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Title: Indigenous Australians critically ill with sepsis: Characteristics, outcomes, and areas for improvement
Authors: Hargovan, Satyen
Groch, Taissa
Brooks, James
Sivalingam, Sayonne
Bond, Tatum 
Carter, Angus
Issue Date: 2024
Publisher: Australian College of Critical Care Nurses
Source: Hargovan S, Groch T, Brooks J, Sivalingam S, Bond T, Carter A. Indigenous Australians critically ill with sepsis: Characteristics, outcomes, and areas for improvement. Aust Crit Care. 2024 Jul;37(4):548-557. doi: 10.1016/j.aucc.2023.11.007. Epub 2024 Jan 11. PMID: 38216417.
Journal Title: Australian critical care : official journal of the Confederation of Australian Critical Care Nurses
Abstract: Aboriginal and Torres Strait Islander Australians have amongst the highest incidence of sepsis globally. The objective of this study was to describe the characteristics, short- and long-term outcomes of non-Indigenous, Aboriginal Australian and Torres Strait Islander Australians admitted with sepsis to an intensive care unit (ICU) to inform healthcare outcome improvement. A retrospective cohort study of 500 consecutive sepsis admissions to the Cairns Hospital ICU compared clinical characteristics, short-term (before ICU discharge) and long-term (2000 days posthospital discharge) outcomes. Cohort stratification was done by voluntary disclosure of Indigenous status. Of the 442 individual admissions, 145 (33%) identified as Indigenous Australian. Indigenous and non-Indigenous Australians had similar admission Acute Physiology and Chronic Health Evaluation-3 scores (median [interquartile range]: 70 [52-87] vs. 69 [53-87], P = 0.87), but Indigenous patients were younger (53 [43-60] vs. 62 [52-73] years, P < 0.001) and were more likely to have chronic comorbidities such as type 2 diabetes (58% vs. 23%, P < 0.001), cardiovascular disease (40% vs 28%, P = 0.01), and renal disease (39% vs. 10%, P < 0.001). They also had more hazardous healthcare behaviours such as smoking (61% vs. 45%, P = 0.002) and excess alcohol consumption (40% vs. 18%, P < 0.001). Despite this, the case-fatality rate of Indigenous and non-Indigenous Australians before ICU discharge (13% vs. 12%, P = 0.75) and 2000 days post hospital discharge (25 % vs. 28 %, P = 0.40) was similar. Crucially, however, Indigenous Australians died younger both in the ICU (median [interquartile range] 54 (50-60) vs. 70 [61-76], P < 0.0001) and 2000 days post hospital discharge (58 [53-63] vs. 70 [63-77] years, P < 0.0001). Although Indigenous Australians critically ill with sepsis have similar short and long-term mortality rates, they present to hospital, die in-hospital, and die post-discharge significantly younger. Unique cohort characteristics may explain these outcomes, and assist clinicians, researchers and policy-makers in targeting interventions to these characteristics to best reduce the burden of sepsis in this cohort and improve their healthcare outcomes.
Description: Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated authors: Satyen Hargovan, Taissa Groch, Sayonne Sivalingam, Tatum Bond
DOI: 10.1016/j.aucc.2023.11.007
Keywords: Sepsis;Indigenous;Public health;Intensive care unit;Improving outcomes;Primary health care
Type: Article
Appears in Sites:Cairns & Hinterland HHS Publications

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