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.

Center for Emergency Medicine Bach Mai Hospital 78 Giai Phong road Phuong Mai ward Dong Da district Hanoi 100000 Vietnam

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

Department of Emergency and Critical Care Medicine Faculty of Medicine Hue University of Medicine and Pharmacy Hue City Thua Thien Hue 530000 Vietnam

Department of Emergency and Critical Care Medicine Hanoi Medical University Hanoi 100000 Vietnam

Department of Emergency Medicine Emory University School of Medicine Atlanta GA 30322 USA

Department of Health Organization and Management Faculty of Public Health Thai Binh University of Medicine and Pharmacy Thai Binh 410000 Vietnam

Department of Intensive Care and Poison Control Vietnam Czechoslovakia Friendship Hospital Hai Phong 180000 Vietnam

Department of Intensive Care Bach Mai Hospital Hanoi 100000 Vietnam

Department of Nutrition and Food Safety Faculty of Public Health Thai Binh University of Medicine and Pharmacy Thai Binh 410000 Vietnam

Division of Respiratory and Critical Care Medicine Department of Medicine National University Health System Singapore 119228 Singapore

Emergency and Critical Care Department Hanoi Medical University Hospital Hanoi Medical University Hanoi 100000 Vietnam

Emergency Department Hue Central General Hospital Hue City Thua Thien Hue 530000 Vietnam

Emergency Department Thanh Nhan General Hospital Hanoi 100000 Vietnam

Emory University Rollins School of Public Health Atlanta GA 30322 USA

Faculty of Medicine University of Medicine and Pharmacy Vietnam National University Hanoi 100000 Vietnam

FAST and Chronic Programmes Alexandra Hospital National University Health System Singapore 159964 Singapore

Intensive Care Department Cho Ray Hospital Ho Chi Minh City 700000 Vietnam

Intensive Care Unit 115 People's Hospital Ho Chi Minh City 700000 Vietnam

Intensive Care Unit Bai Chay General Hospital Quang Ninh 200000 Vietnam

Intensive Care Unit Can Tho Central General Hospital Can Tho 900000 Vietnam

Intensive Care Unit Da Nang Hospital Da Nang 550000 Vietnam

Intensive Care Unit Dong Da General Hospital Hanoi 100000 Vietnam

Intensive Care Unit Hue Central General Hospital Hue City Thua Thien Hue 530000 Vietnam

Intensive Care Unit Saint Paul General Hospital Hanoi 100000 Vietnam

Intensive Care Unit Thai Nguyen Central General Hospital Thai Nguyen 250000 Vietnam

Intensive Care Unit Vinmec Times City International Hospital Hanoi 100000 Vietnam

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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. PubMed DOI PMC

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. PubMed DOI PMC

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. PubMed DOI

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). PubMed

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. PubMed DOI PMC

Bauer M, et al. Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019—Results from a systematic review and meta-analysis. Crit. Care (Lond. Engl.) 2020;24:239. doi: 10.1186/s13054-020-02950-2. PubMed DOI PMC

Schultz MJ, et al. Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future. Intensive Care Med. 2017;43:612–624. doi: 10.1007/s00134-017-4750-z. PubMed DOI

Thorrington D, Andrews N, Stowe J, Miller E, van Hoek AJ. Elucidating the impact of the pneumococcal conjugate vaccine programme on pneumonia, sepsis and otitis media hospital admissions in England using a composite control. BMC Med. 2018;16:13. doi: 10.1186/s12916-018-1004-z. PubMed DOI PMC

Jabaley CS, Blum JM, Groff RF, O'Reilly-Shah VN. Global trends in the awareness of sepsis: Insights from search engine data between 2012 and 2017. Crit. Care (Lond. Engl.) 2018;22:7. doi: 10.1186/s13054-017-1914-8. PubMed DOI PMC

Evans IVR, et al. Association between the New York sepsis care mandate and in-hospital mortality for pediatric sepsis. JAMA. 2018;320:358–367. doi: 10.1001/jama.2018.9071. PubMed DOI PMC

Rhodes A, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Crit. Care Med. 2017;45:486–552. doi: 10.1097/ccm.0000000000002255. PubMed DOI

Seymour CW, et al. Time to treatment and mortality during mandated emergency care for sepsis. N. Engl. J. Med. 2017;376:2235–2244. doi: 10.1056/NEJMoa1703058. PubMed DOI PMC

