Clinical Outcome And Associated Factors Among Patients Admittedto The Intensive Care Unit Of Jigjiga University Sheik Hassen Yabare Referral Hospital, Somali Region, Ethiopia, 2020

doi:10.21203/rs.3.rs-8419546/v1

Background: In developing countries, there is an insufficiency of ICU beds and more than 50% of these countries lack any published data on ICU capacity. In low-income countries, most ICUs are located in large referral hospitals in cities. ICU services are apparently limited in low-income countries.

Objective: To assess the clinical outcomes and associated factors among patients admitted in the Intensive Care Unit of Jigjiga University Sheik Hassen Yabare Referral Hospital Somali Region, Ethiopia, 2020.

Methods: Institutional based retrospective cross-sectional study was conducted based on records of admitted patients from 1^st June to 30^th June. Data was collected by three trained data collectors. Data was entered, coded and cleaned by using the Epi-data software version 3.0 and analyzed using SPSS version 23. Bivariate logistic regression was done to assess the association between dependent and independent variables. In bivariate logistic regression, variables with a P value of <0.25 was considered as a candidate for multivariate logistic regression at 95% CI. In multivariate logistic regression analysis, the level of statistical significance was declared at P-value less than 0.05.

Results: - The highest admitted age group were 20-29 years of age (21.9%).The mortality rate in ICU were found to be 40.0% (95% CI: 33.8, 46.7).More male dies than females 25.7%Vs.14.3%. The death rate is higher in 30-39 age group 9%. Emergency department were admitted the highest admission 68 (32.4%). Highest cases of admission were Immediate post-op 33(15.7%) and ARDS 23 (11.0%). The commonest cause of death was multi-organ failure 70 (83.3%).Moreover, in multivariate logistic regression it was found that the clinical outcomes of patients in the ICU is associated with length of ICU stay (1-5days (AOR= 15.2, 95% CI: 1.2, 184.2), need of Mechanical Ventilation (AOR= 24.10, 95% CI: 8.5, 68.2), inotropes/vasopressors (AOR= 12.1, 95% CI: 3.8, 38.2).

Conclusion: - The mortality rate in the intensive care unit was considerable high. Significant association was found between clinical outcomes of ICU patients and need for mechanical ventilator, Deep Vein Thrombosis prophylaxis, analgesics, inotropes/vasopressors and short ICU stay.

intensive care unit

critical care

clinical outcome

Jigjiga University Sheik Hassen Yabare Referral Hospital Somali Region

Ethiopia

2020

Background

Intensive care Unit (ICU) is a hospital area dedicated to the management and monitoring of patients sever-life threatening condition, that is specially staffed, and equipped, separate, and self- supporting. This offers specialized resources and support for essential activities and uses the expertise of medical, nursing and other professionals who experience the challenges(1).

The practice of critical care medicine came into being in the 1940s when poliomyelitis patients suffered revolutionary changes from anesthesiologists. Intensives are able to treat and support critically ill people by developing new equipment, procedures, and medicines through more invasive procedures. With an ageing population and increasing availability of medical technology, the ICU, have become a critical component of modern hospital care(2).

ICUs have large differences in quantities and quality of working facilities required to provide properly critical care services in developing countries, especially Sub-Saharan African(4). Knowledge of ICU patients’ characteristics and outcomes in developing countries may assist in identifying the priority allocation of resources and improving these types of care(5). In addition to resource allocation, intensive care also requires considerable time and effort to treat and improve the survival of critically ill patients on behalf of medical and nursing staff. Patients from all departments in the hospital must have a broad range of clinical experiences and an integrated approach to the patient care system as a result of their admittance(6).

The main purpose of the ICU is to prevent the deaths of patients with serious illness, who are at high risk of death and are monitored closely. But it costs all those involved in the hospital, staff and patient care provider a huge amount(7). The result of the ICU can be assessed by using indicators like death rate on the basis of the results such as death or survival. The ICU will typically be admitted for patients with a reasonable chance of survival and reversible condition(8).Patients with reversible diseases that can be enhanced by close supervisory and complication treatments in an ICU. From the point of view of reality, there are conditions in the ICU where the most complex and costly administration cannot change the situation(9).

