---
title: "Patterns of Vasopressor Use for Sepsis in Uganda and Rwanda: Multicenter Retrospective Cohort"
id: "pubmed-42726203"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42726203"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42726203/"
doi: "10.1097/CCE.0000000000001481"
published_at: "2026-09-11T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Patterns of Vasopressor Use for Sepsis in Uganda and Rwanda: Multicenter Retrospective Cohort
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42726203
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42726203/)
- **DOI:** [10.1097/CCE.0000000000001481](https://doi.org/10.1097%2FCCE.0000000000001481)
- **Published At:** 2026-09-11T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This multicenter retrospective cohort pooled data from two studies of adults admitted with **sepsis** in one Ugandan and two Rwandan hospitals to describe vasopressor use patterns. - The analysis included 471 patients: median age 51 years (IQR 36–65), 57% female, and 26% living with HIV. - Overall, 113 patients (24%) received a **vasopressor**, and 139 patients (30%) died during hospitalization. - Univariable predictors of vasopressor receipt included higher respiratory rate, higher Universal Vital Assessment (**UVA**) score, lower blood pressure, lower oxygen saturation, lower Glasgow Coma Scale score, presence of abdominal infection, and receiving greater IV fluid volume. - In multivariable analysis, higher **UVA** mortality risk scores independently predicted vasopressor administration (adjusted odds ratio 1.25; 95% CI, 1.14–1.27; p < 0.001). - Hospitalization in Uganda was associated with vasopressor use in the cohort. - Exploratory machine learning analyses replicated the primary predictive findings reported in regression models. - The authors emphasize that sepsis guidelines derive mainly from high-income settings and that further research is needed to define indications, timing, and role of vasopressors in African sepsis care. - No interventions were tested; the study is descriptive and observational, and the source reports no conflicts of interest disclosed by authors.
## Clinical Analysis & Structured Key Points
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Vasopressor Use Among Adults With Sepsis in Uganda and Rwanda: A Multicenter Retrospective Cohort Study [William S Girard](https://pubmed.ncbi.nlm.nih.gov/?term=Girard+WS&cauthor_id=42726203)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-1 "Division of Infectious Diseases, University of Virginia, Charlottesville, VA."), [Farah Turkistani](https://pubmed.ncbi.nlm.nih.gov/?term=Turkistani+F&cauthor_id=42726203)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-1 "Division of Infectious Diseases, University of Virginia, Charlottesville, VA."), [Reagan Kakande](https://pubmed.ncbi.nlm.nih.gov/?term=Kakande+R&cauthor_id=42726203)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-2 "Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda."), [Victor Adejayan](https://pubmed.ncbi.nlm.nih.gov/?term=Adejayan+V&cauthor_id=42726203)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-1 "Division of Infectious Diseases, University of Virginia, Charlottesville, VA."), [Muhammad Zulfiqar](https://pubmed.ncbi.nlm.nih.gov/?term=Zulfiqar+M&cauthor_id=42726203)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-1 "Division of Infectious Diseases, University of Virginia, Charlottesville, VA."), [Michael Ndyomugabe](https://pubmed.ncbi.nlm.nih.gov/?term=Ndyomugabe+M&cauthor_id=42726203)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-2 "Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda."), [Phoebe Gruccio](https://pubmed.ncbi.nlm.nih.gov/?term=Gruccio+P&cauthor_id=42726203)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-1 "Division of Infectious Diseases, University of Virginia, Charlottesville, VA."), [Philemon Ojuman](https://pubmed.ncbi.nlm.nih.gov/?term=Ojuman+P&cauthor_id=42726203)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-2 "Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda."), [Eva Otoupalova](https://pubmed.ncbi.nlm.nih.gov/?term=Otoupalova+E&cauthor_id=42726203)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-3 "Division of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University, New Orleans, LA."), [Paulin R Banguti](https://pubmed.ncbi.nlm.nih.gov/?term=Banguti+PR&cauthor_id=42726203)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-4 "Department of Anesthesia, University of Rwanda, Kigali, Rwanda."), [Dennis Hopkinson](https://pubmed.ncbi.nlm.nih.gov/?term=Hopkinson+D&cauthor_id=42726203)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-5 "Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA."), [Jean Paul