Mortality rate and clinical profile of patients with sepsis admitted at the Department of Medicine, National Referral Hospital of Bhutan, 2021: A cross-sectional study

Abstract

Introduction: Sepsis is a leading cause of death globally, particularly in low and middle-income countries. However, data on adult sepsis in Bhutan remains limited. This study aimed to determine the mortality rate and clinical profile of sepsis patients admitted to the medical ward of the National Referral Hospital in Bhutan. Methods: A cross-sectional study was conducted at the Jigme Dorji Wangchuck National Referral Hospital in 2022. All adult patients with sepsis admitted to the Department of Medicine were included. Data was collected using a structured pro forma and analyzed using Epi Data Analysis version 2.2.2.183 and STATA version 12.1. Results: Among 278 patients with sepsis, the in-hospital mortality rate was 26.6%. Mortality was significantly higher in patients aged over 60 years (p<0.001). Pneumonia was the most common source of infection (39.2%) while spontaneous bacterial peritonitis and bloodstream infections were more strongly associated with mortality (p<0.001). Gram-negative bacteria, particularly Escherichia coli and Klebsiella species were the predominant pathogens. Independent predictors of death included mechanical ventilation (adjusted OR 23.5, 95% CI 11.2–49.2, p<0.001), vasopressor support (adjusted OR 9.78, 95% CI 4.02– 23.8, p<0.001), spontaneous bacterial peritonitis (adjusted OR 3.85, 95% CI 1.43–10.3, p = 0.007 ), and bloodstream infections (adjusted OR 3.62,  95% CI 1.25–10.5, p = 0.018). Conclusion: Mortality was reported in one quarter of patients admitted with sepsis, particularly in the critically ill. Strengthening early recognition, prompt treatment, microbiological diagnostics, and critical care infrastructure are essential to reduce sepsis mortality and improve patient outcomes.