In their respective dimensions and capabilities the ICUs have established a highly specialized area. This variation occurs among regions, states, and even hospitals. The types of ICU can be General, cardiothoracic, pediatric, neonatal, coronary care types may be available as well as for medical, operative, neurosurgical, burns, and trauma(10). Intensive care units (ICUs) have become independent divisions of the majority of hospitals in developed countries with career-intense medical doctors, intensivists from different fields of medicine, but ICUs are run by anesthesiologists in countries which have no intensivists(11).

The critical patient survival rate is high through well-organized ICU, the early detection and effective timely intervention and very well-drafted and equipped ICU. A reversal of the admission indication, or the resolution of the unstable physiological condition promoting admission to the units, will be used to evaluate and consider patients to discharge them(1).

Globally, the biggest challenge in the management of patients with serious illness or accidents is to recognize those who would benefit the most from ICU admission without overriding ICU referrals(12). Intensive care units (ICUs) are now included in the health system. Whereas the majority of ICUs are located in high-income countries, they are increasingly characteristic of low- and medium-income health care systems(13). In developing countries, there is an insufficiency of ICU beds and more than 50% of these countries lack any published data on ICU capacity. In low-income countries, most ICUs are located in large referral hospitals in cities. ICU services are apparently limited in low-income countries(14).

Approximately 4 million ICU admissions are available in United-state annually, 79% of those survive, in England, Wales and Northern Ireland, nearly 164,000 patients are admitted each year(13).

The mortality rate of elderly patients is higher as compared to the survivors of elderly and younger patients in ICU. Nevertheless, it is not age but related factors, such as pre-illness health condition, co-morbidity and disease frequency that tends to be the primary cause of the poorer prognosis. Patient’s sovereignty over life-sustaining care greatly influences the likelihood of outcome. Commonly used prediction models for very elderly patients have not been adapted for use. They also fail to address long-term survival and functional outcome(17). The requirement of intensive care often goes beyond available beds, even in High-Income Countries; therefore accessing the services of intensive care is needed. According to the World Federation of Societies of Intensive and Critical Care Medicine patients who are most likely to recover from intensive care should be prioritized(18).

The Ethiopian health sector faces a double burden of disease due to rapid urbanization, industrialization, and fast-growing conditions. While the health care facilities have been rising and impaired, it has been almost impossible to obtain adequate critical care. The rudimentary state of acute medical practices is found. Patients were treated sub-optimally due to this situation. Morbidity and mortality associated with accidents, acute illness and complication related labor and delivery are high(1).

ICU care was introduced in Ethiopia only some decades ago. Black Lion Hospital was the first to establish an ICU. Currently in Jigjiga University Sheik Hassen Yabare Referral Hospital (JJUSHYRH) with only five beds available for ICU, it’s prudent to have a basic understanding of which patients are treated and the outcome of the treatment. Starting from the opening of the ICU of JJUSHYRH (2010 E.C/2018G.C.) many patients have been admitted and treated. However, there is no recent study that summarizes the pattern and outcome of patients in the ICU. So this study is intended to assess the clinical outcomes and associated factors among patient admitted to the ICU of JJUSHYRH during a period of one year. Furthemore Evaluation of the morbidity and outcome of admitted patients can assess the efficacy of treatment, making it possible to make better decisions, to further improve quality of care, to standardize the unit, and to ensure effective management of the resources

Study area and period

The study was conducted in ICU of JJUSHYRH, south eastern Ethiopia. JJUSHYRH is a referral and teaching hospital situated in Jigjiga town, the hospital gives different inpatient and outpatient services to the population in the surrounding area of Jigjiga town and referral service to south eastern population of the country (a catchment population of about 7 million). Currently there are five beds and four functional mechanical ventilator machines, one defibrillator, five non-invasive patient monitors, five infusion pumps, one electro-cardio-graph (ECG), and 4 four functional suction machines. Fourteen trained ICU nurses and 1 untrained nurse, 2 consultant anesthesiologist, and 3 general practitioner doctors and one trained biomedical engineering are present in the ICU of JJUSHYRH round the clock. From June 1^st to June 30^th 2020.G.C. 210 patients were admitted in the ICU.

