title: Sepsis carries a high mortality among hospitalised adults in Malawi in the era of antiretroviral therapy scale-up: a longitudinal cohort study.
abstract: OBJECTIVE
  To assess mortality risk among adults presenting to an African teaching hospital with sepsis and severe sepsis in a setting of high HIV prevalence and widespread ART uptake.
  
  
  METHODS
  Prospective cohort study of adults (age ≥16 years) admitted with clinical suspicion of severe infection between November 2008 and January 2009 to Queen Elizabeth Central Hospital, a 1250-bed government-funded hospital in Blantyre, Malawi. Demographic, clinical and laboratory information, including blood and cerebrospinal fluid cultures were obtained on admission.
  
  
  RESULTS
  Data from 213 patients (181 with sepsis and 32 with severe sepsis; M:F = 2:3) were analysed. 161 (75.6%) patients were HIV-positive. Overall mortality was 22%, rising to 50% amongst patients with severe sepsis. The mortality of all sepsis patients commenced on antiretroviral therapy (ART) within 90 days was 11/28 (39.3%) compared with 7/42 (16.7%) among all sepsis patients on ART for greater than 90 days (p = 0.050). Independent associations with death were hypoxia (OR = 2.4; 95% CI, 1.1-5.1) and systolic hypotension (OR 7.0; 95% CI: 2.4-20.4).
  
  
  CONCLUSIONS
  Sepsis and severe sepsis carry high mortality among hospitalised adults in Malawi. Measures to reduce this, including early identification and targeted intervention in high-risk patients, especially HIV-positive individuals recently commenced on ART, are urgently required.
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Malawi.
authors.forename: Peter I
authors.initials: PI
authors.lastname: Waitt
authors.affiliation: Malawi-Liverpool-Wellcome Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi. Electronic address: mmukaka@gmail.com.
authors.forename: Mavuto
authors.initials: M
authors.lastname: Mukaka
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Malawi; Malawi-Liverpool-Wellcome Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Patrick
authors.initials: P
authors.lastname: Goodson
authors.affiliation: Malawi-Liverpool-Wellcome Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Felanji D
authors.initials: FD
authors.lastname: SimuKonda
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Malawi; Malawi-Liverpool-Wellcome Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Catriona J
authors.initials: CJ
authors.lastname: Waitt
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Malawi; Malawi-Liverpool-Wellcome Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Nick
authors.initials: N
authors.lastname: Feasey
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Malawi.
authors.forename: Theresa J
authors.initials: TJ
authors.lastname: Allain
authors.affiliation: Department of Anaesthetics, College of Medicine, University of Malawi, Malawi.
authors.forename: Paul
authors.initials: P
authors.lastname: Downie
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Malawi; Malawi-Liverpool-Wellcome Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Heyderman
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D016470:Bacteremia; D002443:Ceftriaxone / Q000008:administration & dosage; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006760:Hospitalization; D006779:Hospitals, Public; D006801:Humans; D008137:Longitudinal Studies; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018805:Sepsis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D044966:Anti-Retroviral Agents; D002443:Ceftriaxone
keywords: Adults; Africa; Antiretroviral therapy; Bacteraemia; HIV; Sepsis