Fleischmann C, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am. J. Respir. Crit. Care Med. 2016;193:259–272. doi: 10.1164/rccm.201504-0781OC. PubMed DOI

Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet. 2010;376:1339–1346. doi: 10.1016/s0140-6736(10)60446-1. PubMed DOI PMC

Fleischmann-Struzek C, et al. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir. Med. 2018;6:223–230. doi: 10.1016/s2213-2600(18)30063-8. PubMed DOI

Vincent JL, et al. Prevalence and outcomes of infection among patients in intensive care units in 2017. JAMA. 2020;323:1478–1487. doi: 10.1001/jama.2020.2717. PubMed DOI PMC

Phua J, et al. Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study. BMJ. 2011;342:d3245. doi: 10.1136/bmj.d3245. PubMed DOI PMC

Southeast Asia Infectious Disease Clinical Research Network Causes and outcomes of sepsis in southeast Asia: a multinational multicentre cross-sectional study. Lancet Glob. Health. 2017;5:e157–e167. doi: 10.1016/s2214-109x(17)30007-4. PubMed DOI PMC

World Bank. World Development Indicators. Available from https://databank.worldbank.org/data/download/POP.pdf. (The World Bank Group, Washington, D.C., United States, 2019).

World Health Organization . Weekly Epidemiological Record. The World Health Organization; 2003. pp. 145–146.

South East Asia Infectious Disease Clinical Research, N Effect of double dose oseltamivir on clinical and virological outcomes in children and adults admitted to hospital with severe influenza: Double blind randomised controlled trial. BMJ (Clin. Res. Ed.) 2013;346:f3039. doi: 10.1136/bmj.f3039. PubMed DOI PMC

World Health Organization. Cumulative number of confirmed human cases for avian influenza A(H5N1) reported to WHO, 2003–2016. Available from https://www.who.int/influenza/human_animal_interface/2016_07_19_tableH5N1corrected.pdf (The World Health Organization, Geneva, Switzerland, 2016).

World Health Organization. COVID-19 in Viet Nam Situation Report 36. Available from https://www.who.int/vietnam/internal-publications-detail/covid-19-in-viet-nam-situation-report-36/ (The World Health Organization, Geneva, Switzerland, 2021).

Anders KL, et al. Epidemiological factors associated with dengue shock syndrome and mortality in hospitalized dengue patients in Ho Chi Minh City, Vietnam. Am. J. Trop. Med. Hyg. 2011;84:127–134. doi: 10.4269/ajtmh.2011.10-0476. PubMed DOI PMC

Mai NT, et al. Streptococcus suis meningitis in adults in Vietnam. Clin. Infecti. Diseases. 2008;46:659–667. doi: 10.1086/527385. PubMed DOI

Nguyen KV, et al. Antibiotic use and resistance in emerging economies: A situation analysis for Viet Nam. BMC Public Health. 2013;13:1158. doi: 10.1186/1471-2458-13-1158. PubMed DOI PMC

Phu VD, et al. Burden of hospital acquired infections and antimicrobial use in Vietnamese adult intensive care units. PLoS ONE. 2016;11:e0147544. doi: 10.1371/journal.pone.0147544. PubMed DOI PMC

The World Bank. The World Bank In Vietnam. Available from https://www.worldbank.org/en/country/vietnam/overview (The World Bank, Washington, 2020).

Dat VQ, et al. Healthcare infrastructure capacity to respond to severe acute respiratory infection (SARI) and sepsis in Vietnam: A low-middle income country. J. Crit. Care. 2017;42:109–115. doi: 10.1016/j.jcrc.2017.07.020. PubMed DOI PMC

Chinh LQ, et al. Clinical epidemiology and mortality on patients with acute respiratory distress syndrome (ARDS) in Vietnam. PLoS ONE. 2019;14:e0221114. doi: 10.1371/journal.pone.0221114. PubMed DOI PMC

Takashima K, Wada K, Tra TT, Smith DR. A review of Vietnam's healthcare reform through the Direction of Healthcare Activities (DOHA) Environ. Health Prev. Med. 2017;22:74. doi: 10.1186/s12199-017-0682-z. PubMed DOI PMC

Asian Critical Care Clinical Trials Group. Management of Sepsis in Asia’s Intensive Care unitS II (MOSAICS II) Study. Available from https://sicm.org.sg/article/YDNc8 (Society of Intensive Care Medicine (Singapore), Singapore, 2019).

Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med. 2018;44:925–928. doi: 10.1007/s00134-018-5085-0. PubMed DOI

Ranzani OT, et al. A comparison of mortality from sepsis in Brazil and England: The impact of heterogeneity in general and sepsis-specific patient characteristics. Crit. Care Med. 2019;47:76–84. doi: 10.1097/ccm.0000000000003438. PubMed DOI

Levy MM, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med. 2003;29:530–538. doi: 10.1007/s00134-003-1662-x. PubMed DOI

Rhodes A, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304–377. doi: 10.1007/s00134-017-4683-6. PubMed DOI

Levy MM, et al. Surviving Sepsis Campaign: Association between performance metrics and outcomes in a 7.5-year study. Crit. Care Med. 2015;43:3–12. doi: 10.1097/ccm.0000000000000723. PubMed DOI

Pollack MM, Patel KM, Ruttimann E. Pediatric critical care training programs have a positive effect on pediatric intensive care mortality. Crit. Care Med. 1997;25:1637–1642. doi: 10.1097/00003246-199710000-00011. PubMed DOI

Diaz JV, Ortiz JR, Lister P, Shindo N, Adhikari NKJ. Development of a short course on management of critically ill patients with acute respiratory infection and impact on clinician knowledge in resource-limited intensive care units. Influenza Other Respir. Viruses. 2018;12:649–655. doi: 10.1111/irv.12569. PubMed DOI PMC

Sharma S, Kelly YP, Palevsky PM, Waikar SS. Intensity of renal replacement therapy and duration of mechanical ventilation: Secondary analysis of the acute renal failure trial network study. Chest. 2020;158:1473–1481. doi: 10.1016/j.chest.2020.05.542. PubMed DOI PMC

Elseviers MM, et al. Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury. Crit. Care (Lond. Engl.) 2010;14:R221. doi: 10.1186/cc9355. PubMed DOI PMC

Barbar SD, et al. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis. N. Engl. J. Med. 2018;379:1431–1442. doi: 10.1056/NEJMoa1803213. PubMed DOI

Palevsky PM, et al. Intensity of renal support in critically ill patients with acute kidney injury. N. Engl. J. Med. 2008;359:7–20. doi: 10.1056/NEJMoa0802639. PubMed DOI PMC

Mueller BA, Pasko DA, Sowinski KM. Higher renal replacement therapy dose delivery influences on drug therapy. Artif. Organs. 2003;27:808–814. doi: 10.1046/j.1525-1594.2003.07283.x. PubMed DOI

Btaiche IF, Mohammad RA, Alaniz C, Mueller BA. Amino acid requirements in critically ill patients with acute kidney injury treated with continuous renal replacement therapy. Pharmacotherapy. 2008;28:600–613. doi: 10.1592/phco.28.5.600. PubMed DOI

Mc Causland FR, Asafu-Adjei J, Betensky RA, Palevsky PM, Waikar SS. Comparison of urine output among patients treated with more intensive versus less intensive RRT: Results from the acute renal failure trial network study. Clin. J. Am. Soc. Nephrol. CJASN. 2016;11:1335–1342. doi: 10.2215/cjn.10991015. PubMed DOI PMC

Tripepi G, Jager KJ, Dekker FW, Zoccali C. Selection bias and information bias in clinical research. Nephron Clin. Pract. 2010;115:c94–99. doi: 10.1159/000312871. PubMed DOI

King G, Zeng L. Logistic regression in rare events data. Polit. Anal. 2017;9:137–163. doi: 10.1093/oxfordjournals.pan.a004868. DOI

Babyak MA. What you see may not be what you get: A brief, nontechnical introduction to overfitting in regression-type models. Psychosom. Med. 2004;66:411–421. doi: 10.1097/01.psy.0000127692.23278.a9. PubMed DOI

Sequential Organ Failure Assessment (SOFA) Score for predicting mortality in patients with sepsis in Vietnamese intensive care units: a multicentre, cross-sectional study

Predictive validity of the quick Sequential Organ Failure Assessment (qSOFA) score for the mortality in patients with sepsis in Vietnamese intensive care units