Altered mental status is an indicator of mortality and associated with both infectious and non-communicable disease in Lilongwe, Malawi

Harrington, Bryna J.; Vorkas, Charles Kyriakos; Kanyama, Cecilia; Ngoma, Jonathan; Hoffman, Irving; Hosseinipour, Mina C.

doi:10.1177/0049475515577024

Cited by 3 publications

(7 citation statements)

References 9 publications

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“…Amongst the patients with AMS seen in these two EDs, the overall in-hospital mortality rate was 35.4% including the deaths in the EMD. This mortality rate corresponds to other studies done in Africa [ 13 - 15 ] but is significantly higher in comparison to studies done in high income countries [ 10 , 11 , 19 , 20 ]. The high mortality rate suggests both gaps in stabilization and care of patients presenting with AMS as well as multiple demographic and clinical factors which contribute to this high rate of death.…”

Section: Discussionsupporting

confidence: 87%

“…This indicates that besides neurological causes directly affecting brain function, AMS in many in our study was due to systemic illness where the brain suffers end organ damage. This finding is supported by studies, both within African countries and non-African countries where neurological and infectious etiologies were the dominant causes of AMS in patients [ 10 , 13 - 15 , 20 ].…”

Section: Discussionsupporting

confidence: 69%

“…In studies in Africa the mortality associated with AMS appears to be much higher. Most patients with AMS belong to a younger age group and a significant number were HIV positive [ 13 - 15 ]. There is a paucity of studies conducted in relation to this presentation in low-income settings and therefore very scarce data on the profile and outcomes of such patients.…”

Section: Introductionmentioning

confidence: 99%

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Clinical profile and mortality among adult patients presenting with altered mental status to the emergency departments of a tertiary hospital in Tanzania: a descriptive cohort study

Manji¹,

Sawe²,

Kilindimo³

et al. 2022

Pan Afr Med J

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Introduction Altered mental status (AMS) in the Emergency Department (ED) can be associated with morbidity and mortality. In high income countries, mortality rate is under 10% for patients presenting with AMS. There is a paucity of data on the profile and mortality amongst this group of patients in limited income countries. Methods this was a prospective cohort study of adults ≥18 years presenting to the Emergency Departments of Muhimbili National Hospital (MNH) Upanga and Mloganzila in Tanzania with Altered Mental Status (AMS) unrelated to psychiatric illness or trauma, from August 2019 to February 2020. Patient demographic data, clinical profile, disposition and 7-day outcome were recorded. The outcome of mortality was summarized using descriptive statistics. Results among 26,125 patients presenting during the study period, 2,311 (8.9%) patients had AMS and after exclusion for trauma and psychiatric etiology, 226 (9.8%) patients were included. The median age was 56 years (43-69 years) and 127 (56.2%) were male. Confusion 88 (38.9%) was the most common presenting symptom. Hypertension 121 (53.5%) was the most frequent associated comorbidity. The overall mortality was 80 (35.4%) within 7 days. Of 173 patients admitted to the wards, 54 (31.2%) died and of the 46 (20.4%) admitted to the intensive care unit (ICU), 20 (43.5%) died within 7 days. Six (2.7%) patients died in the emergency department. Conclusion patients with AMS presenting to two EDs in Tanzania have substantially higher mortality than reported from Hospital Incident Command System (HICS). This could be due to underlying disease, comorbidities or management. Further research could help identify individual etiologies involved and high risk groups which can cater to better understanding this population.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

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Clinical profile and mortality among adult patients presenting with altered mental status to the emergency departments of a tertiary hospital in Tanzania: a descriptive cohort study

Manji¹,

Sawe²,

Kilindimo³

et al. 2022

Pan Afr Med J

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“…We examined the performance of qSOFA to predict mortality in patients with suspected infection in Kamuzu Central Hospital (KCH), a 750-bed tertiary care hospital in Lilongwe, Malawi, with a catchment population of over 5 million people. A previous study in this hospital demonstrated that altered mental state, which is also included in qSOFA, was associated with high mortality rates [ 4 ], but the qSOFA score has not been previously evaluated in KCH.…”

Section: Introductionmentioning

confidence: 99%

Application of the qSOFA score to predict mortality in patients with suspected infection in a resource-limited setting in Malawi

et al. 2017

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PurposeTo determine the predictive value of qSOFA (quick Sequential Organ Failure Assessment) in Malawian patients with suspected infection.MethodsProspective observational study in a tertiary referral hospital in Malawi.ResultsPredictive ability of qSOFA was reasonable [AUROC 0.73 (95% CI 0.68–0.78)], increasing to 0.77 (95% CI 0.72–0.82) when classifying all patients with altered mental status as high risk. Adding HIV status as a variable to the qSOFA score did not improve predictive value.ConclusionqSOFA is a simple tool that can aid risk stratification in resource-limited settings.Electronic supplementary materialThe online version of this article (doi:10.1007/s15010-017-1057-5) contains supplementary material, which is available to authorized users.

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“…In the present study, disorientation was another risk factor for death, increasing mortality more than five-fold, in accordance with previous studies 35 . However, altered mental status has been demonstrated to increase mortality not only when there is ongoing HIV-associated CNS infection, but also in general wards 36,37 . Such findings suggest that the increase in the risk of death derives primarily from the progression of the systemic disease, rather than from the infection of the CNS.…”

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confidence: 99%

Acute kidney injury and other factors associated with mortality in hiv-infected patients

Silva

Filho

Soares

et al. 2018

Rev. Assoc. Med. Bras.

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SUMMARY OBJECTIVE: HIV-related mortality is still high, especially in developed countries. The aim of this study is to investigate factors associated to death in HIV-infected patients. METHODS: This is a cross-sectional study with all HIV adult patients admitted to a tertiary infectious diseases hospital in Fortaleza, Northeast Brazil, from January 2013 to December 2014. Patients were divided into two groups: survivors and non-survivors. Demo-graphical, clinical and laboratory data were compared and a logistic regression was performed in order to investigate risk factors for death. P values ≤0.05 were considered statistically significant. RESULTS: A total of 200 patients with mean age of 39 years were including in the study, 69.5% males. Fifteen patients (7.5%) died. Non-survivors presented a higher percentage of males (93.3 vs. 67.3%, p = 0.037). Non-survivors presented AKI (73.3 vs. 10.3%, p < 0.001), liver dysfunction (33.3 vs. 11.5, p = 0.031), dyspnea (73.3 vs. 33.0%, p = 0.002) and disorientation (33.3 vs. 12.4%, p = 0.025) more frequently. Non-survivors also had higher levels of urea (73.8 ± 52.7vs. 36.1 ± 29.1 mg/dL, p < 0.001), creatinine (1.98 ± 1.65 vs. 1.05 ± 1.07 mg/dL, p < 0.001), aspartate aminotransferase (130.8 vs. 84.8 U/L, p = 0.03), alanine aminotransferase (115.6 vs. 85.4 U/L, p = 0.045) and lactate dehydrogenase (LDH) (1208 vs. 608 U/L, p = 0.012), as well as lower levels of bicarbonate (18.0 ± 4.7 vs. 21.6 ± 4.6 mEq/L, p = 0.016) and PCO2 (27.8 ± 7.7 vs. 33.0 ± 9.3 mmHg, p = 0.05). In multivariate analysis, disorientation (p = 0.035, OR = 5.523, 95%CI = 1.130 – 26.998), dyspnoea (p = 0.046, OR = 4.064, 95%CI = 1.028 – 16.073), AKI (p < 0.001, OR = 18.045, 95%CI = 4.308 – 75.596) and disseminated histoplasmosis (p = 0.016, OR = 12.696, 95%CI = 1.618 – 99.646) and LDH > 1000 U/L (p = 0.038, OR = 4.854, 95%CI = 1.093 – 21.739) were risk factors for death.]CONCLUSION: AKI and disseminated histoplasmosis (DH) were the main risk factors for death in the studied population. Neurologic and respiratory impairment as well as higher levels of LDH also increased mortality in HIV-infected patients.

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Altered mental status is an indicator of mortality and associated with both infectious and non-communicable disease in Lilongwe, Malawi

Cited by 3 publications

References 9 publications

Clinical profile and mortality among adult patients presenting with altered mental status to the emergency departments of a tertiary hospital in Tanzania: a descriptive cohort study

Clinical profile and mortality among adult patients presenting with altered mental status to the emergency departments of a tertiary hospital in Tanzania: a descriptive cohort study

Application of the qSOFA score to predict mortality in patients with suspected infection in a resource-limited setting in Malawi

Acute kidney injury and other factors associated with mortality in hiv-infected patients

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