Mvukiyehe](https://pubmed.ncbi.nlm.nih.gov/?term=Mvukiyehe+JP&cauthor_id=42726203)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-4 "Department of Anesthesia, University of Rwanda, Kigali, Rwanda."), [Aamer Syed](https://pubmed.ncbi.nlm.nih.gov/?term=Syed+A&cauthor_id=42726203)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-5 "Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA."), [Elisabeth Riviello](https://pubmed.ncbi.nlm.nih.gov/?term=Riviello+E&cauthor_id=42726203)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-6 "Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA."), [Edwin Nuwagira](https://pubmed.ncbi.nlm.nih.gov/?term=Nuwagira+E&cauthor_id=42726203)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-2 "Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda."), [Christopher C Moore](https://pubmed.ncbi.nlm.nih.gov/?term=Moore+CC&cauthor_id=42726203)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#full-view-affiliation-1 "Division of Infectious Diseases, University of Virginia, Charlottesville, VA.") Affiliations Expand ### Affiliations * 1 Division of Infectious Diseases, University of Virginia, Charlottesville, VA. * 2 Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda. * 3 Division of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University, New Orleans, LA. * 4 Department of Anesthesia, University of Rwanda, Kigali, Rwanda. * 5 Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA. * 6 Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA. * PMID: **42726203** * DOI: [ 10.1097/CCE.0000000000001481 ](https://doi.org/10.1097/cce.0000000000001481) Item in Clipboard Multicenter Study # Vasopressor Use Among Adults With Sepsis in Uganda and Rwanda: A Multicenter Retrospective Cohort Study William S Girard et al. Crit Care Explor. 2026. Show details Display options Display options Format Abstract PubMed PMID Crit Care Explor Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Crit+Care+Explor%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Crit+Care+Explor%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42726203/) . 2026 Sep 11;8(9):e1481. doi: 10.1097/CCE.0000000000001481. eCollection 2026 Sep 1. ### Authors [William S Girard](https://pubmed.ncbi.nlm.nih.gov/?term=Girard+WS&cauthor_id=42726203)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-1 "Division of Infectious Diseases, University of Virginia, Charlottesville, VA."), [Farah Turkistani](https://pubmed.ncbi.nlm.nih.gov/?term=Turkistani+F&cauthor_id=42726203)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-1 "Division of Infectious Diseases, University of Virginia, Charlottesville, VA."), [Reagan Kakande](https://pubmed.ncbi.nlm.nih.gov/?term=Kakande+R&cauthor_id=42726203)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-2 "Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda."), [Victor Adejayan](https://pubmed.ncbi.nlm.nih.gov/?term=Adejayan+V&cauthor_id=42726203)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-1 "Division of Infectious Diseases, University of Virginia, Charlottesville, VA."), [Muhammad Zulfiqar](https://pubmed.ncbi.nlm.nih.gov/?term=Zulfiqar+M&cauthor_id=42726203)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-1 "Division of Infectious Diseases, University of Virginia, Charlottesville, VA."), [Michael Ndyomugabe](https://pubmed.ncbi.nlm.nih.gov/?term=Ndyomugabe+M&cauthor_id=42726203)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-2 "Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda."), [Phoebe Gruccio](https://pubmed.ncbi.nlm.nih.gov/?term=Gruccio+P&cauthor_id=42726203)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-1 "Division of Infectious Diseases, University of Virginia, Charlottesville, VA."), [Philemon Ojuman](https://pubmed.ncbi.nlm.nih.gov/?term=Ojuman+P&cauthor_id=42726203)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-2 "Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda."), [Eva Otoupalova](https://pubmed.ncbi.nlm.nih.gov/?term=Otoupalova+E&cauthor_id=42726203)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-3 "Division of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University, New Orleans, LA."), [Paulin R Banguti](https://pubmed.ncbi.nlm.nih.gov/?term=Banguti+PR&cauthor_id=42726203)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-4 "Department of Anesthesia, University of Rwanda, Kigali, Rwanda."), [Dennis Hopkinson](https://pubmed.ncbi.nlm.nih.gov/?term=Hopkinson+D&cauthor_id=42726203)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-5 "Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA."), [Jean Paul Mvukiyehe](https://pubmed.ncbi.nlm.nih.gov/?term=Mvukiyehe+JP&cauthor_id=42726203)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-4 "Department of Anesthesia, University of Rwanda, Kigali, Rwanda."), [Aamer