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Intensive Care Outcomes and Mortality Prediction at a National Referral Hospital in Western Kenya.

Publication ,  Journal Article
Lalani, HS; Waweru-Siika, W; Mwogi, T; Kituyi, P; Egger, JR; Park, LP; Kussin, PS
Published in: Ann Am Thorac Soc
November 2018

RATIONALE: 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. OBJECTIVES: To identify factors associated with mortality at Moi Teaching and Referral Hospital and validate the Mortality Probability Admission Model II (MPM0-II). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

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Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

November 2018

Volume

15

Issue

11

Start / End Page

1336 / 1343

Location

United States

Related Subject Headings

  • Young Adult
  • Survival Analysis
  • Retrospective Studies
  • Referral and Consultation
  • Middle Aged
  • Male
  • Kenya
  • Intensive Care Units
  • Humans
  • Hospitals, Public
 

Citation

APA
Chicago
ICMJE
MLA
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Lalani, H. S., Waweru-Siika, W., Mwogi, T., Kituyi, P., Egger, J. R., Park, L. P., & Kussin, P. S. (2018). Intensive Care Outcomes and Mortality Prediction at a National Referral Hospital in Western Kenya. Ann Am Thorac Soc, 15(11), 1336–1343. https://doi.org/10.1513/AnnalsATS.201801-051OC
Lalani, Hussain S., Wangari Waweru-Siika, Thomas Mwogi, Protus Kituyi, Joseph R. Egger, Lawrence P. Park, and Peter S. Kussin. “Intensive Care Outcomes and Mortality Prediction at a National Referral Hospital in Western Kenya.Ann Am Thorac Soc 15, no. 11 (November 2018): 1336–43. https://doi.org/10.1513/AnnalsATS.201801-051OC.
Lalani HS, Waweru-Siika W, Mwogi T, Kituyi P, Egger JR, Park LP, et al. Intensive Care Outcomes and Mortality Prediction at a National Referral Hospital in Western Kenya. Ann Am Thorac Soc. 2018 Nov;15(11):1336–43.
Lalani, Hussain S., et al. “Intensive Care Outcomes and Mortality Prediction at a National Referral Hospital in Western Kenya.Ann Am Thorac Soc, vol. 15, no. 11, Nov. 2018, pp. 1336–43. Pubmed, doi:10.1513/AnnalsATS.201801-051OC.
Lalani HS, Waweru-Siika W, Mwogi T, Kituyi P, Egger JR, Park LP, Kussin PS. Intensive Care Outcomes and Mortality Prediction at a National Referral Hospital in Western Kenya. Ann Am Thorac Soc. 2018 Nov;15(11):1336–1343.

Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

November 2018

Volume

15

Issue

11

Start / End Page

1336 / 1343

Location

United States

Related Subject Headings

  • Young Adult
  • Survival Analysis
  • Retrospective Studies
  • Referral and Consultation
  • Middle Aged
  • Male
  • Kenya
  • Intensive Care Units
  • Humans
  • Hospitals, Public