The Burden of intensive care unit mortality and the Predictors in Amhara regional state, Northwest Ethiopia

The Burden of intensive care unit mortality and the Predictors in Amhara regional state, Northwest Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Burden of intensive care unit mortality and the Predictors in Amhara regional state, Northwest Ethiopia Tilahun Bizuayehu Demass, Abel Girma Guadie, Tilahun Birara Mengistu, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2231736/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Intensive care unit (ICU) is a multidisciplinary staffed and specially equipped area of a hospital dedicated to providing quality care for patients with life-threatening conditions. The provision of intensive care services to critically ill patients is a global issue. Though care is advancing globally, the quality of available ICUs in Ethiopia is still lagging far from the standard. Objective : This study aimed to assess ICU mortality and its associated factors among patients at Tibebe Ghion specialized hospital, Northwest Ethiopia, 2021. Method : A retrospective cohort study was conducted from February 24 th , 2019 to January 24 th , 2021. Data were collected from medical records by using pretested structured data retrieval checklist. The collected data was entered into Epi-data version 3.1 and analyzed using R version 4.0 software. Descriptive statistics computed. A simple logistic analysis was run (at 95% CI and p-value < 0.05) to identify the determinants for ICU mortality. Results: A total of 568 study participants’ charts were reviewed. The median length of ICU stay was 4 days. The overall mortality rate of the ICU-admitted patients was 29.6% (95% CI: 26%, 33%). Admitted in 2020 (AOR=0.51; 95%CI: 0.31, 0.85), having altered mentation (AOR=13.44; 95%CI: 5.77, 31.27), mechanical ventilator used (AOR = 4.11; 95%CI: 2.63, 6.43), and stayed < 5 days in the ICU (AOR = 3.74; 95%CI: 2.31, 6.06) were significantly associated with ICU mortality. Conclusion : The ICU mortality rate was 29.6%. Years of admission, altered mentation, mechanical ventilator use and days of stay in the ICU were the predictors for ICU mortality. Improvement efforts led by the Ministry of Health with input from the acute care workforce are an urgent priority. ICU Admission Tibebe Ghion Specialized Hospital Bahir Dar city Figures Figure 1 Figure 2 Background The intensive care unit (ICU) is a separate, specially-staffed, and equipped hospital unit dedicated to the observation, care, and treatment of patients with life-threatening conditions ( 1 – 4 ). Intensive care could reduce mortality rates by 15–60%, when it is well-equipped, and staffed with intensivists ( 5 ). Studies in resource-rich settings showed that the physician, nurse, pharmacist, respiratory or physical therapists, and dietician staffing model in use affect the outcomes of critically ill patients ( 6 – 9 ). However, in resource-limited settings intensive care specialists are unavailable and the ICUs are served by anaesthetic officers in collaboration with surgeons, internists, and paediatricians ( 10 – 13 ). In sub-Saharan Africa, ICUs have varying qualities and quantities of infrastructure, which are mainly determined by the economic level of the country ( 14 ). In Ethiopia, besides ICU staff shortage, there is also limited ICU equipment and supplies leading to the quality of ICU services lagging behind the standard ( 15 – 17 ). The ICU mortality in Ethiopia ranges from 38.7–50.4% ( 17 – 19 ). As a result, it is one of the countries with the highest ICU mortality in Africa ( 15 , 20 ). For these and many other reasons, there has been increased interest in studying the outcomes of ICU care. Therefore, this study aimed to assess the outcomes of adult ICU admission in Tibebe Ghion Specialized Hospital. Methods Study Design, Period And Setting A retrospective cohort study was conducted from February 24th, 2019 to January 24th, 2021 at Tibebe Ghion Specialized Hospital, which is 565 km away from Addis Ababa, the capital city of Ethiopia, in the North West direction. In this hospital, there are 6 wards, 2 intensive care units (pediatric and adult), and 452 beds. The adult ICU was equipped with 9 beds, 6 functioning mechanical ventilators, and one bedside ultrasound. This unit is staffed with 2 anesthesiologists, internal medicine specialists, and sub-specialists, trained nurses, medical and surgical residents. It gives service to critically ill medical, surgical and gynecology, and obstetrics patients admitted from the emergency department, wards, operation rooms, and from referrals. Eligibility Criteria Clinically diagnosed and critically ill patients whose age is greater than fifteen years and admitted to the adult ICU units were included. While patients whose charts were missing or incomplete or patients whose COVID-19 test results become positive and transferred to the COVID-19 treatment centre were excluded from the study. Sample Size All critically ill patients who fulfilled the eligibility criteria were included. Study Variables Dependent variable ICU mortality (yes = 1, no = 0). Independent variables Sociodemographic characteristics Age, sex, residence, and years of admission ICU admission-related characteristics Source of admission, admission category, admission diagnosis, admission outcome, cause of death, length of stay in ICU and mental status Data Collection Tools And Procedures Data from