a greater number of dysfunctional organs at baseline and a lower chance to have sepsis diagnosed within two hours of the onset of organ dysfunction. Private hospitals had a better compliance to lactate and blood culture sampling and maintenance of glycemic control. The multivariate analysis showed that age, disease severity at baseline and being treated at a public hospital were independent risk factors for mortality. A delay in the sepsis diagnosis of longer than two hours was associated with mortality only in the public setting.

Conclusions: We confirmed a lower sepsis mortality rate in the private hospitals of this network. Being treated in a public hospital was an independent factor for mortality. Delayed recognition of sepsis was more frequent in public institutions and this might have been associated with a higher mortality. Improving sepsis recognition and early diagnosis may be important targets in public institutions.

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Conflict of interest statement

Competing Interests: This research was partially funded by an unrestricted research grant from Eli Lilly Brasil in a partnership with Latin America Sepsis Institute. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Study flowchart.
Figure 2
Figure 2. Comparison of propensity scores for patients from public and private hospitals within each propensity score quintile.
The groups are comparable because there is sufficient overlap in the propensity score within each block.
Figure 3
Figure 3. Mortality according to the time of the sepsis diagnosis in public and private hospitals.
NS: Non-significant.
See this image and copyright information in PMC

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