Syed](https://pubmed.ncbi.nlm.nih.gov/?term=Syed+A&cauthor_id=42726203)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-5 "Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA."), [Elisabeth Riviello](https://pubmed.ncbi.nlm.nih.gov/?term=Riviello+E&cauthor_id=42726203)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-6 "Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA."), [Edwin Nuwagira](https://pubmed.ncbi.nlm.nih.gov/?term=Nuwagira+E&cauthor_id=42726203)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-2 "Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda."), [Christopher C Moore](https://pubmed.ncbi.nlm.nih.gov/?term=Moore+CC&cauthor_id=42726203)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42726203/#short-view-affiliation-1 "Division of Infectious Diseases, University of Virginia, Charlottesville, VA.") ### Affiliations * 1 Division of Infectious Diseases, University of Virginia, Charlottesville, VA. * 2 Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda. * 3 Division of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University, New Orleans, LA. * 4 Department of Anesthesia, University of Rwanda, Kigali, Rwanda. * 5 Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA. * 6 Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA. * PMID: **42726203** * DOI: [ 10.1097/CCE.0000000000001481 ](https://doi.org/10.1097/cce.0000000000001481) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Objectives:** Africa has the highest global sepsis burden. Yet, sepsis treatment guidelines, including those for vasopressor use, incorporate data from high-income settings. We aimed to determine patterns of vasopressor use among adults admitted to hospital with sepsis in East Africa. **Design:** Retrospective cohort study. **Setting:** One hospital in Uganda and two hospitals in Rwanda. **Patients:** Adults admitted to hospital with sepsis, defined as suspected infection and greater than or equal to 2 quick Sequential Organ Failure Assessment criteria. **Interventions:** None. **Measurements and main results:** We performed an analysis of pooled data from two retrospective studies of adults with sepsis admitted to hospital in Rwanda or Uganda. Of 471 septic patients analyzed, 263 (57%) were female, the median (interquartile) age was 51 years (36-65), 121 (26%) were living with HIV, 113 (24%) received a vasopressor, and death occurred in 139 patients (30%). In the univariable logistic regression analysis, higher respiratory rate and Universal Vital Assessment (UVA) scores; lower blood pressure, oxygen saturation, and Glasgow Coma Scale score at the time of sepsis diagnosis; presence of abdominal infection; and receiving a greater volume of IV fluids predicted receipt of a vasopressor. In the multivariable analysis, higher UVA mortality risk scores (adjusted odds ratio 1.25; 95% CI, 1.14-1.27; p < 0.001) predicted vasopressor receipt. We replicated these findings in exploratory machine learning analyses. **Conclusions:** In patients with sepsis in East Africa, UVA score and hospitalization in Uganda were predictive of vasopressor administration. Further research is required to address existing knowledge gaps in the role, timing, and indications for vasopressors in sepsis management in Africa. Copyright © 2026 The Authors. Published by Wolters Kluwer Health, LLC. on behalf of the Society of Critical Care Medicine. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement The authors have disclosed that they do not have any potential conflicts of interest. ## References 1. 1. Rudd KE, Johnson SC, Agesa KM, et al.: Global, regional, and national sepsis incidence and mortality, 1990–2017: Analysis for the Global Burden of Disease Study. Lancet 2020; 395:200–211 2. 1. Prescott HC, Antonelli M, Alhazzani W, et al.: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med 2026; 54:725–812 3. 1. Cheng AC, West TE, Limmathurotsakul D, et al.: Strategies to reduce mortality from bacterial sepsis in adults in developing countries. PLoS Med 2008; 5:e175 4. 1. Burke RM, Feasey N, Rangaraj A, et al.: Ending AIDS deaths requires improvements in clinical care for people with advanced HIV disease who are seriously ill. Lancet HIV 2023; 10:e482–e484 5. 1. Shapiro NI, Douglas IS, Brower RG, et al.; National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network: Early restrictive or liberal fluid management for sepsis-induced hypotension. N Engl J Med 2023; 388:499–510 Show all 36 references ## Publication types * Multicenter Study Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Multicenter+Study%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Multicenter+Study) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42726203/) ## MeSH terms * Adult Actions * [
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