ICU medical records were collected by trained ICU nurses using pretested structured data retrieval checklist. Regular check-up of data completeness and consistency was made daily. Data Processing And Analysis Data were entered into Epi-data version 3.1 and analyzed using R version 4.0 software. Descriptive statistics were computed. Bivariate and multivariate logistic regression analyses were employed to assess the association between the exploratory variables and ICU mortality. The strength of the association was measured using the adjusted odds ratio (AOR) and 95% ICU mortality. Results Demographic characteristics among patients admitted to ICU A total of 648 patients were admitted over 2 years period. Of these, 568 (88%) of patients' charts had complete data. The median (± IQR) age of the respondents was 45 ( ± 33) years. More than one-third of the patients were in the age groups of 21–40 years. Nearly 59% of the patients were males and admitted in 2020 G.C. Half of the admitted patients came from rural areas ( Table 1 ) . Table 1 Socio-demographic characteristics of patients admitted to the ICU of TGSH, 2021 Variable Category Frequency Percent Age group (in years) 80 14 2.5 Sex Male 332 58.5 Female 236 41.5 Residence Rural 282 49.6 Urban 286 50.4 Year of admission 2019 234 41.2 2020 334 58.8 Medical ICU Admission related characteristics About 74% of patients were admitted from the emergency department followed by the operation theatre (12.3%) and surgical ward (9.7%), respectively. Nearly 64% of the admitted patients were medical patients. The commonest specific diagnosis at medical ICU admission was head trauma (16.9%) followed by general surgical (16.2%). Whereas shock (19.1%) was the predominant cause of ICU death followed by head trauma (17.9%) (Table 2 ). Table 2 The ICU admission-related characteristics of patients admitted to TGSH, 2021 Variable Category Frequency Percent Source of admission Emergency department 422 74.3 Medical ward 18 3.2 Surgical Ward 55 9.7 Operation Theater 70 12.3 Gynecology/Obstetrics 3 0.5 Admission category Medical patient 371 65.3 Surgical Patient 191 33.6 Gynecology/Obstetrics 6 1.1 Admission Diagnosis Myocardial infarction 49 8.6 Congestive heart failure 15 2.6 Shock 61 10.7 Pneumonia 41 7.2 Acute respiratory distress syndrome 32 5.6 Pulmonary thromboembolism 14 2.5 Diabetic ketoacidosis 13 2.3 Stroke 34 6.0 Head trauma 96 16.9 General Surgical 92 16.2 Others* 121 21.4 ICU admission outcome Improved 400 70.4 Died 168 29.6 Cause of death Myocardial infarction 5 3.0 Congestive heart failure 4 2.4 Shock 32 19.1 Pneumonia 17 10.1 Acute respiratory distress syndrome 13 7.7 Diabetic ketoacidosis 2 1.2 Stroke 11 6.5 Head trauma 30 17.9 Others* 54 32.1 Length of stay (days) 20 21 3.7 Glasgow coma scale Conscious 72 12.7 Confused 281 49.5 Lethargic 122 21.5 Comatose 93 16.4 *(Tetanus, GBS, Thyroid storm, Malignancy, Gastro intestinal bleeding, post−surgery, and poisoning) Trends of medical ICU Admission and its outcomes In this study, 334 and 224 patients were admitted to the medical ICU in 2020 and 2019 G.C. respectively. The peak admission was observed in July 2020. While the lowest admission was seen in February 2019 (Fig. 1 ). Regarding, the medical ICU admission outcomes, 20.9% (49/234) of the admitted patients died in 2019. While 35.6% (119/334) of the admitted patients died in 2020 (Fig. 2 ). The magnitude of ICU Mortality The magnitude of death among patients admitted to ICU was 29.6% (95% CI: 26, 33). Factors associated with ICU mortality Logistic regression analysis was conducted to identify independent predictors of mortality among patients admitted to the intensive care unit. Five predictor variables having a p-value < 0.2 at bivariate regression analysis were taken into a multivariable logistic regression analysis to see associations between dependent and independent variables. On the multivariable logistic regression model four variables, namely year of admission, Glasgow comma scale, length of stay, and mechanical ventilator use were significantly associated with ICU mortality at a p-value of 0.05. Accordingly, for those patients who were admitted in 2020 G.C to the ICU, the odds of ICU mortality were about 49% (AOR = 0.51; 95% CI: 0.31, 0.85) less compared to patients who were admitted in 2019 G.C. For those patients who had altered mentation, the odds of ICU mortality were 13.5 (AOR = 13.44; 95% CI: 5.77, 31.27) times higher compared to those who had stable mentation. Similarly, for patients who used mechanical ventilators, the odds of ICU mortality were about four (AOR = 4.11; 95% CI: 2.63, 6.43) times higher compared to those who were not ventilated. Similarly, for those patients who stayed < 5 days in the ICU, the odds of ICU mortality were about 3.7 (AOR = 3.74; 95%CI: 2.31, 6.06) times higher compared to those who stayed 5 and more days (Table 3 ) Table 3 Factors associated with ICU mortality at Tibebe Ghion specialized hospital northwest, Ethiopia, 2021 Variable Category ICU Mortality COR (95%CI) AOR (95%CI) P-value Yes No Year of admission 2019 R 49 185 1.00 1.00 0.01 2020 119 215 2.09 (1.42, 3.07) 0.51 (0.31, 0.85) Mental status Stable R 7 175 1.00 1.00 0.0001 Unstable 161 225 17.89 (8.18, 39.1) 13.44 (5.77, 31.27) Mechanical ventilation used Yes 95 90 4.48 (3.05, 6.59) 4.11 (2.63, 6.43) 0.0001 No R 73 310 1.00 1.00 Length of stay < 5 days 177 135 5.15 (3.36, 7.91) 3.74 (2.31, 6.06) 0.0001 ≥ 5 days R 223 33 1.00 