title: Differences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study.
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.
  
  
  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.
authors.affiliation: Departamento de Anestesiologia, Dor e Terapia Intensiva. Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Katia Aparecida Pessoa
authors.initials: KA
authors.lastname: Conde
authors.forename: Eliezer
authors.initials: E
authors.lastname: Silva
authors.forename: Carla Oliveira
authors.initials: CO
authors.lastname: Silva
authors.forename: Elaine
authors.initials: E
authors.lastname: Ferreira
authors.forename: Flavio Geraldo Rezende
authors.initials: FG
authors.lastname: Freitas
authors.forename: Isac
authors.initials: I
authors.lastname: Castro
authors.forename: Alvaro
authors.initials: A
authors.lastname: Rea-Neto
authors.forename: Cintia Magalhaes Carvalho
authors.initials: CM
authors.lastname: Grion
authors.forename: Anselmo Dornas
authors.initials: AD
authors.lastname: Moura
authors.forename: Suzana Margareth
authors.initials: SM
authors.lastname: Lobo
authors.forename: Luciano Cesar Pontes
authors.initials: LC
authors.lastname: Azevedo
authors.forename: Flavia Ribeiro
authors.initials: FR
authors.lastname: Machado
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001938:Brazil; D057210:Delayed Diagnosis; D005260:Female; D005440:Fluid Therapy; D017052:Hospital Mortality / Q000639:trends*; D016304:Hospitals, Private / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents