Predictors of ICU Mortality among Mechanically Ventilated Patients: An Inception Cohort Study from a Tertiary Care Center in Addis Ababa, Ethiopia

Abstract

Background. Mechanical ventilation is a life-saving intervention for patients with critical illnesses, yet it is associated with higher mortality in resource-constrained settings. This study intended to determine factors associated with the mortality of mechanically ventilated adult intensive care unit (ICU) patients. Methods. A one-year retrospective inception cohort study was conducted using manual chart review in ICU patients (age >13) admitted to Tikur Anbessa Specialized Hospital (Addis Ababa, Ethiopia) from September 2019 to September 2020; mechanically ventilated patients were followed to hospital discharge. Demographic, clinical, and outcome data were collected; logistic regression was used to determine mortality predictors in the ICU. Result. A total of 160 patients were included; 85/160 (53.1%) were females and the mean (SD) age was 38.9 (16.2) years. The commonest indication for ICU admission was a respiratory problem (n = 97/160, 60.7%). ICU and hospital mortality were 60.7% (n = 97/160) and 63.1% (n = 101/160), respectively. Coma (Glasgow Coma Score <8 or 7 with an endotracheal tube (7T)) (adjusted odds ratio [AOR] 6.3, 95% confidence interval 1.19–33.00), cardiovascular diagnosis (AOR 5.05 [1.80–14.15]), and a very low serum albumin level (<2 g/dl) (AOR 4.9 [1.73–13.93]) were independent predictors of mortality ( P < 0.05 ). The most commonly observed complication was ICU acquired infection (n = 48, 30%). Conclusions. ICU mortality in ventilated patients is high. Coma, a very low serum albumin level (<2 g/dl), and cardiovascular diagnosis were independent predictors of mortality. A multifaceted approach focused on developing and implementing context appropriate guidelines and improving skilled healthcare worker availability may prove effective in reducing mortality.

Prevalence of mortality and associated factors among ICU admitted adult patients with mechanical ventilation in Ethiopia; Systematic review and meta-analysis

“…While some pooled ORs lacked significance, closer examination revealed significant associations and trends in individual studies. Admission with a cardiovascular diseases were consistently emerged as a significant factor associated with mortality in four prior studies, with adjusted ORs (AORs) ranging from 1.04 to 5.05 (12,22–24). Another critical determinant of mortality is the presence of sepsis or septic shock, as evidenced by AORs ranging from 1.938 to 7.4 in previous studies (11,24).…”

“…Another critical determinant of mortality is the presence of sepsis or septic shock, as evidenced by AORs ranging from 1.938 to 7.4 in previous studies (11,24). Furthermore, a GCS level of ≤8 was identified as a predictor of mortality in two studies, with ORs ranging from 0.85 to 6.3 (12,22–25). Additionally, medical case admissions have shown a consistent association with mortality, with AORs ranging from 2.9 to 6.67 in two separate studies (22,25).…”

“…Similarly, a decreased GCS score (≤8) at admission has been identified as another determinant of mortality in patients on MV. Despite an insignificant pooled OR, the literature review highlighted significant associations in three studies (22,23,25). It is consistent with other studies across globe (28).…”

“…Cardiovascular disease as an admission diagnosis or as a comorbidity is also another factor in the increased mortality of patients who underwent MV. Based on our review, one study in Ethiopia showed that CVS disease was another significant factor in the mortality among ICU-admitted patients who underwent MV (23).…”

Characteristics and outcomes of patients with severe COVID-19 in Indonesia: Lessons from the first wave

“…In an overwhelmed healthcare service, effective resource allocation, especially for ICU, which requires qualified personnel and advanced equipment is crucial. In low resource settings, patients may be less likely to immediately seek health care due to lack of awareness, access, or financial constraints [ 24 ]. These findings indicate that the appropriate monitoring outside the medical hospital and optimized rapid transfer systems should be managed in collaboration with the local health care system.…”