Vasopressor Use Among Adults With Sepsis in Uganda and Rwanda: A Multicenter Retrospective Cohort Study

Abstract

OBJECTIVES: Africa has the highest global sepsis burden. Yet, sepsis treatment guidelines, including those for vasopressor use, incorporate data from high income settings. We aimed to determine patterns of vasopressor use among adults admitted to hospital with sepsis in East Africa. DESIGN: Retrospective cohort study. SETTING: One hospital in Uganda and two hospitals in Rwanda. PATIENTS: Adults admitted to hospital with sepsis, defined as suspected infection and greater than or equal to 2 quick Sequential Organ Failure Assessment criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We performed an analysis of pooled data from two retrospective studies of adults with sepsis admitted to hospital in Rwanda or Uganda. Of 471 septic patients analyzed, 263 (57%) were female, the median (interquartile) age was 51 years (36–65), 121 (26%) were living with HIV, 113 (24%) received a vasopressor, and death occurred in 139 patients (30%). In the univariable logistic regression analysis, higher respiratory rate and Universal Vital Assessment (UVA) scores; lower blood pressure, oxygen saturation, and Glasgow Coma Scale score at the time of sepsis diagnosis; presence of abdominal infection; and receiving a greater volume of IV fluids predicted receipt of a vasopressor. In the multivariable analysis, higher UVA mortality risk scores (adjusted odds ratio 1.25; 95% CI, 1.14–1.27; p < 0.001) predicted vasopressor receipt. We replicated these findings in exploratory machine learning analyses. CONCLUSIONS: In patients with sepsis in East Africa, UVA score and hospitalization in Uganda were predictive of vasopressor administration. Further research is required to address existing knowledge gaps in the role, timing, and indications for vasopressors in sepsis management in Africa.