The outcomes of patients admitted to the intensive care unit depends on the clinical condition of the patient’s arrival, the level of training and experience of staff, resource, infrastructure, and capacity of the ICU unit (1, 2, 17).
This study identified the magnitude of mortality and the predictors among patients admitted to the adult ICU of Tibebe Ghion specialized hospital. The study revealed that 29.6% (95% CI: 26, 33) of the admitted patients have died in the ICU. This finding was consistent with an indigenous study from Mekele 27% (21). This finding was higher than the studies done in South Africa 19.7% (22) and Canada 19% (23). However, it was lower compared to the studies from Gondar- 38.7% (17), Addis Ababa 39% (18), Jimma 50.4% (19), Nigeria 34.6% (24), Uganda 40.1% (25), and Tanzania 41.1% (26). This discrepancy might be due to a lack of necessary medical equipment (ABG-analyzer machine, portable dialysis machine, and portable x-ray service), infrastructure, and training. In addition, the lack of a high-dependency unit in the study area and the fact that TGSH ICU is still on new establishment might be the contributing factors for the higher rate of ICU mortality. The other possible justification for the discrepancy might be due to differences in sample size, level of ICU care, availability of medical supplies, and stratification of skilled staff.
This study revealed that patients who were admitted in 2020 G.C, were approximately 49% (AOR = 0.51: 0.31, 0.85) less likely to die as compared to those who were admitted in 2019. This low risk of death might be related to COVID-19 admissions and might have a low chance of case fatality rate compared to organ failure-related admissions. This pandemic might be positively reinforced the health facilities to fulfil the emergency and ICU-related equipment, availability of more mechanical ventilators and the recruitment of pulmonologists and trained ICU nurses in the study hospital to protect the communities from COVID-19-related death.
In addition, patients who stayed in ICU for less than five days were 5 times more likely to die than patients who stayed five or more days (AOR = 3.74: 2.31, 6.06) which is analogous to the study finding of Uganda (27). However, the current finding was varied from the study conducted in Hosanna, the length of ICU stay was more than 14 days with ICU mortality (28). This discrepancy might be explained due to late arrival to ICU and delay in intervention, shortage of crucial emergency drugs, and absence of airway management equipment in the medical emergency ward. Furthermore, the vital signs of the patients on admission to the MICU were found to be poor, which may show a gap in the continuity of care from the admission source to the medical ICU. Early death might also be explained by a limited number of ICU beds since the World Federation of Societies of Intensive and Critical Care Medicine recommends the ICU need to have at least 5% of total hospital beds. Besides, the shortage of functional mechanical ventilators delays and denied the admission of critically ill patients to medical ICU (29, 30).
The current study reported that mechanical ventilator use was about a 4 fold risk for ICU mortality. However, this finding was in agreement with the study findings of Gondar (17) Kenya (31), Uganda (25) and Brazil (32). The possible explanation for this association could be related that mechanical ventilators initiated for patients with respiratory failure, unable to protect the airway and hemodynamic instability. Furthermore, patients who need intubation and mechanical ventilator are more vulnerable to ventilator-associated pneumonia and other nosocomial infections (33, 34). This could also suggest the improved practice of mechanical ventilation at TGSH ICU by the available pulmonologist and trained nurses.
This study revealed that patients who were admitted with abnormal mental status were more likely to die than conscious patients (AOR = 13.44: 5.77, 31.27). The conscious disturbance is connected to severe decompensated disease, cerebral hypo-perfusion due to sepsis, blood loss, poisoning, and neurological disorder (35). In addition, in this study, severe head injury was the most common cause of abnormal mental status and mortality.
Limitations Of The Study
Due to the nature of the study design, a retrospective study based on the ICU registries and charts, only limited data were retrieved. So the necessary variables, which help to identify independent risk factors of clinical outcomes of patients admitted to the ICU were not collected. In addition, data related to Physiologic and laboratory variables necessary to calculate severity and prognostic score such as sequential organ failure assessment (SOFA), Simplified Acute Physiology Score (SAPS), and Acute Physiology and Chronic Health Disease Classification System (APACHE) to predict in ICU mortality were not collected due to inability to locate in the available written chart and incomplete ICU registry books.