Study design

Institutional based retrospective cross – sectional study design was employed

Source and study population

Source population

Medical records of all patients’ who were admitted to ICU of Jigjiga University Sheik Hassen Yabare Referral Hospital from September 11, 2018 to September 11, 2019

Study population

All sampled Medical records of all patients’ who were admitted to ICU from September 11 2018 to September 11 2019 and fulfil inclusion criteria.

Inclusion and exclusion criteria

Inclusion: All patients who were admitted to ICU and fully medical recorded information were included in this study.

Exclusion: Dead on arrivals

Sample size determination

Since the study is retrospective it is not needed to calculate prevalence, all sampled (n = 210) was taken as sample size to increase the power of the study.

Sampling technique

Consecutive sampling technique was used to collect the data from the records of all patients admitted to the ICU.

Data collection techniques and tools

Data collection tool was adapted after review of relevant literature(16, 24). The registration of ICU was first reviewed, then after by having patients file number/patient record, card review was done in the record room. Data were collected by three trained data collectors used to retrieve information about patient demographic characteristic, pattern of ICU admission, reason for admission, duration of ICU stay, nature of interventions and patient outcome through patient record or card review in the record room, close supervision was done by the supervisor and principal investigator and each filled check list was rechecked for completeness.

Data collection procedure

Data collectors were given one day of training about data collection technique, objective, relevance of the study, confidentiality of information, pre-test, and techniques of collecting proper data

Study variables

Independent variable Dependent variable

Age Patient outcome (transfer to wards/dead)

Sex

Mechanical ventilation

Length of ICU stay

Diagnosis of disease (primary disease)

Co-morbidity

Pattern of admission

Use major therapeutic options

Location before ICU admission

Data quality control

Data collectors were assigned from Karamara General Hospital, Jigjiga, for the reduction of bias. One week before the actual survey, pre-test was carried out one month (May 2020) of documented patients’ charts in ICU of JJUSHYRH, hence there is no other ICU in the region with similar character of 10% of the study population and necessary modification may be made before it is applied on the study population. Close supervision was done by supervisor and principle investigator. Three trained BSc nurses were done data collection procedure and proper recording was taken. Immediate checkup was carried out and any unfilled data was filled immediately. Data was placed properly in secured and safe place.

Operational definitions

Intensive Care Unit –Place of health care delivery service for patients who needs life supporting service with potentially recoverable diseases.

Pattern of admission- the process in which the patient enters to the ICU. This could be from emergency, general wards of the hospital and other hospitals.

Outcome -patient status after critical care in the ICU which includes transfer to wards and died.

Transfer to wards –patient discharged alive by physician in the ICU

Died- patient passed away in ICU after admission

Data processing and analysis

Data was cleaned for inconsistence and missing values modification was considered as necessitate, coded and entered into Epi data version 3.02 and then it was exported into SPSS version 23.0 for analysis. Characteristics of study participants were analyzed using descriptive statistics, Model fitness was checked since for the value for COX and snell R square (0.46) was greater than 0.05 the model was well fitted. In bivariate logistic regression, variables with a P value of <0.25 were considered candidate for multivariate logistic regression, in order to describe the relation of dependent and independent variables, Bivariate, and multivariate logistic regression were used to assess the effect of co-variance on dependent variable with 95% CI and P value less than 0.05 was considered statistical significance.

Ethical consideration

Ethical approval for this study was obtained from the Research and Ethics Committee of the College of Medicine and Health Sciences, Jigjiga University (Approval No: JJU/SGS/MPH/033/59). Permission to access patient medical records was obtained from the administration of Jigjiga University Sheik Hassen Yabare Referral Hospital prior to data collection.

As this study was a retrospective review of medical records, the requirement for informed consent to participate was waived by the Jigjiga University Research and Ethics Committee, in accordance with national regulations and institutional guidelines.

Confidentiality of patient information was strictly maintained. No personal identifiers were collected, and all data were used solely for the purpose of this study. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki.