1.00 Blood pressure status Stable R 169 17 1.00 1.00 0.587 Unstable 231 151 6.49 (3.79, 11.14) 0.78 (0.32, 1.90) R reference category Discussion 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. Conclusion And Recommendation The burden of ICU mortality was high. The main cause of death was shock followed by head injury. Years of admission, altered mentation, mechanical ventilator use and days of stay in the ICU were the predictors for ICU mortality. It shows an epidemiologic transition from the cardiovascular system disease and may need strict regulation on weapon handling and expansion of ICU service. Abbreviations ARDS: Acute respiratory distress syndrome, CI: Confidence interval, GBS: Guliam Barie syndrome, ICU: Intensive Care Unit, OR: Odds Ratio Declarations Ethical Consideration and consent to participate Ethical approval was obtained from the Institutional Review Board of Bahir Dar University with reference number: BDU/IN/MD/14. The study was performed following the declaration of Helsinki. A permission letter was obtained from the Bahir Dar University School of public health. The support letter was obtained from the Amhara national regional state Public health institute. The hospital medical director and the ICU head were informed about the objectives of the study. And a permission letter was received from the Tibebe Ghion specialized hospital to retrieve data from the ICU registry and patient charts. Finally, the data collection tools were documented and kept confidential in a secure place. Availability of data and materials All data generated or analyzed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Consent to publication Not applicable. Authors’ Contributions All authors have an equal contribution. Funding information No fund was received. Acknowledgements We would like to thank our study participants, data collectors, supervisor, and Tibebe Ghion specialized hospital staff for their cooperation and support during the data collection. References Australia CoICMo, Zealand N. Minimum standards for intensive care units. 2010. Chong M. Patient early mobilization: a Malaysia’s study of nursing practices. Journal of Intensive and Critical Care. 2017;3(3):29. Haftu H, Hailu T, Medhaniye A, G/tsadik T. Assessment of pattern and treatment outcome of patients admitted to pediatric intensive care unit, Ayder Referral Hospital, Tigray, Ethiopia, 2015. BMC Research Notes. 2018;11(1):339. 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Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department-a prospective cohort study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2012;20(1):1–10. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2231736","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":149421234,"identity":"3f842d1a-19b0-4b68-b468-e62d204c122c","order_by":0,"name":"Tilahun Bizuayehu Demass","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tilahun","middleName":"Bizuayehu","lastName":"Demass","suffix":""},{"id":149421235,"identity":"f1b50a00-3976-48ea-a665-a8d795ef60cd","order_by":1,"name":"Abel Girma Guadie","email":"","orcid":"","institution":"Bahir Dar 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Bantie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYFADdiD+AMRs7ASVMsNpxsYZIC3M+FSja2nmQRbABeTd+w9+/FFxONrgMPPzxza/tsnzAfV++JiDW4vhmcPM0jxnDuduOMxm2Jzbd9uwjZmBWXLmNjxaZiQzSDO23QZqYQBq6bnNCNTCxsyLT8v8x8w/f/4DaWH/2GzZc9ueoBZ5CWY2Cd4GkBYew2aGH7cTCWox4Ek2s+Y59j935mGewpm9DbeT25gZm/H6Rb794OObP2rScvuOt2/48OPPbdv57c0HP3zEZ8sBZB5jG5hswK0eZAuq9B+8ikfBKBgFo2CEAgD58VSaFRSdCQAAAABJRU5ErkJggg==","orcid":"","institution":"Amhara national regional state Public Health Institute","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Getasew","middleName":"Mulat","lastName":"Bantie","suffix":""}],"badges":[],"createdAt":"2022-11-02 21:29:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2231736/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2231736/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":28762479,"identity":"5c97dad6-bce1-434f-8e63-35afeda9a6cf","added_by":"auto","created_at":"2022-11-07 17:58:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":43845,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTrends of medical ICU admissions among patients admitted to TGSH, 2021\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2231736/v1/bee056af1660149f2ea85f0b.png"},{"id":28762793,"identity":"6afd3884-d81d-43b8-a279-056bd16b456e","added_by":"auto","created_at":"2022-11-07 18:06:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":24893,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMedical ICU admission outcomes among patients admitted to TGSH, 2021\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2231736/v1/7fea9646c0927145fcf3b34e.png"},{"id":28803170,"identity":"09641561-f2f8-4a25-bf36-80c23277ba35","added_by":"auto","created_at":"2022-11-08 13:14:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":528383,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2231736/v1/44deef7b-a6dd-402b-bf53-90824285cde4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Burden of intensive care unit mortality and the Predictors in Amhara regional state, Northwest Ethiopia","fulltext":[{"header":"Background","content":"\u003cp\u003eThe intensive care unit (ICU) is a separate, specially-staffed, and equipped hospital unit dedicated to the observation, care, and treatment of patients with life-threatening conditions (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e). Intensive care could reduce mortality rates by 15\u0026ndash;60%, when it is well-equipped, and staffed with intensivists (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eStudies in resource-rich settings showed that the physician, nurse, pharmacist, respiratory or physical therapists, and dietician staffing model in use affect the outcomes of critically ill patients (\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e). However, in resource-limited settings intensive care specialists are unavailable and the ICUs are served by anaesthetic officers in collaboration with surgeons, internists, and paediatricians (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e). In sub-Saharan Africa, ICUs have varying qualities and quantities of infrastructure, which are mainly determined by the economic level of the country (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn Ethiopia, besides ICU staff shortage, there is also limited ICU equipment and supplies leading to the quality of ICU services lagging behind the standard (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e). The ICU mortality in Ethiopia ranges from 38.7\u0026ndash;50.4% (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e). As a result, it is one of the countries with the highest ICU mortality in Africa (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e). For these and many other reasons, there has been increased interest in studying the outcomes of ICU care. Therefore, this study aimed to assess the outcomes of adult ICU admission in Tibebe Ghion Specialized Hospital.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch3\u003eStudy Design, Period And Setting\u003c/h3\u003e\n\u003cp\u003eA retrospective cohort study was conducted from February 24th, 2019 to January 24th, 2021 at Tibebe Ghion Specialized Hospital, which is 565 km away from Addis Ababa, the capital city of Ethiopia, in the North West direction. In this hospital, there are 6 wards, 2 intensive care units (pediatric and adult), and 452 beds. The adult ICU was equipped with 9 beds, 6 functioning mechanical ventilators, and one bedside ultrasound. This unit is staffed with 2 anesthesiologists, internal medicine specialists, and sub-specialists, trained nurses, medical and surgical residents. It gives service to critically ill medical, surgical and gynecology, and obstetrics patients admitted from the emergency department, wards, operation rooms, and from referrals.\u003c/p\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cp\u003eClinically diagnosed and critically ill patients whose age is greater than fifteen years and admitted to the adult ICU units were included. While patients whose charts were missing or incomplete or patients whose COVID-19 test results become positive and transferred to the COVID-19 treatment centre were excluded from the study.\u003c/p\u003e\n\u003ch3\u003eSample Size\u003c/h3\u003e\n\u003cp\u003eAll critically ill patients who fulfilled the eligibility criteria were included.\u003c/p\u003e\n\u003ch3\u003eStudy Variables\u003c/h3\u003e\n\u003cdiv\u003e\n \u003ch2\u003eDependent variable\u003c/h2\u003e\n \u003cp\u003eICU mortality (yes\u0026thinsp;=\u0026thinsp;1, no\u0026thinsp;=\u0026thinsp;0).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ch2\u003eIndependent variables\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eSociodemographic characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAge, sex, residence, and years of admission\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eICU admission-related characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSource of admission, admission category, admission diagnosis, admission outcome, cause of death, length of stay in ICU and mental status\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eData Collection Tools And Procedures\u003c/h3\u003e\n\u003cp\u003eData from ICU medical records were collected by trained ICU nurses using pretested structured data retrieval checklist. Regular check-up of data completeness and consistency was made daily.\u003c/p\u003e\n\u003ch3\u003eData Processing And Analysis\u003c/h3\u003e\n\u003cp\u003eData were entered into Epi-data version 3.1 and analyzed using R version 4.0 software. Descriptive statistics were computed. Bivariate and multivariate logistic regression analyses were employed to assess the association between the exploratory variables and ICU mortality. The strength of the association was measured using the adjusted odds ratio (AOR) and 95% ICU mortality.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics among patients admitted to ICU\u003c/h2\u003e \u003cp\u003eA total of 648 patients were admitted over 2 years period. Of these, 568 (88%) of patients' charts had complete data. The median (\u0026plusmn;\u0026thinsp;IQR) age of the respondents was 45 (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;33) years. More than one-third of the patients were in the age groups of 21\u0026ndash;40 years. Nearly 59% of the patients were males and admitted in 2020 G.C. Half of the admitted patients came from rural areas \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of patients admitted to the ICU of TGSH, 2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAge group (in years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYear of admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMedical ICU