Background Globally, mortality rates of patients admitted to the intensive care unit (ICU) have decreased over the last two decades. However, evaluations of the temporal trends in the characteristics and outcomes of ICU patients in Asia are limited. The objective of this study was to describe the characteristics and risk adjusted outcomes of all patients admitted to publicly funded ICUs in Hong Kong over a 11-year period. The secondary objective was to validate the predictive performance of Acute Physiology And Chronic Health Evaluation (APACHE) IV for ICU patients in Hong Kong. Methods This was an 11-year population-based retrospective study of all patients admitted to adult general (mixed medical-surgical) intensive care units in Hong Kong public hospitals. ICU patients were identified from a population electronic health record database. Prospectively collected APACHE IV data and clinical outcomes were analysed. Results From 1 April 2008 to 31 March 2019, there were a total of 133,858 adult ICU admissions in Hong Kong public hospitals. During this time, annual ICU admissions increased from 11,267 to 14,068, whilst hospital mortality decreased from 19.7 to 14.3%. The APACHE IV standard mortality ratio (SMR) decreased from 0.81 to 0.65 during the same period. Linear regression demonstrated that APACHE IV SMR changed by − 0.15 (95% CI − 0.18 to − 0.11) per year (Pearson’s R = − 0.951, p < 0.001). Observed median ICU length of stay was shorter than that predicted by APACHE IV (1.98 vs. 4.77, p < 0.001). C-statistic for APACHE IV to predict hospital mortality was 0.889 (95% CI 0.887 to 0.891) whilst calibration was limited (Hosmer–Lemeshow test p < 0.001). Conclusions Despite relatively modest per capita health expenditure, and a small number of ICU beds per population, Hong Kong consistently provides a high-quality and efficient ICU service. Number of adult ICU admissions has increased, whilst adjusted mortality has decreased over the last decade. Although APACHE IV had good discrimination for hospital mortality, it overestimated hospital mortality of critically ill patients in Hong Kong.
BackgroundTuberculosis (TB) is a preventable and curable disease, but mortality remains high among those who develop sepsis and critical illness from TB.MethodsThis was a population-based, multicentre retrospective cohort study of patients admitted to all 15 publicly funded Hong Kong adult intensive care units (ICUs) between 1 April 2008 and 31 March 2019. 940 adult critically ill patients with at least one positive Mycobacterium tuberculosis (MTB) culture were identified out of 133 858 ICU admissions. Generalised linear modelling was used to determine the impact of delay in TB treatment on hospital mortality. Trend of annual Acute Physiology and Chronic Health Evaluation (APACHE) IV-adjusted standardised mortality ratio (SMR) over the 11-year period was analysed by Mann-Kendall’s trend test.ResultsICU and hospital mortality were 24.7% (232/940) and 41.1% (386/940), respectively. Of those who died in the ICU, 22.8% (53/232) never received antituberculosis drugs. SMR for ICU patients with TB remained unchanged over the study period (Kendall’s τb=0.37, p=0.876). After adjustment for age, Charlson comorbidity index, APACHE IV, albumin, vasopressors, mechanical ventilation and renal replacement therapy, delayed TB treatment was directly associated with hospital mortality. In 302/940 (32.1%) of patients, TB could only be established from MTB cultures alone as Ziehl-Neelsen staining or PCR was either not performed or negative. Among this group, only 31.1% (94/302) had concurrent MTB PCR performed.ConclusionsSurvival of ICU patients with TB has not improved over the last decade and mortality remains high. Delay in TB treatment was associated with higher hospital mortality. Use of MTB PCR may improve diagnostic yield and facilitate early treatment.
