Long-term Mortality Among Hospitalized Adults with Sepsis in Uganda: a Prospective Cohort Study

Background Twelve-month mortality in sepsis survivors has not been previously characterized in sub-Saharan Africa. Methods Hospitalized adults with ≥ 2 modified systemic inflammatory response syndrome (SIRS) criteria (temperature < 36°C or > 38°C, heart rate ≥ 90 beats per minute, or respiratory rate ≥ 20 breaths per minute) were enrolled at a tertiary care centre from October 2017 to August 2022. Multiple clinical blood and respiratory molecular and antigen assays were used to identify infectious etiologies. Baseline demographics were evaluated for risk of death by 1 month and 12 months using Cox proportional hazards regression. Results Among 435 participants, the median age was 45.0 years (interquartile range [IQR]: 28.0, 60.0) years, 57.6% were female, and 31.7% were living with HIV. Malaria (17.7%) followed by tuberculosis (4.7%), and bacteremia (4.6%) were the most common detected causes of illness. Overall, 49 (11.3%) participants died, and 24 participants died between one month and one year (49.0% of deaths and 5.5% of the cohort). Female participants had a decreased risk of death by 12-months (unadjusted hazard ratio [HR]: 0.37; 95% confidence interval [CI]: 0.21 to 0.66). Conclusions The burden of sepsis may be underestimated in sub-Saharan Africa due to limited long-term follow-up. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This protocol and informed consent were approved by the U.S. Army Medical Research and Development Command Institutional Review (# M-10573) and Makerere University School of Public Health IRB# 490). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes De-identified data will be made available upon reasonable request and if it is in accordance with local IRB regulations.