Admission related characteristics\u003c/h2\u003e \u003cp\u003eAbout 74% of patients were admitted from the emergency department followed by the operation theatre (12.3%) and surgical ward (9.7%), respectively. Nearly 64% of the admitted patients were medical patients. The commonest specific diagnosis at medical ICU admission was head trauma (16.9%) followed by general surgical (16.2%). Whereas shock (19.1%) was the predominant cause of ICU death followed by head trauma (17.9%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe ICU admission-related characteristics of patients admitted to TGSH, 2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eSource of admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical Ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOperation Theater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGynecology/Obstetrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAdmission category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical Patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGynecology/Obstetrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"10\" rowspan=\"11\"\u003e \u003cp\u003eAdmission Diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMyocardial infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCongestive heart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute respiratory distress syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePulmonary thromboembolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetic ketoacidosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHead trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral Surgical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eICU admission outcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImproved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eCause of death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMyocardial infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCongestive heart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute respiratory distress syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetic ketoacidosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHead trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eLength of stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eGlasgow coma scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConscious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConfused\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLethargic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComatose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*(Tetanus, GBS, Thyroid storm, Malignancy, Gastro intestinal bleeding, post\u0026minus;surgery, and poisoning)\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTrends of medical ICU Admission and its outcomes\u003c/h2\u003e \u003cp\u003eIn this study, 334 and 224 patients were admitted to the medical ICU in 2020 and 2019 G.C. respectively. The peak admission was observed in July 2020. While the lowest admission was seen in February 2019 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRegarding, the medical ICU admission outcomes, 20.9% (49/234) of the admitted patients died in 2019. While 35.6% (119/334) of the admitted patients died in 2020 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eThe magnitude of ICU Mortality\u003c/h2\u003e \u003cp\u003eThe magnitude of death among patients admitted to ICU was 29.6% (95% CI: 26, 33).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with ICU mortality\u003c/h2\u003e \u003cp\u003eLogistic regression analysis was conducted to identify independent predictors of mortality among patients admitted to the intensive care unit. Five predictor variables having a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.2 at bivariate regression analysis were taken into a multivariable logistic regression analysis to see associations between dependent and independent variables. On the multivariable logistic regression model four variables, namely year of admission, Glasgow comma scale, length of stay, and mechanical ventilator use were significantly associated with ICU mortality at a p-value of 0.05.\u003c/p\u003e \u003cp\u003eAccordingly, for those patients who were admitted in 2020 G.C to the ICU, the odds of ICU mortality were about 49% (AOR\u0026thinsp;=\u0026thinsp;0.51; 95% CI: 0.31, 0.85) less compared to patients who were admitted in 2019 G.C.\u003c/p\u003e \u003cp\u003eFor those patients who had altered mentation, the odds of ICU mortality were 13.5 (AOR\u0026thinsp;=\u0026thinsp;13.44; 95% CI: 5.77, 31.27) times higher compared to those who had stable mentation. Similarly, for patients who used mechanical ventilators, the odds of ICU mortality were about four (AOR\u0026thinsp;=\u0026thinsp;4.11; 95% CI: 2.63, 6.43) times higher compared to those who were not ventilated.\u003c/p\u003e \u003cp\u003eSimilarly, for those patients who stayed\u0026thinsp;\u0026lt;\u0026thinsp;5 days in the ICU, the odds of ICU mortality were about 3.7 (AOR\u0026thinsp;=\u0026thinsp;3.74; 95%CI: 2.31, 6.06) times higher compared to those who stayed 5 and more days (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with ICU mortality at Tibebe Ghion specialized hospital northwest, Ethiopia, 2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eICU Mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYear of admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019 \u003csup\u003e\u003cem\u003eR\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.09 (1.42, 3.07)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.51 (0.31, 0.85)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMental status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStable \u003csup\u003e\u003cem\u003eR\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnstable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e17.89 (8.18, 39.