1 Division of Pulmonary, Allergy, and Critical Care Medicine, and.
2 Academic Model Providing Access to Healthcare, Eldoret, Kenya.
Ann Am Thorac Soc. 2018 Nov;15(11):1336-1343. doi: 10.1513/AnnalsATS.201801-051OC.
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.
To identify factors associated with mortality at Moi Teaching and Referral Hospital and validate the Mortality Probability Admission Model II (MPM-II).
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.
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. MPM-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).
In a Kenyan public ICU, high mortality was noted despite the use of advanced therapies. MPM-II has acceptable discrimination but poor calibration. Modification of MPM-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.
危重病的负担在资源有限的环境中最大。肯尼亚公立医院重症监护病房（ICU）的结局尚不清楚。鉴于肯尼亚卫生部扩大 ICU 容量的倡议，本研究具有及时性。
确定莫伊教学与转诊医院死亡率相关的因素，并验证死亡率概率入院模型 II（MPM-II）。
对 2013 年 1 月 1 日至 2015 年 4 月 5 日期间的 450 名患者进行回顾性队列评估，评估内容包括人口统计学、就诊诊断、干预措施、死亡率和成本数据。
ICU 死亡率为 53.6%，30 天死亡率为 57.3%。大多数患者为男性（61%），年龄至少为 18 岁（70%）；中位年龄为 29 岁。与高调整后的死亡率相关的因素如下：年龄小于 10 岁（调整后的优势比[OR]，3.59；P≤0.001）、35-49 岁（OR，3.13；P=0.002）和 50 岁以上（OR，2.86；P=0.004），参考年龄范围为 10-24 岁；脓毒症（OR，3.39；P=0.01）；急性中风（OR，8.14；P=0.011）；急性呼吸衰竭或机械通气（OR，6.37；P<0.001）；血管加压支持（OR，7.98；P<0.001）。药物/酒精中毒（OR，0.33；P=0.005）与较低的调整后死亡率相关。MPM-II 区分显示接受者操作特征曲线下的面积为 0.78（95%置信区间，0.72-0.82）。校准的 Hosmer-Lemeshow 检验结果显著（P<0.001）。
在肯尼亚的一家公立医院 ICU 中，尽管使用了先进的治疗方法，但死亡率仍然很高。MPM-II 具有可接受的区分度，但校准效果不佳。需要使用前瞻性多中心全球合作来修改 MPM-II 或开发新模型。需要为高危诊断制定标准化分诊和治疗方案，以改善 ICU 结局。
