title: Sepsis in Haiti: Prevalence, treatment, and outcomes in a Port-au-Prince referral hospital.
abstract: Developing countries carry the greatest burden of sepsis, yet few descriptive data exist from the Western Hemisphere. We conducted a retrospective cohort study to elucidate the presentation, treatment, and outcomes of sepsis at an urban referral hospital in Port-au-Prince, Haiti.
  
  
  
  We studied all adult emergency department patient encounters from January through March 2012. We characterized presentation, management, and outcomes using univariable and multivariable analyses.
  
  
  
  Of 1078 adult patients, 224 (20.8%) had sepsis and 99 (9.2%) had severe sepsis. In-hospital mortality for severe sepsis was 24.2%. Encephalopathy was a predictor of intravenous fluid administration (adjusted odds ratio [OR], 5.63; 95% confidence interval [CI], 1.46-21.76; P=.01), and lower blood pressures predicted shorter time to fluid administration. Increasing temperature and lower blood pressures predicted antibiotic administration. Encephalopathy at presentation (adjusted OR, 6.92; 95% CI, 1.94-24.64; P=.003), oxygen administration (adjusted OR, 15.96; 95% CI, 3.05-83.59; P=.001), and stool microscopy (adjusted OR, 45.84; 95% CI, 1.43-1469.34; P=.03) predicted death in severe sepsis patients.
  
  
  
  This is the first descriptive study of sepsis in Haiti. Our findings contribute to the knowledge base of global sepsis and reveal similarities in independent predictors of mortality between high- and low-income countries.
authors.affiliation: Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: apapali@medicine.umaryland.edu.
authors.forename: Alfred
authors.initials: A
authors.lastname: Papali
authors.affiliation: Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Avelino C
authors.initials: AC
authors.lastname: Verceles
authors.affiliation: Department of Medicine, St Luke Family Hospital, Port-au-Prince, Haiti.
authors.forename: Marc E
authors.initials: ME
authors.lastname: Augustin
authors.affiliation: Department of Medicine, St Luke Family Hospital, Port-au-Prince, Haiti.
authors.forename: L Nathalie
authors.initials: LN
authors.lastname: Colas
authors.affiliation: Department of Medicine, St Luke Family Hospital, Port-au-Prince, Haiti.
authors.forename: Carl H
authors.initials: CH
authors.lastname: Jean-Francois
authors.affiliation: Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Devang M
authors.initials: DM
authors.lastname: Patel
authors.affiliation: Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Nevins W
authors.initials: NW
authors.lastname: Todd
authors.affiliation: Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: McCurdy
authors.affiliation: Division of Pulmonary & Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, USA; International Respiratory and Severe Illness Center, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: T Eoin
authors.initials: TE
authors.lastname: West
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D005260:Female; D005440:Fluid Therapy; D006205:Haiti / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality
keywords: Critical care; Global health; Haiti; Intensive care; Resource-limited; Sepsis