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e13.44 (5.77, 31.27)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMechanical ventilation used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4.48 (3.05, 6.59)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e4.11 (2.63, 6.43)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo \u003csup\u003e\u003cem\u003eR\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLength of stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5.15 (3.36, 7.91)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.74 (2.31, 6.06)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;5 days \u003csup\u003e\u003cem\u003eR\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBlood pressure status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStable \u003csup\u003e\u003cem\u003eR\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.587\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnstable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e6.49 (3.79, 11.14)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.78 (0.32, 1.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cem\u003eR\u003c/em\u003e\u003c/sup\u003e \u003cem\u003ereference category\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe outcomes of patients admitted to the intensive care unit depends on the clinical condition of the patient\u0026rsquo;s arrival, the level of training and experience of staff, resource, infrastructure, and capacity of the ICU unit (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThis 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% (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e). This finding was higher than the studies done in South Africa 19.7% (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e) and Canada 19% (\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e). However, it was lower compared to the studies from Gondar- 38.7% (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e), Addis Ababa 39% (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e), Jimma 50.4% (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e), Nigeria 34.6% (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e), Uganda 40.1% (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e), and Tanzania 41.1% (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e). 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.\u003c/p\u003e\n\u003cp\u003eThis study revealed that patients who were admitted in 2020 G.C, were approximately 49% \u003cstrong\u003e(\u003c/strong\u003eAOR\u0026thinsp;=\u0026thinsp;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.\u003c/p\u003e\n\u003cp\u003eIn 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\u0026thinsp;=\u0026thinsp;3.74: 2.31, 6.06) which is analogous to the study finding of Uganda (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e). 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 (\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e). 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 (\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe 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 (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e) Kenya (\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e), Uganda (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e) and Brazil (\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e). 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 (\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e). This could also suggest the improved practice of mechanical ventilation at TGSH ICU by the available pulmonologist and trained nurses.\u003c/p\u003e\n\u003cp\u003eThis study revealed that patients who were admitted with abnormal mental status were more likely to die than conscious patients (AOR\u0026thinsp;=\u0026thinsp;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 (\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e). In addition, in this study, severe head injury was the most common cause of abnormal mental status and mortality.\u003c/p\u003e\n\u003ch3\u003eLimitations Of The Study\u003c/h3\u003e\n\u003cp\u003eDue 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.\u003c/p\u003e"},{"header":"Conclusion And Recommendation","content":"\u003cp\u003eThe burden of ICU mortality was high. The main cause of death was shock followed by head injury. Years of admission, altered mentation, mechanical ventilator use and days of stay in the ICU were the predictors for ICU mortality. It shows an epidemiologic transition from the cardiovascular system disease and may need strict regulation on weapon handling and expansion of ICU service. \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eARDS: Acute respiratory distress syndrome, CI: Confidence interval, GBS: Guliam Barie syndrome, ICU: Intensive Care Unit, OR: Odds Ratio\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Consideration\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Board of Bahir Dar University with reference number: BDU/IN/MD/14. The study was performed following the declaration of Helsinki. A permission letter was obtained from the Bahir Dar University School of public health.