title: Outcomes of patients with severe sepsis after the first 6 hours of resuscitation at a regional referral hospital in Uganda.
abstract: The optimal resuscitation strategy for patients with severe sepsis in resource-limited settings is unknown. Therefore, we determined the association between intravenous fluids, changes in vital signs and lactate after the first 6 hours of resuscitation from severe sepsis, and in-hospital mortality at a hospital in Uganda.
  
  
  
  We enrolled patients admitted with severe sepsis to Mbarara Regional Referral Hospital and obtained vital signs and point-of-care blood lactate concentration at admission and after 6 hours of resuscitation. We used logistic regression to determine predictors of in-hospital mortality.
  
  
  
  We enrolled 218 patients and had 6 hour postresuscitation data for 202 patients. The median (interquartile range) age was 35 (26-50) years, 49% of patients were female, and 57% were HIV infected. The in-hospital mortality was 32% and was associated with admission Glasgow Coma Score (adjusted odds ratio [aOR], 0.749; 95% confidence interval [CI], 0.642-0.875; P < .001), mid-upper arm circumference (aOR, 0.876; 95% CI, 0.797-0.964; P = .007), and 6-hour systolic blood pressure (aOR, 0.979; 95% CI, 0.963-0.995; P = .009) but not lactate clearance of 10% or greater (aOR, 1.2; 95% CI, 0.46-3.10; P = .73).
  
  
  
  In patients with severe sepsis in Uganda, obtundation and wasting were more closely associated with in-hospital mortality than lactate clearance of 10% or greater.
authors.affiliation: Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda. Electronic address: dr.amir83@yahoo.com.
authors.forename: Abdallah
authors.initials: A
authors.lastname: Amir
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA. Electronic address: kaciesaulters@gmail.com.
authors.forename: Kacie J
authors.initials: KJ
authors.lastname: Saulters
authors.affiliation: Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda. Electronic address: soketokeny@gmail.com.
authors.forename: Sam
authors.initials: S
authors.lastname: Olum
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA. Electronic address: kp7dq@virginia.edu.
authors.forename: Kelly
authors.initials: K
authors.lastname: Pitts
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA. Electronic address: asp5c@virginia.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Parsons
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA. Electronic address: cc8qg@virginia.edu.
authors.forename: Cristina
authors.initials: C
authors.lastname: Churchill
authors.affiliation: Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda. Electronic address: kabtash@yahoo.com.
authors.forename: Kabanda
authors.initials: K
authors.lastname: Taseera
authors.affiliation: Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda. Electronic address: drmuhindo@gmail.com.
authors.forename: Rose
authors.initials: R
authors.lastname: Muhindo
authors.affiliation: Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA. Electronic address: ccm5u@virginia.edu.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Moore
mesh_terms: D000328:Adult; D003422:Critical Care; D005260:Female; D015600:Glasgow Coma Scale; D015658:HIV Infections / Q000150:complications*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D012151:Resuscitation; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000628:therapy; D014454:Uganda; D055986:Vital Signs
keywords: Africa; Monitoring; Mortality; Resuscitation; Severe sepsis; Uganda