Patient’s demographic characteristics

During the study period out of 210 patients were admitted in ICU of JJUSHYRH among the reviewed patients card their age category were 1month to 80 years, the majority age group 46(21.9%), were between 20-29years old, while the least 12 (5.7%).was those who were >70years old, The mean of age the patients was 4.1+ 1.91. Regarding sex of the patients 126 (60.0%) of them were male and 84 (40.0%) were female. (Table 1)

Admission Characteristics and co-morbidities

From 210 admitted patient, 68 (32.3%) were admitted from the emergency department (ED) which is the major source of ICU admission, 58(27.6) of them were from surgery (including emergency operative and selective ones), while 49 (23.3%), were from internal medicine, 25 (11.9%) Gyn/obs and10 (4.7%) paediatrics respectively (Figure 2)

Cause of ICU admission

Regarding the admission, the most leading cause ICU admission was acute respiratory distress syndrome (ARDS) including impending respiratory failure from emergency and internal Medicine 23 (11.0%), followed by Myocardial infarction (MI) 22(10.5%), immediate post-op 33 (15.7%) and severe traumatic brain injury(STBI) 23 (11.0%)from surgery.

From specific diagnoses that lead to ICU admissions among surgical patients was immediate post-op, 33(15.7%), from internal medicine the common cause of ICU admission were ARDS 23 (11.0%), from Gyn/obstetric the leading cause of admission in ICU was severe Eclampsia 24(11.4%), from pediatric department complicated pyogenic meningitis7 (3.3%) respectively. (Table 2)

ICU Co-morbidities

Regarding co-morbidities, out of 210 admitted patients in the ICU 162 (77.1%)of them had no co-morbidities, meanwhile 29 (13.8%) had HTN respectively.( Figure 3)

ICU outcome and overall management

Regarding ICU outcome, the mortality rate was found to be 40.0 %( 95% CI: 33.8, 46.7). From the total admission 126 (60.0%) patients were transferred to their respective wards and 84(40.0%) were died. From specific cause of death the commonest was multi-organ failure (MOF) 70 (83.3%), followed by brain herniation 6 (7.1%), massive MI 6(7.1%) and other problems related to ventilator problem 2(2.4%). (Figure 4)

Distribution of length of ICU stays, mechanical ventilation and their outcome among patient’s admitted to the ICU of JJUSHYRH, 2020 G.C

Rendering to their length of stay in ICU 144(68.6%) patients stayed 1-5 days, from this 95 (45.2%) were transferred to their respective wards, 49(23.3%) patients died. The median length of ICU stay was found to be 3 days +3.1.

Regarding about mechanical ventilation from the total of 210, 104 (49.5%) of them were intubated. among those intubated patient’s 37(17.6%) were transferred to their respective wards and 67 (31.9%) were died.Among non-ventilated patient’s 89(42.3%) of them were transferred to their respective wards and 17 (8.0%) were died. (Table 3)

Over all ICU management

From total admission of 210 admitted patients, 191 (91.0%) of them were on antibiotics and 19 (9.0%) were not received antibiotics. Furthermore, 130 (61.9%), 79 (37.6%), 178(84.7%) and 50(23.8%) were on ulcer prophylaxis, DVT prophylaxis, anti-pain and Inotropes/vasopressors respectively.

Among admitted surgical patient to ICU 38 (18.0%) were transferred to surgical ward and 20 (9.5%) died. From internal medicine patients 27 (12.8%) were transferred to medical ward, 22(10.4%) died. Among gyn/obstetric patients 18(8.5%) were transferred to their wards, 7(3.3%) died. From pediatric patients 6 (2.8%) were transferred to ward, 4(1.9%) died and from emergency department 37 (17.6%) were transferred to their respective wards and 31 (14.7%) were died in ICU.

Concerning patients’ age, from 20-29, age group 32 (15.2%), were transferred to their respective wards respectively and from age groups that has the highest death was observed in 30-39 age group 19 (9.0%) and the least 5 (2.3%) was observed in age group >70 years.

