ArticleCritical care medicine2019
A Comparison of Mortality From Sepsis in Brazil and England: The Impact of Heterogeneity in General and Sepsis-Specific Patient Characteristics.
Article in Critical care medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Sepsis mortality prediction using machine learning and deep learning - a systematic review.BMC medical informatics and decision making · 2025Pooled it
- Understanding and Enhancing Sepsis Survivorship. Priorities for Research and Practice.American journal of respiratory and critical care medicine · 2019Pooled it
- The customization of general outcome prediction models: a statistical exercise or a necessity?Critical care science · 2026Article
- Comparison of outcomes of community-acquired sepsis and hospital-acquired sepsis in critically ill patients: a systematic review and meta-analysis.Annals of medicine and surgery (2012) · 2025Article
- Development and Validation of the Hospital Medicine Safety Sepsis Initiative Mortality Model.Chest · 2024Article
- Update on the Epimed Monitor Adult ICU Database: 15 years of its use in national registries, quality improvement initiatives and clinical research.Critical care science · 2024Review
- Predicting Bacteremia among Septic Patients Based on ED Information by Machine Learning Methods: A Comparative Study.Diagnostics (Basel, Switzerland) · 2022Article
- Hospital-onset sepsis and community-onset sepsis in critical care units in Japan: a retrospective cohort study based on a Japanese administrative claims database.Critical care (London, England) · 2022Article
- Factors relating to mortality in septic patients in Vietnamese intensive care units from a subgroup analysis of MOSAICS II study.Scientific reports · 2021Observational
- Rethinking animal models of sepsis - working towards improved clinical translation whilst integrating the 3Rs.Clinical science (London, England : 1979) · 2020Review
- Prevalence of organ failure and mortality among patients in the emergency department: a population-based cohort study.BMJ open · 2019Observational
- Exploring the Pathways Revealed by International Sepsis Benchmarking.Critical care medicine · 2019Article
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Abstract
objectivesTo test whether differences in both general and sepsis-specific patient characteristics explain the observed differences in sepsis mortality between countries, using two national critical care (ICU) databases.
designCohort study.
settingWe analyzed 62 and 164 ICUs in Brazil and England, respectively. PATIENTS: Twenty-two-thousand four-hundred twenty-six adult ICU admissions from January 2013 to December 2013.
interventionsNone. MEASUREMENTS AND MAIN
resultsAfter harmonizing relevant variables, we merged the first ICU episode of adult medical admissions from Brazil (ORganizational CHaractEeriSTics in cRitical cAre study) and England (Intensive Care National Audit & Research Centre Case Mix Programme). Sepsis-3 definition was used, and the primary outcome was hospital mortality. We used multilevel logistic regression models to evaluate the impact of country (Brazil vs England) on mortality, after adjustment for general (age, sex, comorbidities, functional status, admission source, time to admission) and sepsis-specific (site of infection, organ dysfunction type and number) patient characteristics. Of medical ICU admissions, 13.2% (4,505/34,150) in Brazil and 30.7% (17,921/58,316) in England met the sepsis definition. The Brazil cohort was older, had greater prevalence of severe comorbidities and dependency compared with England. Respiratory was the most common infection site in both countries. The most common organ dysfunction was cardiovascular in Brazil (41.2%) and respiratory in England (85.8%). Crude hospital mortality was similar (Brazil 41.4% vs England 39.3%; odds ratio, 1.12 [0.98-1.30]). After adjusting for general patient characteristics, there was an important change in the point-estimate of the odds ratio (0.88 [0.75-1.02]). However, after adjusting for sepsis-specific patient characteristics, the direction of effect reversed again with Brazil having higher risk-adjusted mortality (odds ratio, 1.22 [1.05-1.43]).
conclusionsPatients with sepsis admitted to ICUs in Brazil and England have important differences in general and sepsis-specific characteristics, from source of admission to organ dysfunctions. We show that comparing crude mortality from sepsis patients admitted to the ICU between countries, as currently performed, is not reliable and that the adjustment for both general and sepsis-specific patient characteristics is essential for valid international comparisons of mortality amongst sepsis patients admitted to critical care units.
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