\u0026nbsp;The support letter was obtained from the Amhara national regional state Public health institute. The hospital medical director and the ICU head were informed about the objectives of the study. And a permission letter was received from the Tibebe Ghion specialized hospital to retrieve data from the ICU registry and patient charts. Finally, the data collection tools were documented and kept confidential in a secure place.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have an equal contribution.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo fund was received.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank our study participants, data collectors, supervisor, and Tibebe Ghion specialized hospital staff for their cooperation and support during the data collection. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eAustralia CoICMo, Zealand N. 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Journal of critical care. 2017;37:270\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLalani 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. Annals of the American Thoracic Society. 2018;15(11):1336\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eToufen Junior C, Franca SA, Okamoto VN, Salge JM, Carvalho CRR. Infection as an independent risk factor for mortality in the surgical intensive care unit. Clinics. 2013;68:1103\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBouadma L, Sonneville R, Garrouste-Orgeas M, Darmon M, Souweine B, Voiriot G, et al. Ventilator-associated events: prevalence, outcome, and relationship with ventilator-associated pneumonia. Critical care medicine. 2015;43(9):1798\u0026ndash;806.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eFialkow L, Farenzena M, Wawrzeniak IC, Brauner JS, Vieira SRR, Vigo A, et al. Mechanical ventilation in patients in the intensive care unit of a general university hospital in southern Brazil: an epidemiological study. Clinics. 2016;71:144\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBarfod C, Lauritzen MMP, Danker JK, S\u0026ouml;l\u0026eacute;tormos G, Forberg JL, Berlac PA, et al. Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department-a prospective cohort study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2012;20(1):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ICU, Admission, Tibebe Ghion, Specialized Hospital, Bahir Dar city ","lastPublishedDoi":"10.21203/rs.3.rs-2231736/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2231736/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Intensive care unit (ICU) is a multidisciplinary staffed and specially equipped area of a hospital dedicated to providing quality care for patients with life-threatening conditions. The provision of intensive care services to critically ill patients is a global issue. Though care is advancing globally, the quality of available ICUs in Ethiopia is still lagging far from the standard.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: This study aimed to assess ICU mortality and its associated factors among patients at Tibebe Ghion specialized hospital, Northwest Ethiopia, 2021.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: A retrospective cohort study was conducted from February 24\u003csup\u003eth\u003c/sup\u003e, 2019 to January 24\u003csup\u003eth\u003c/sup\u003e, 2021. Data were collected from medical records by using pretested structured data retrieval checklist. The collected data was entered into Epi-data version 3.1 and analyzed using R version 4.0 software. Descriptive statistics computed. A simple logistic analysis was run (at 95% CI and p-value \u0026lt; 0.05) to identify the determinants for ICU mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 568 study participants’ charts were reviewed. The median length of ICU stay was 4 days. The overall mortality rate of the ICU-admitted patients was 29.6% (95% CI: 26%, 33%). Admitted in 2020 (AOR=0.51; 95%CI: 0.31, 0.85), having altered mentation (AOR=13.44; 95%CI: 5.77, 31.27), mechanical ventilator used (AOR = 4.11; 95%CI: 2.63, 6.43), and stayed \u0026lt; 5 days in the ICU (AOR = 3.74; 95%CI: 2.31, 6.06) were significantly associated with ICU mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The ICU mortality rate was 29.6%. Years of admission, altered mentation, mechanical ventilator use and days of stay in the ICU were the predictors for ICU mortality. Improvement efforts led by the Ministry of Health with input from the acute care workforce are an urgent priority.\u003c/p\u003e","manuscriptTitle":"The Burden of intensive care unit mortality and the Predictors in Amhara regional state, Northwest Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-07 17:58:03","doi":"10.21203/rs.3.rs-2231736/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b5daef54-3a2f-4ab5-ab81-8f91437cfba4","owner":[],"postedDate":"November 7th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-11-08T13:14:42+00:00","versionOfRecord":[],"versionCreatedAt":"2022-11-07 17:58:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2231736","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2231736","identity":"rs-2231736","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}