肯尼亚4546例入住高依赖和重症监护病房的成人患者的流行病学、临床特征及结局（EPOK）：一项基于多中心注册登记的观察性研究

EPidemiology, clinical characteristics and Outcomes of 4546 adult admissions to high-dependency and intensive care units in Kenya (EPOK): a multicentre registry-based observational study.

作者信息

Njoki Carolyne, Simiyu Nabukwangwa, Kaddu Ronnie, Mwangi Wambui, Sulemanji Demet, Oduor Peter, Dona Dilanthi Gamage, Otieno Dorothy, Abonyo Teddy Thaddeus, Wangeci Patricia, Kabanya Thomas, Mutuku Selina, Kioko Annastacia, Muthoni Joy, Kamau Peter Mburu, Beane Abigail, Haniffa Rashan, Dondorp Arjen, Misango David, Pisani Luigi, Waweru-Siika Wangari

机构信息

Department of Anesthesia, Aga Khan University, Nairobi, Kenya.

Department of Anesthesia and Intensive Care, Kisii Hospital, Kisii, Kenya.

出版信息

Crit Care Explor. 2024 Feb 1;6(2):e1036. doi: 10.1097/CCE.0000000000001036.

DOI:10.1097/CCE.0000000000001036

PMID:38356864

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7615640/

Abstract

OBJECTIVE

to describe clinical, management and outcome features of critically ill patients admitted to intensive care units (ICUs) and high dependency units (HDUs) in Kenya.

DESIGN

prospective registry-based observational study.

SETTING

three HDUs and eight ICUs in Kenya.

PATIENTS

consecutive adult patients admitted between January 2021 and June 2022.

INTERVENTIONS

none.

MEASUREMENTS AND MAIN RESULTS

data was entered in a cloud based platform using a common data model. Study endpoints included case mix variables, management features and patient centred outcomes. Patients with Coronavirus disease 2019 (COVID-19) were reported separately. Of the 3892/4546 patients without COVID-19, 2445 patients (62.8%) were from HDUs and 1447 (37.2%) from ICUs. Patients had a median age of 53 years (interquartile range [IQR] 38-68), with HDU patients being older but with a lower severity (APACHE II 6 [3-9] in HDUs vs 12 [7-17] in ICUs; p<0.001). One out of four patients were postoperative with 604 (63.4%) receiving emergency surgery. Readmission rate was 4.8%. Hypertension and diabetes were prevalent comorbidities, with a 4.0% HIV/AIDS rate. Invasive mechanical ventilation (IMV) was applied in 3.4% in HDUs vs. 47.6% in ICUs (P<0.001), with a duration of 7 days (IQR 3-21). There was a similar use of renal replacement therapy (4.0% vs. 4.7%; P<0.001). Vasopressor use was infrequent while half of patients received antibiotics. Average length of stay was 2 days (IQR 1-5). Crude HDU mortality rate was 6.5% in HDUs versus 30.5% in the ICUs (P<0.001). Of the 654 COVID-19 admissions, most were admitted in ICUs (72.3%) with a 33.2% mortality.

CONCLUSIONS

We provide the first multicenter observational cohort study from an African ICU national registry. Distinct management features and outcomes characterise HDU from ICU patients.

STUDY REGISTRATION

Clinicaltrials.gov (reference number NCT05456217, date of registration 07 Nov 2022).

摘要

目的

描述肯尼亚重症监护病房（ICU）和高依赖病房（HDU）收治的危重症患者的临床、管理及预后特征。

设计

基于前瞻性登记的观察性研究。

地点

肯尼亚的3个HDU和8个ICU。

患者

2021年1月至2022年6月期间连续收治的成年患者。

干预措施

无。

测量指标及主要结果

使用通用数据模型将数据录入基于云的平台。研究终点包括病例组合变量、管理特征和以患者为中心的结局。单独报告2019冠状病毒病（COVID-19）患者。在3892/4546例非COVID-19患者中，2445例（62.8%）来自HDU，1447例（37.2%）来自ICU。患者的中位年龄为53岁（四分位间距[IQR]38 - 68），HDU患者年龄较大但病情较轻（HDU的急性生理与慢性健康状况评分系统II [APACHE II]为6[3 - 9]，而ICU为12[7 - 17]；p<0.001）。四分之一的患者为术后患者，其中604例（63.4%）接受急诊手术。再入院率为4.8%。高血压和糖尿病是常见的合并症，HIV/AIDS患病率为4.0%。HDU中3.4%的患者应用有创机械通气（IMV），而ICU中为47.6%（P<0.001），通气持续时间为7天（IQR 3 - 21）。肾脏替代治疗的使用情况相似（4.0%对4.7%；P<0.001）。血管活性药物使用较少，而一半的患者接受了抗生素治疗。平均住院时间为2天（IQR 1 - 5）。HDU的粗死亡率为6.5%，而ICU为30.5%（P<0.001）。在654例COVID-19入院患者中，大多数入住ICU（72.3%），死亡率为33.2%。