Characteristics and outcomes of adult emergency ward patients with sepsis who received corticosteroids at the Mbarara Regional Referral Hospital in Uganda.

Abstract

Background: Corticosteroids are recommended for the treatment of septic shock but are understudied in Africa. We aimed to determine (1) characteristics of patients with sepsis in Uganda who received corticosteroids, and (2) the association between receiving corticosteroids and outcomes.

Methods: We conducted a single centre retrospective observational cohort study of patients with sepsis at the Mbarara Regional Referral Hospital in Uganda. We included patients admitted from the emergency ward with suspected infection and ≥2 quick sequential organ failure assessment criteria. We determined predictors of receiving corticosteroids with logistic regression and predictors of 28-day mortality using Cox proportional hazards regression. We adjusted models for severity of illness using the Universal Vital Assessment (UVA) mortality risk score.

Results: Of the 300 patients analysed, 141 (47%) were female, and the median (IQR) age was 55 (43-66) years. Corticosteroids were received by 71 (23%) patients at a median (IQR) of 1 (0-2) day from admission. The UVA score (adjusted OR (aOR) 1.16, 95% CI 1.03 to 1.30) and meningitis (aOR 4.31, 95% CI 2.04 to 9.12) were predictors of receiving corticosteroids. The UVA score (adjusted HR (aHR) 1.14, 95% CI 1.02 to 1.26) and receiving corticosteroids (aHR 0.43, 95% CI 0.21 to 0.91) were predictors of increased and decreased 28-day mortality, respectively. Receiving corticosteroids remained an independent predictor of decreased 28-day mortality when entered into the model as a time dependent variable (aHR 0.33, 95% CI 0.13 to 0.83, p=0.02). In a sensitivity analysis adjusted for age, sex and severity of illness, receiving vasopressors (aHR 3.48, 95% CI 1.88 to 6.43, p<0.001) and receiving corticosteroids (aHR 0.40, 95% CI 0.19 to 0.85, p=0.02) were independent predictors of increased and decreased 28-day mortality, respectively.

Conclusions: In patients with sepsis in Uganda, receiving corticosteroids was associated with severity of illness and meningitis, and receiving corticosteroids was associated with improved outcomes.