Cross Sectional Study on Mortality and Associated Factors in the Adult ICU of Myungsung Christian Medical Center, a Private Hospital in Addis Ababa Ethiopia

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Date

2020-10

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Addis Abeba University

Abstract

Background: Intensive Care Unit (ICU) is a special department of a tertiary hospital for patients with the most severe and life-threatening conditions. Critical care is a major challenge in developing countries where health needs often outstrip available resources. In these countries most of the critical health care facilities are still in their primordial stages of development. The mortality rate of patients admitted to the ICU is higher in Ethiopia than developed countries. There are no published data on mortality in ICU of private hospitals in Ethiopia. Objectives: The objective of this study was to identify mortality and its associated factors in Myungsung Christian Medical Center, a private hospital in Addis Ababa Ethiopia. Methods: A cross sectional study of adult patients admitted to the ICU at MCMC from January 2018 to December 2019 was conducted. There were a total of 743 patients in the study period. 47 patients were excluded due to incomplete outcome data and unavailable charts. 37 (10% of sample size) patients were used for the pilot study to prepare structured checklist. 366 final sample size was selected by simple random sampling. Data collectors were trained about the study. Data entry was done using EpiData software and exported to SPSS for data cleaning and statistical data analysis. Summary statistics, descriptive and analytic statistical procedures were performed. Ethical clearance was obtained from the Emergency Medicine and Critical Care department. A formal permission letter was taken to Myungsung Christian Medical Center and permission was granted. Results: Out of 366 patients 220 (60.1%) were males and 144 (39.3%) were between the age of 36 – 60 years with a mean age of 50±19.18 years. Sepsis (24.3%), Stroke (16.1%) and Trauma (14.5%) were the leading causes of admission. 39% had Cancer, 34% had Hypertension and 21.9% had more than one chronic illness. 46.7% of the patients required mechanical ventilator and 22.1% required vasopressors. From the 366 patients, 231 (63.1%) were transferred to ward, 105(28.6%) died, and 16(4.3%) were referred to another hospital. In bivariate logistic regression age of the patients (>60 years) (COR: 3.54 95% CI: 1.87, 6.68; P< 0.001), those with medical illness (COR: 2.21 95% CI: 1.35, 3.63 P=0.002), shock (COR: 4.61 95% CI: 2.63, 8.08; P<0.001), infection on admission (COR:3.05 95% CI: 1.91, 4.89; P<0.001), infection 48 hours after admission (COR:2.28 95% CI: 1.24, 4.16; P<0.001), mechanical ventilator (COR: 9.94 95% CI: 5.62, 17.59; P<0.001), use of vasopressor (COR: 10.18 95% CI: 5.82, 17.81; P<0.001), GCS≤8 (COR: 3.51 95% CI: 2.17, 5.69; P<0.001), surgery history within one month of admission (COR: 0.29 95% CI: 0.16, 0.51; P< 0.001) were significant at p-value <0.05. In multivariate logistic regression the age of patients > 60 years (AOR:3.13 95% CI: 1.14, 8.58; P=0.043), shock (AOR:3.74 95% CI: 1.22, 11.26; P=0.019), mechanical ventilator (AOR:13.28 95% CI: 5.22, 33.75; P<0.001), infection on admission (AOR:2.11 95% CI: 1.01, 4.39; P=0.046), use of vasopressor (AOR:3.86 95% CI: 1.50, 9.92; P=0.050), and GCS ≤ 8 (AOR:2.25 95% CI: 1.103, 4.591; P=0.026) were significantly associated (P value <0.05) with death at ICU after controlling for other variables. Conclusion: According to this study, the mortality of patients in the adult ICU of MCMC, a private medical center in Addis Ababa is similar to the public hospitals. Age>60 years, presence of shock, use of mechanical ventilator and vasopressor, presence of infection and GCS ≤ 8 were significantly associated with mortality.

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Keywords

Ethiopia, Intensive Care Unit, Critical Care, Mortality, Adult

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