The global incidence of sepsis is increasing due to earlier recognition, but mortality from sepsis still remains high. Local data on the management according to the 2012 Surviving Sepsis Campaign guideline is still lacking. Hence, this study looks at the epidemiology, patient characteristics and management of septic patients admitted to intensive care unit (ICU) in a regional hospital in Hong Kong.Clinical records of all patients admitted to ICU of Tseung Kwan O Hospital from 1 st January to 30 th June, 2014 were screened. There were 108 patients who fulfilled the inclusion criteria, corresponding to incidence of 32%. There were 62% males with a mean age of 63.6 years. Most patients (34.3%) were diagnosed in emergency department and the majority (46%) were transferred to ICU within 3 h of diagnosis, whereas 44% were transferred >6 h after diagnosis and 10% were transferred between 3-6 h. Most common source of infection was respiratory (26%), followed by blood (15.7%) and urinary tract (7%). Three-hour bundle compliance: measurement of lactate (0%), blood culture before antibiotics (56%), administration of antibiotics (100%) and administration of intravenous fluids volume to 30 ml/kg (21%). Six-hour bundle compliance: Vasopressor use (89%), central venous pressure monitoring (68%), central venous oxygen saturation measurement (0%). The hospital mortality rate was 26.8%.In conclusion, mortality of sepsis is high. Relentless effort is needed to boost the adherence to sepsis care bundles, especially the measurement of serum lactate. Protocols, checklists, education and simulation training are possible means to improve the quality of care and clinical outcome of septic patients.
ObjectivesDirect comparisons between COVID-19 and influenza A in the critical care setting are limited. The objective of this study was to compare their outcomes and identify risk factors for hospital mortality.Design and settingThis was a territory-wide, retrospective study on all adult (≥18 years old) patients admitted to public hospital intensive care units in Hong Kong. We compared COVID-19 patients admitted between 27 January 2020 and 26 January 2021 with a propensity-matched historical cohort of influenza A patients admitted between 27 January 2015 and 26 January 2020. We reported outcomes of hospital mortality and time to death or discharge. Multivariate analysis using Poisson regression and relative risk (RR) was used to identify risk factors for hospital mortality.ResultsAfter propensity matching, 373 COVID-19 and 373 influenza A patients were evenly matched for baseline characteristics. COVID-19 patients had higher unadjusted hospital mortality than influenza A patients (17.5% vs 7.5%, p<0.001). The Acute Physiology and Chronic Health Evaluation IV (APACHE IV) adjusted standardised mortality ratio was also higher for COVID-19 than influenza A patients ((0.79 (95% CI 0.61 to 1.00) vs 0.42 (95% CI 0.28 to 0.60)), p<0.001). Adjusting for age, PaO2/FiO2, Charlson Comorbidity Index and APACHE IV, COVID-19 (adjusted RR 2.26 (95% CI 1.52 to 3.36)) and early bacterial-viral coinfection (adjusted RR 1.66 (95% CI 1.17 to 2.37)) were directly associated with hospital mortality.ConclusionsCritically ill patients with COVID-19 had substantially higher hospital mortality when compared with propensity-matched patients with influenza A.
AimsProvider initiated testing and counselling (PITC) is recommended for all inpatients in Malawi if they have not been tested in the previous 3 months. However testing rates remain low. We sought to determine if a bedside diagnostic HIV testing service would improve testing rates amongst paediatric inpatients.MethodsWe audited the existing HIV testing service to determine the numbers of children being tested for HIV. This was followed by the introduction of a bedside diagnostic service followed by re-audit. Bedside testing was facilitated by health systems strengthening measures including identification of motivated counsellors, appropriate supervision and remuneration.ResultsIn the initial audit in March–April 2014, 81 (60%) of 135 children had documented HIV tests, with 54 (40%) having no documented test. Following implementation of the bedside diagnostic HIV testing service, there was a significant increase in the proportion of children whose HIV status was known. On re-audit in July 2015, 110 (94.8%) of 116 children had documented HIV tests, with 6 (5.2%) having no documented test. [‘known HIV status’ of inpatients X2 (2, N=251) = 41.60, p < 0.001]. Of those with documented tests, 94.5% were tested within the 3-month standard, compared to 67% initially. Following the introduction of the service, the proportion of children tested for HIV during admission increased from 31.8% to 68.1% [X2 (2, N=251) = 48.57, p < 0.001].ConclusionA bedside diagnostic HIV testing service lead to considerably improved HIV testing rates among paediatric inpatients compared to a non-bedside service. It is yet to be seen if this will lead to more children receiving HIV treatment.
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