We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Intensive Care Outcomes and Mortality Prediction at a National Referral Hospital in Western Kenya.
- Authors
Lalani, Hussain S; Waweru-Siika, Wangari; Mwogi, Thomas; Kituyi, Protus; Egger, Joseph R; Park, Lawrence P; Kussin, Peter S
- Abstract
<bold>Rationale: </bold>The burden of critical care is greatest in resource-limited settings. Intensive care unit (ICU) outcomes at public hospitals in Kenya are unknown. The present study is timely, given the Kenyan Ministry of Health initiative to expand ICU capacity.<bold>Objectives: </bold>To identify factors associated with mortality at Moi Teaching and Referral Hospital and validate the Mortality Probability Admission Model II (MPM0-II).<bold>Methods: </bold>A retrospective cohort of 450 patients from January 1, 2013, to April 5, 2015, was evaluated using demographics, presenting diagnoses, interventions, mortality, and cost data.<bold>Results: </bold>ICU mortality was 53.6%, and 30-day mortality was 57.3%. Most patients were male (61%) and at least 18 years old (70%); the median age was 29 years. Factors associated with high adjusted odds of mortality were as follows: age younger than 10 years (adjusted odds ratio [aOR], 3.59; P ≤ 0.001), ages 35-49 years (aOR, 3.13; P = 0.002), and age above 50 years (aOR, 2.86; P = 0.004), with reference age range 10-24 years; sepsis (aOR, 3.39; P = 0.01); acute stroke (aOR, 8.14; P = 0.011); acute respiratory failure or mechanical ventilation (aOR, 6.37; P < 0.001); and vasopressor support (aOR, 7.98; P < 0.001). Drug/alcohol poisoning (aOR, 0.33; P = 0.005) was associated with lower adjusted odds of mortality. MPM0-II discrimination showed an area under the receiver operating characteristic curve of 0.78 (95% confidence interval, 0.72-0.82). The result of the Hosmer-Lemeshow test for calibration was significant (P < 0.001).<bold>Conclusions: </bold>In a Kenyan public ICU, high mortality was noted despite the use of advanced therapies. MPM0-II has acceptable discrimination but poor calibration. Modification of MPM0-II or development of a new model using a prospective multicenter global collaboration is needed. Standardized triage and treatment protocols for high-risk diagnoses are needed to improve ICU outcomes.
- Publication
Annals of the American Thoracic Society, 2018, Vol 15, Issue 11, p1336
- ISSN
2329-6933
- Publication type
journal article
- DOI
10.1513/AnnalsATS.201801-051OC