Regarding about the sex of patients admitted to ICU during the study period 72 (34.3%) of male and 54 (25.7%) of female patients were transferred to their respective wards, and 54 (25.7%) of male and 30 (14.3%) of female patients were died. (Table 4)

Factors associated with clinical outcome among patients in the intensive care unit of Jigjiga University Sheik Hassen Yabare referral hospital

In Bivariate logistic regression patient outcome status comorbidities, (no comorbidities (COR= 4.8, 95% CI: 0.5, 40.0, HTN(5.6, 95% CI: 1.6, 52.3, DM (COR= 7.0, 95% CI: 1.5, 86.3)), Length of stay in the ICU in 1-5days (COR=0.7, 95% CI:0.1, 4.7), Mechanical ventilation (COR= 9.4, 95% CI: 4.9, 18.2), ulcer prophylaxis (COR=2.6, 95% CI: 1.4, 4.8), DVT prophylaxis(COR= 2.4 95% CI: 1.3, 4.2), inotropes/vase-pressers.(COR= 10.5, 95% CI: 4.8, 22.8), and analgesic (COR = 4.3 , 95% CI: 1.5, 11.7)were significantly associated with patients outcome (dead) at P-value< 0.25 among patients admitted in the ICU of JJUSHYRH. (Table 5)

In bivariate logistic regression 7 variables were eligible at P-value <0.25 (comorbidities, diagnosis, length of stay in the ICU, mechanical ventilation, DVT prophylaxis, analgesic/anti-pain, and inotropes/vasopressors) were performed for bivariate model. And those eligible variables at P-value less than 0.05 have been taken for subsequent model (multivariate).

Multivariate logistic regression of clinical outcome among patients in ICU of JJUSHYRH, 2020 G.C

In multivariate logistic regression LOS in ICU (1-5days (AOR= 15.2, 95% CI: 1.2, 184.2)), MV (AOR= 24.1, 95% CI:8.5, 68.2), DVT prophylaxis (AOR= 4.0, 95% CI: 1.5, 10.5), inotropes/vasopressors (AOR= 12.1, 95% CI: 3.8, 38.2), analgesic/anti-pain (AOR= 8.1, 95% CI: 1.7, 38.7) were significantly associated with the outcome variable (Table 6)

The present study was conducted to assess clinical outcome and associated factors among patients admitted to the ICU of Jigjiga University Sheik Hassen Yabare referral hospital

The outcomes of patients admitted to intensive care unit depends on the clinical condition of patients on admission, level of training and experience of staffs, supply, structure and dimensions of the unit(31, 32).

In the current study, the mortality rate in ICU were found to be 40.0 %( 95% CI: 33.8, 46.7) this finding is comparable with studies done in Addis Ababa (39%), Tanzania (41.1%) and Uganda (40.1%), (4, 27, 33).However, this result was lower in studies done in Congo, Burkina Faso and Malawi 43.7%, 51.6% and 60.9% (34-36).On the other hand, this result was higher than studies done in Mekelle, Ethiopia (27%), Nigeria (34.6%), and Scandinavian countries (9.1%)(29), (24, 37).

This discrepancy might be due to lack of necessary medical equipment’s (ABG analyzer machine, portable dialysis machine and portable x-ray service), study period, ICU infrastructure, and training of the staff. In addition, lack of high dependency unit in the study area may contribute high mortality rate.

In the current study, the median length of ICU stay found to be 3 days which has positively significant association with patient death(AOR=15.2, 95% CI: 1.2, 184.2), In addition, patients who stayed in ICU for less than four days were 15.2 times more likely to die than patients who stayed four or more days with which is comparable with the study done in Uganda (14), Tanzania and Kenya (4, 38). However, this result was different from the study conducted in Hosanna, the length of ICU stay was more than 14 days with ICU mortality (OR=4.1,P <0.039)(39).

This inconsistency might be explained due to late arrival to ICU and delay in intervention, shortage of crucial emergency drugs, absence of airway management equipment’s in the wards.

The finding of this study was also discovered that there is significant positive association between the need for mechanical ventilation and patient death (AOR: 24.1, 95% CI: 8.5, 68.2) patients who are intubated has 24.1 times higher risk of death when compared to those who are not intubated which is similar with the studies done in Kenya and Brazil (AOR= 10.7, p<0.001) and (AOR: 6.37, p<0.001) respectively(38, 40).

The possible explanation for this association could be related that mechanical ventilators commenced for the patients with respiratory failure, unable to protect the airway and hemodynamic instability. Furthermore, patients who have respiratory failure and need intubation are more vulnerable for ventilator associated pneumonia and other nosocomial infections and lack off culture studies in the study setup.

