Estimates of Sepsis Prevalence and Outcomes in Adult Patients in the ICU in India: A Cross-sectional Study

Naomi E Hammond; Ashwani Kumar; Parmeet Kaur; Bharath Kumar Tirupakuzhi Vijayaraghavan; Arpita Ghosh; Sarah Grattan; Vivekanand Jha; Dilip Mathai; Balasubramanian Venkatesh; Sepsis in India Prevalence Study (SIPS) Investigator Network

doi:10.1016/j.chest.2021.12.673

Estimates of Sepsis Prevalence and Outcomes in Adult Patients in the ICU in India: A Cross-sectional Study

Chest. 2022 Jun;161(6):1543-1554. doi: 10.1016/j.chest.2021.12.673. Epub 2022 Jan 31.

Authors

Naomi E Hammond¹, Ashwani Kumar², Parmeet Kaur³, Bharath Kumar Tirupakuzhi Vijayaraghavan⁴, Arpita Ghosh⁵, Sarah Grattan², Vivekanand Jha⁶, Dilip Mathai³, Balasubramanian Venkatesh⁷; Sepsis in India Prevalence Study (SIPS) Investigator Network

Collaborators

Sepsis in India Prevalence Study (SIPS) Investigator Network:
Pradeep Bhatia, Parmeet Kaur, Subhash Todi, Sharmila Chatterjee, Samir Sahu, Sanjeev Singh, Meghena Mathew, Ashwin Mani, Swarup Ranjan De, Bharath Kumar Tirupakuzhi Vijayaraghavan, Ramesh Venkataraman, Sudeep Sirga, Pratheema Ramachandran, Devachandran Jayakumar, Dedeepiya Devaprasad, Usha Rani, Ebenezer Rabindrarajan, Nikhilesh Jain, Binila Chacko, Abhishek Samprathi, Shaleen Trivedi, Palepu B Gopal, Prasad Rajhans, Prasanna Marudwar, Kishore Mangal, Rahul Pandit, Badri Narayana, Niyaz Ashraf, Khalid Ansari, Sujith Thomas, Sajith Kumar Radhakrishnan, Neeta George, Mahesh Balakrishna, Yatin Mehta, Tariq Ali, Joby V George, Anusha Rohit, Narayana Yaddanapudi, Dhruva Chaudhry, Prachee Sathe, Tatyasaheb Jadhav, Sanjith Saseedharan, Roopa Karanam, Rajat Gupta, Sowmya Gopalan, Jaba Chauhan, Prathiba Dileep

Affiliations

¹ Critical Care Program, The George Institute for Global Health and the University of New South Wales, Sydney, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia. Electronic address: nhammond@georgeinstitute.org.au.
² Critical Care Program, The George Institute for Global Health and the University of New South Wales, Sydney, Australia.
³ Department of General Internal Medicine, Apollo Institute of Medical Sciences & Research, Hyderabad, India.
⁴ Department of Critical Care Medicine, Apollo Main Hospital Chennai, Apollo Hospitals, Chennai, India; The George Institute for Global Health India, New Delhi, India.
⁵ The George Institute for Global Health India, New Delhi, India.
⁶ The George Institute for Global Health India, New Delhi, India; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India; School of Public Health, Imperial College, London, United Kingdom.
⁷ Critical Care Program, The George Institute for Global Health and the University of New South Wales, Sydney, Australia; The George Institute for Global Health India, New Delhi, India; Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Intensive Care, The Wesley Hospital, Brisbane, Australia.

PMID: 35092747
DOI: 10.1016/j.chest.2021.12.673

Abstract

Background: Sepsis is a global health problem. Limited data exist on the prevalence of sepsis using current definitions in ICUs in India.

Research question: In adult patients admitted to ICUs in India, what is the prevalence of sepsis using the previous (Second International Consensus Definitions for Sepsis and Septic Shock [Sepsis-2]) and current (Third International Consensus Definitions for Sepsis and Septic Shock [Sepsis-3]) definitions?

Study design and methods: Prospective, observational, multicentre, 1-day, cross-sectional study. The primary outcome was the sepsis prevalence using both the Sepsis-2 and Sepsis-3 definitions and their concordance (using Cohen's κ coefficient). Additional outcomes included reporting on current microbiological characteristics, antimicrobial use, multidrug-resistant infections, and 30-day discharge and mortality status in patients with sepsis.

Results: A total of 35 ICUs (85.7% private, 14.3% public) participated, enrolling 680 patients (median age, 60 years [interquartile range, 24 years]; 62.1% men). The most common primary diagnosis was renal disease, and common comorbidities were diabetes (44.0%) and chronic renal failure (11.6%). The sepsis prevalence on the study day was 382 of 677 patients (56.4%). Prevalence by Sepsis-3 and Sepsis-2 definitions was 33.2% and 46.2%, respectively, with minimal concordance (κ = 0.32). In patients with sepsis, the most common microorganisms were bacterial (77.9%) followed by fungal (14.1%) infections. Approximately 45% of infections were caused by multidrug-resistant organisms. Mortality at 30 days after the study day (27.6% vs 5.3%; P < .01) and rates of discharge against medical advice (12.8% vs 4.9%; P < .01) were significantly higher in the sepsis cohort compared with the cohort without sepsis, respectively.

Interpretation: This multicenter point prevalence study in Indian ICUs showed a high burden of sepsis using both Sepsis-2 and Sepsis-3 criteria, with associated high rates of antimicrobial resistance and mortality. These findings have implications for public health and future research.

Keywords: India; intensive care; prevalence; sepsis, SIRS.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anti-Infective Agents*
Cross-Sectional Studies
Female
Hospital Mortality
Humans
Intensive Care Units
Male
Middle Aged
Prevalence
Prospective Studies
Sepsis* / diagnosis
Shock, Septic*

Substances

Anti-Infective Agents