Sepsis Bundle Compliance and Sepsis-Related Mortality in People Living With HIV Restricted; Files Only
Monda, Alyssa (Summer 2024)
Abstract
Introduction
Sepsis poses a significant threat across patient populations, with people living with HIV (PLWH) potentially at heightened risk. Despite the ongoing assessment of the effectiveness of standardized sepsis treatment, the impact of socio-demographic factors on care outcomes in PLWH remains underexplored. The purpose of this dissertation research was to identify those factors associated with the implementation of the sepsis treatment bundle and time to sepsis bundle compliance in PLWH.
Methods
This was a retrospective 1:2 matched case-control study using data from the Clinical Data Warehouse (CDW) available from three large academic-affiliated hospitals in Georgia. Data were available on patient demographic and clinical characteristics as well as hospital characteristics and residential segregation. Patient diagnoses, treatments, and procedures were identified based on International Classification of Diseases (ICD) 9th and 10th Edition codes. The Dissimilarity Index was used to assess residential segregation. Propensity score matching on patient age and sex allowed for pseudo-randomization. Descriptive and inferential analyses were used to examine all data and to estimate the effects of factors associated with sepsis bundle compliance and in-hospital mortality.
Results
The final matched sample included 726 PLWH and 1454 PLOH. A smaller percentage (47%) of PLWH received antibiotics and fluids within the recommended sepsis bundle timeframe compared to PWOH (49%). There were no significant differences noted in time to fluid/antibiotic compliance based on HIV status. In a fully adjusted regression model, each hour of delay in the start of antibiotic treatment was associated with a 3% increase in mortality (OR 1.03, p=0.009). An interaction model showed that residential segregation is a significant moderator of the relationship between HIV status and time to antibiotic administration (HR=1.01, p=0.016).
Discussion
The findings from this dissertation research highlight the importance of timely antibiotic administration and suggests potential exacerbation of delays in patients who reside in residential areas with higher levels of segregation. Additional research is warranted to better understand the impact of residential segregation on the delivery and quality of care provided to PLWH.
Table of Contents
Chapter One: Introduction and Specific Aims- 1
HIV and Sepsis- 1
Framework- 5
Theoretical Framework- 5
Conceptual Framework- 6
Specific Aims- 11
Long Term Objectives- 12
Overview of Chapters- 13
Chapter Two: Background and Significance- 14
Sepsis- 14
The Surviving Sepsis Campaign- 18
Early Goal-directed Therapy- 22
Morbidity- 25
Length of Stay- 27
Impact of Process Factors on Patient Outcomes- 28
The Sepsis Bundle- 28
Sepsis Bundle Compliance- 30
System Factors and Sepsis Outcomes- 33
Hospital Location- 34
Hospital Resources- 36
Nurse Staffing- 40
Impact of Patient Factors on Patient Outcomes- 43
Age- 43
Sex- 46
Race- 48
Insurance Status- 52
Residential Segregation- 53
Comorbid Disease- 56
HIV Status- 58
Gaps in Current Literature- 67
Significance of the Current Study- 70
Chapter Three: Research Designs and Methods- 72
Design- 72
Sampling Methods- 74
Power Analysis- 75
Data Collection- 76
Dependent Variables- 77
Independent Variables- 78
Data Analysis- 82
Data Import 83
Data Management 84
Data Cleaning- 86
Data Matching and Demographic Analysis- 91
Specific Aim 1 Analysis- 92
Specific Aim 2 Analysis- 93
Specific Aim 3 Analysis- 95
Limitations- 97
Chapter Four: Results- 99
Sample Description- 100
Demographic and Clinical Characteristics- 101
Unmatched Data- 101
Matched Data- 105
Specific Aim1- 113
Hypothesis 1- 113
Specific Aim 2- 117
Hypothesis 1- 117
Specific Aim 3- 121
Hypothesis 1- 121
Hypothesis 2- 123
Chapter Five: Summary- 129
Findings- 129
Rates of Compliance- 132
Time to Compliance- 134
Mortality- 138
Strengths- 143
Limitations- 144
Recommendations for Clinical Practice and Research- 147
Clinical Practice- 147
Research- 150
Policy- 152
Conclusions- 154
References- 157
About this Dissertation
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File download under embargo until 21 August 2026 | 2024-07-03 16:01:27 -0400 | File download under embargo until 21 August 2026 |
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