Furthermore the finding of this study forwards that there is significant positively associated between the need of DVT prophylaxis and patient death with (AOR: 4.0, 95% CI: 1.5, 10.5)patients who didn’t use DVT prophylaxis had 4 times higher risk to death than those who use it, which is comparable with the studies done in London, previous venous thromboembolism (OR 3.9, 95% CI 1.4, 10.6)(41).

This association may be since patients in the ICU are immobile, may be higher risk to hypercoagulability and vessel injury, they can easily develop DVT, Pulmonary thromboembolism which may contribute high mortality rate.

The finding of this study shows that there significant positive association between analgesics and patient death (AOR=8.1, 95% CI: 1.7, 38.7). Patients who didn’t use anti pain had 8.1 times higher risk of death compared to those who use it.This is parallel with study conducted in European countries (AOR= 1.06, 95% CI: 1.03-1.08) (42).

This association may be due to unrelieved pain in the ICU has been linked to adverse effects such as prolonged intubation, infections, hemodynamic instability, delirium, and may lead to unstable vital signs.

Inappropriate pain assessment and management could contribute high ICU mortality rate because of this, improvement of pain assessment and management would have important for good prognostic ICU outcomes.

The result of the study also shows that there is association between vasopressor/inotropes and patient death (AOR= 12.1, 95% CI: 3.8, 38.2). Patients who use of inotropes has 12times high risk to deaththan those patients who didn’t used it. This comparable with study done on effects of Inotropes on the Mortality in Patients with Septic Shock epinephrine, epinephrine (AOR= 3.8, 95%, CI: 1.1, 13.6), dobutamine (AOR= 3.9, 95% CI: 1.1, 13.7)(43).

This association can explained sepsis can cause sepsis induced cardiomyopathy, which is temporary myocardial dysfunction, and it is known that sepsis-induced cardiomyopathy is associated with worse outcomes.

The mortality rate in the intensive care unit was considerable high, which is higher than in study conducted in Mekele. Significant association were found between death of patientsin the ICU and need for mechanical ventilator, patients who don’t use DVT prophylaxis, patients who don’t use analgesics, inotropes/vasopressors and short ICU stay.

The study revealed that there was not significant association between clinical outcomes (dead) of ICU patients and age of the patients, sex of the patients, pattern of admission, diagnosis, comorbidities, use of major antibiotics, and ulcer prophylaxis.

Limitation of the study

This study has several limitations. First, the retrospective nature of the study limits the ability to establish causal relationships between associated factors and clinical outcomes. Second, as the study was conducted in a single referral hospital, the findings may not be generalizable to other intensive care units with different patient populations or resources.

In addition, the study relied on routinely documented medical records, which may be subject to incomplete or inaccurate data. Some potentially important clinical variables were not consistently recorded and therefore could not be included in the analysis. Despite these limitations, the study provides valuable insight into the clinical outcomes and associated factors among patients admitted to the intensive care unit in the study setting..

Recommendation

For the hospital:- ICU set up needs more advanced invasive monitoring, perfussor, defibrillator and departmentalized ICU isrecommended for patient care and managements, supply of emergency equipmentand medications.

For health care professionals:-The majority of ICU patients were dying with-in 1-5days of admission. Therefore, improving the acute critical care through the expansion of the care, early and timely intervention. Implementation of admission criteria protocols and other local guidelines.

For future research:-Lastly, this study only assessed a one year retrospective record analysis and this study suggests that further studies should be conducted.

Ethics approval and consent to participate:

Ethical approval for this study was obtained from the Research and Ethics Committee of the College of Medicine and Health Sciences, Jigjiga University (Approval No: JJU/SGS/MPH/033/59). Permission to access patient medical records was obtained from the administration of Jigjiga University Sheik Hassen Yabare Referral Hospital prior to data collection. As this study was a retrospective review of medical records, the requirement for informed consent to participate was waived by the Jigjiga University Research and Ethics Committee, in accordance with national regulations and institutional guidelines. Confidentiality of patient information was strictly maintained. No personal identifiers were collected, and all data were used solely for the purpose of this study. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki.

