Evidence map›Paper›PMID 28826588›Full record

Observational studyThe Lancet. Infectious diseases2017

The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study.

Flavia R Machado, Alexandre Biasi Cavalcanti, Fernando Augusto Bozza, Elaine M Ferreira, Fernanda Sousa Angotti Carrara, Juliana Lubarino Sousa, Noemi Caixeta, Reinaldo Salomao, Derek C Angus, Luciano Cesar Pontes Azevedo and 2 more

2 registry-linked trialsOpen access · bronzeAbstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in The Lancet. Infectious diseases, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 173 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
173citing papers in PubMed, 11 pooled it
26.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04693923 naunknown statusnot on this mapstarted 2021, after this paper: background citation

Capillary Refill Time Response to a Rapid Fluid Challenge in Septic Shock Patients: Pathophysiological Determinants, and Relation to Changes in Systemic, Regional and Microcirculatory Blood Flow

TypeinterventionalSponsorPontificia Universidad Catolica de ChileRan2021 to 2023Enrolled42ConditionsSeptic ShockArmsFluid challenge
NCT07167173 not yet recruitingnot on this mapstarted 2025, after this paper: background citation

Predictive Model for Multidrug Resistance in Patients Admitted to the Emergency Department With Sepsis

TypeobservationalSponsorHospital Italiano de Buenos AiresRan2025 to 2025Enrolled10,000ConditionsSepsis, Septic Shock
3 · Its place in the literature

Who cites it

173 citing papers in PubMed, 11 syntheses or guidelines pooled it, 406 citations in OpenAlex.

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  5. What Animal Models Can Tell Us About Long-Term Psychiatric Symptoms in Sepsis Survivors: a Systematic Review.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2021
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  6. Clinical course and outcomes of critically ill patients with COVID-19 infection: a systematic review.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2021
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113 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 4 institutions in 2 countries.

Flavia R MachadoAnesthesiology, Pain, and Intensive Care Department, Universidade Federal de São Paulo, São Paulo, Brazil; Latin America Sepsis Institute, São Paulo, Brazil; Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil. Electronic address: frmachado@unifesp.br.
Alexandre Biasi CavalcantiLatin America Sepsis Institute, São Paulo, Brazil; Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil; Research Institute, Hospital do Coração (HCor), São Paulo, Brazil.
Fernando Augusto BozzaLatin America Sepsis Institute, São Paulo, Brazil; Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil; Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.
Elaine M FerreiraLatin America Sepsis Institute, São Paulo, Brazil.
Fernanda Sousa Angotti CarraraLatin America Sepsis Institute, São Paulo, Brazil.
Juliana Lubarino SousaLatin America Sepsis Institute, São Paulo, Brazil.
Noemi CaixetaLatin America Sepsis Institute, São Paulo, Brazil.
Reinaldo SalomaoInfectious Disease Department, Universidade Federal de São Paulo, São Paulo, Brazil; Latin America Sepsis Institute, São Paulo, Brazil.
Derek C AngusDepartment of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Luciano Cesar Pontes AzevedoLatin America Sepsis Institute, São Paulo, Brazil; Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil; Hospital Sírio Libanes, São Paulo, Brazil.
SPREAD Investigators
Latin American Sepsis Institute Network
Brazilian Research in Intensive Care Network · BRLatin American Sepsis Institute · BRUniversity of Pittsburgh · USHospital Sírio-Libanês · BR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe sepsis burden on acute care services in middle-income countries is a cause for concern. We estimated incidence, prevalence, and mortality of sepsis in adult Brazilian intensive care units (ICUs) and association of ICU organisational factors with outcome.

methodsWe did a 1-day point prevalence study with follow-up of patients in ICU with sepsis in a nationally representative pseudo-random sample. We produced a sampling frame initially stratified by geographical region. Each stratum was then stratified by hospitals' main source of income (serving general public vs privately insured individuals) and ICU size (ten or fewer beds vs more than ten beds), finally generating 40 strata. In each stratum we selected a random sample of ICUs so as to enrol the total required beds in 1690 Brazilian adult ICUs. We followed up patients until hospital discharge censored at 60 days, estimated incidence from prevalence and length of stay, and generated national estimates. We assessed mortality prognostic factors using random-effects logistic regression models.

findingsOn Feb 27, 2014, 227 (72%) of 317 ICUs that were randomly selected provided data on 2632 patients, of whom 794 had sepsis (30·2 septic patients per 100 ICU beds, 95% CI 28·4-31·9). The ICU sepsis incidence was 36·3 per 1000 patient-days (95% CI 29·8-44·0) and mortality was observed in 439 (55·7%) of 788 patients (95% CI 52·2-59·2). Low availability of resources (odds ratio [OR] 1·67, 95% CI 1·02-2·75, p=0·045) and adequacy of treatment (OR 0·56, 0·37-0·84, p=0·006) were independently associated with mortality. The projected incidence rate is 290 per 100 000 population (95% CI 237·9-351·2) of adult cases of ICU-treated sepsis per year, which yields about 420 000 cases annually, of whom 230 000 die in hospital.

interpretationThe incidence, prevalence, and mortality of ICU-treated sepsis is high in Brazil. Outcome varies considerably, and is associated with access to adequate resources and treatment. Our results show the burden of sepsis in resource-limited settings, highlighting the need to establish programmes aiming for sepsis prevention, early diagnosis, and adequate treatment.

fundingFundação de Apoio a Pesquisa do Estado de São Paulo (FAPESP).

Indexed as

Intensive Care UnitsBrazilHumansIncidenceLength of StayPrevalenceRandom AllocationRisk FactorsSepsisSurvival Analysis

Identifiers

PMID28826588
OpenAlexW2745432684

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.