Epidemiology, Management, and Outcomes of Sepsis in ICUs among Countries of Differing National Wealth across Asia

<b>Rationale:</b> Directly comparative data on sepsis epidemiology and sepsis bundle implementation in countries of differing national wealth remain sparse. <b>Objectives:</b> To evaluate across countries/regions of differing income status in Asia <i>1</i>) the prevalence, causes, and outcomes of sepsis as a reason for ICU admission and <i>2</i>) sepsis bundle (antibiotic administration, blood culture, and lactate measurement) compliance and its association with hospital mortality. <b>Methods:</b> A prospective point prevalence study was conducted among 386 adult ICUs from 22 Asian countries/regions. Adult ICU participants admitted for sepsis on four separate days (representing the seasons of 2019) were recruited. <b>Measurements and Main Results:</b> The overall prevalence of sepsis in ICUs was 22.4% (20.9%, 24.5%, and 21.3% in low-income countries/regions [LICs]/lower middle-income countries/regions [LMICs], upper middle-income countries/regions, and high-income countries/regions [HICs], respectively; <i>P</i> < 0.001). Patients were younger and had lower severity of illness in LICs/LMICs. Hospital mortality was 32.6% and marginally significantly higher in LICs/LMICs than HICs on multivariable generalized mixed model analysis (adjusted odds ratio, 1.84; 95% confidence interval, 1.00-3.37; <i>P</i> = 0.049). Sepsis bundle compliance was 21.5% at 1 hour (26.0%, 22.1%, and 16.2% in LICs/LMICs, upper middle-income countries/regions, and HICs, respectively; <i>P</i> < 0.001) and 36.6% at 3 hours (39.3%, 32.8%, and 38.5%, respectively; <i>P</i> = 0.001). Delaying antibiotic administration beyond 3 hours was the only element independently associated with increased mortality (adjusted odds ratio, 2.53; 95% confidence interval, 2.07-3.08; <i>P</i> < 0.001). <b>Conclusions:</b> Sepsis is a common cause of admission to Asian ICUs. Mortality remains high and is higher in LICs/LMICs after controlling for confounders. Sepsis bundle compliance remains low. Delaying antibiotic administration beyond 3 hours from diagnosis is associated with increased mortality. Clinical trial registered with www.ctri.nic.in (CTRI/2019/01/016898).