Consent for publication:
Not applicable.

Clinical trial number:
Not applicable.

Competing interests:
The authors declare that they have no competing interests.

Funding statement:
The authors did not receive any specific funding for this work.

Authors' contributions:
Mohamedamin Ahmed Ibrahim, Amin Ugas Mahad, Shilpa GS, Getachew G, and Ahmed Mohammed Ibrahim contributed to the study conception, design, data collection, analysis, and manuscript writing. All authors read and approved the final manuscript.

Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Acknowledgment

The authors express their gratitude to everybody who contributed to this original article at any step.

ORCID

Amin Ugas Mahad https://orcid.org/0009-0003-8009-6654

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Table 1:-Distribution of patient’s-Demographic Characteristics of the Study Participants among patients admitted to the ICU of JJUSHYRH, 2020 G.C.

Categories		Frequency (n=210)		Percent (%)
Age categories
0-9		19		9.0
10-19		21		10.0
	20-29	46		21.9
	30-39	42		20.0
	40-49	29		13.8
	50-59	24		11.4
60-69		17		8.1
>70		12		5.7
Sex
Male			126	60.0
Female			84	40.0
Total			210	100.0

Table 2:-Distribution of Cases (diagnosis) of ICU admitted pt. in ICU JJUSHYRH, 2020 G.C

Categories	Cases (diagnosis)	Frequency (n=210)	Percent (%)
Internal Medicine	ARDS	23	11.0
	MI	22	10.5
	Stroke	10	4.8
	cardio-genic shock	11	5.2
	Others	11	5.2
	CHF	5	2.4
	Tetanus	5	2.4
Surgery	Immediate post-op	33	15.7
	STBI	23	11.0
	Septic shock	14	6.7
	post cardiac-arrest	4	1.9
	Trauma	8	3.8
	hypovolemic shock	4	1.9
	subdural hematoma	3	1.4
	Burn	3	1.4
Gyn/Obs	Sever Eclampsia	24	11.4
Paediatrics	Complicated Pyogenic Meningitis	7	3.3
Total		210	100.0

Table 3:-Distribution of length of ICU stays, mechanical ventilation and their outcome among patients admitted to the ICU of JJUSHYRH, 2020 G.C

Length of stay	Outcome					Total
	Transfer to wards			Died		Total
	Frequency		Percent	Frequency	Percent
1-5days	96		45.6	63	29.9	159
6-10days	18		8.4	12	5.7	30
11-20days	7		3.2	5	2.3	12
21-25days	2		0.9	2	0.9	4
>26	3		1.4	2	0.9	5
Total	126			84		210
Mechanical Ventilation
	Outcome
	Transfer to wards			Died		Total
Mechanical Ventilation	Frequency	Percent		Frequency	Percent
No	89	42.3		17	8.0	106
Yes	37	17.6		67	31.9	104
Total	126			84		210

Table 4:-Distribution of Patient’s age, sex and their outcome and their outcome among patient’s admitted to the ICU of JJUSHYRH, 2020 G.C

Patients’ age
Age Categories	Outcome						Total
	Dead (%)			Transfer to wards (%)
0-9	7 (3.3)			12 (5.7)			19
10-19	9 (4.2)			12 (5.7)			21
20-29	14 (6.6)			32 (15.2)			46
30-39	19 (9.0)			23 (10.9)			42
40-49	15 (7.1)			14 (6.6)			29
50-59	10 (4.7)			14 (6.6)			24
60-69	5 (2.3)			12 (5.7)			17
>70	5 (2.3)			7 (3.3)			12
Patients’ Sex
Sex of the patients		Male	54 (25.7)		72 (34.3)	126
		Female	30 (14.3)		54 (25.7)	84
Total			84		126	210

Table 5:- Bivariate logistic regression of clinical outcome among patients in ICU of JJUSHYRH, 2020 G.C


		Dead (%)	Transfer to wards (%)
Co-morbidities	No	66(40.7)	96(59.2)	4.8 (0.5, 40.0)*	0.14
	HTN	13(44.8)	16(55.1)	5.6 (1.6, 52.3)*	0.12
	DM	4(50.0)	4(50.0)	7.0 (1.5, 86.3)*	0.12
	Malignancy	66(40.8)	96(59.2)	1.00(0.00)
LOS	6-10hours	10 (90.0)	1(10.0)	15.0 (0.9, 228.8)*	0.05
	1-5days	49(34.0)	95 (66.0)	0.7 (0.1, 4.7)	0.78
	6-10days	12(40.0)	18 (60.0)	1.0 (0.1 , 6.9)	1.00
	11-15days	5(50.0)	5 (50.0)	1.5 (0.1, 13.2)	0.71
	>26	2(40.0)	3 (60.0)	1.00
MV	Yes	67 (64.4)	37(35.5 )	9.4(4.9, 18.2)^*	0.000
MV	No	17(16.0)	89 (84.0 )	1.00
Ulcer prophylaxis	Yes	63(48.4)	67 (51.6)	2.6 (1.4, 4.8)^*	0.02
Ulcer prophylaxis	No	21(26.5)	59(73.5)	1.00
DVT	Yes	42(53.1)	37(46.9)	2.4 (1.3, 4.2)^*	0.003
DVT	No	42(32.0)	89(68.0)	1.00
Inotropes	Yes	40(80.0)	10(20.0)	10.5 (4.8, 22.8)^*	0.000
Inotropes	No	44(27.5)	116(72.5)	1.00
Analgesics(anti pain)	Yes	79(44.4)	99(55.6)	4.3 (1.5, 11.7)^*	0.004
Analgesics(anti pain)	No	5(15.6)	27(84.4)	1.00
P-Value <0.25

Table 6:- Multivariate logistic regression of clinical outcome among patients in ICU of JJUSHYRH, 2020 G.C

Variable	Categories	Outcome		AOR 95%CI	P- value
Variable	Categories	Dead (%)	Transfer to wards (%)	AOR 95%CI	P- value
LOS	6-10hours	10 (90.0)	1(10.0)	359.8(10.5, 123.3)	0.10
	1-5days	49(34.0)	95 (66.0)	15.2 (1.2, 184.2)^*	0.03
	6-10days	12(40.0)	18 (60.0)	14.7 (1.0, 198.8)	0.43
	11-15days	5(50.0)	5 (50.0)	6.2 (0.4, 96.9)	0.18
	21-25days	2(50.0)	2 (50.0)	2.2 (0.0, 54.0)	0.19
	>26	2(40.0)	3 (60.0)	1.00
Need of Mechanical Ventilation	Yes	67 (64.4)	37(35.5 )	24.1 (8.5, 68.2)*	0.000
Need of Mechanical Ventilation	No	17(16.0)	89 (84.0 )	1.00
DVT prophylaxis	Yes	42(53.1)	37(46.9)	4.0 (1.5, 10.5)*	0.005
DVT prophylaxis	No	42(32.0)	89(68.0)	1.00
Inotropes/vasopressors	Yes	40(80.0)	10(20.0)	12.1 (3.8, 38.2)*	0.000
Inotropes/vasopressors	No	44(27.5)	116(72.5)	1.00
Analgesics(anti pain)	Yes	99(55.6)	79(44.4)	8.1 (1.7, 38.7)*	0.008
Analgesics(anti pain)	No	27(84.4)	5(15.6)	1.00
P value <0.05

No competing interests reported.

ANNEX1Questionaire.docx

Clinical Outcome And Associated Factors Among Patients Admittedto The Intensive Care Unit Of Jigjiga University Sheik Hassen Yabare Referral Hospital, Somali Region, Ethiopia, 2020

Status:

Version 1

Abstract

Figures

Introduction

Background

METHODS AND MATERIALS

RESULTS

Patient’s demographic characteristics

Admission Characteristics and co-morbidities

Cause of ICU admission

ICU Co-morbidities

ICU outcome and overall management

Distribution of length of ICU stays, mechanical ventilation and their outcome among patient’s admitted to the ICU of JJUSHYRH, 2020 G.C

Over all ICU management

Factors associated with clinical outcome among patients in the intensive care unit of Jigjiga University Sheik Hassen Yabare referral hospital

Discussion

Conclusion

Limitation of the study

Recommendation

Declarations

Data Availability Statement

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1