Uganda Cancer Institute, Kampala, Uganda.
Makerere University, Kampala, Uganda.
Sci Rep. 2024 Apr 30;14(1):9963. doi: 10.1038/s41598-024-59031-5.
Intensive care unit (ICU) mortality rates have decreased over time. However, in low-and lower-middle income countries (LMICs), there remains an excess ICU mortality with limited understanding of patient characteristics, treatments, and outcomes from small single centre studies. We aimed therefore, to describe the characteristics, therapies and outcomes of patients admitted to all intensive care units in Uganda. A nationwide prospective observational study including all patients admitted Uganda's ICUs with available daily charts was conducted from 8th January 2018 to 1st April 2018. Socio-demographics and clinical characteristics including worst vital signs in the first 24 h of admission were recorded with calculation of the National Early Warning Score (NEWS-2) and quick Sequential Organ Function Assessment (qSOFA) score. ICU interventions were recorded during the ICU stay and patients were followed up to 28 days in ICU. The primary outcome was 28 day ICU mortality. Three-hundred fifty-one patients were analysed with mean age 39 (24.1) years, 205 (58.4%) males with 197 (56%) surgical admissions. The commonest indication for ICU admission was postoperative care (42.9%), 214 (61%) had at least one comorbidity, with hypertension 104 (48.6%) most prevalent and 35 (10%) HIV positive. The 28 day ICU mortality was 90/351 (25.6%) with a median ICU stay of 3 (1-7) days. The highest probability of death occurred during the first 10 days with more non-survivors receiving mechanical ventilation (80% vs 34%; p < 0.001), sedation/paralysis (70% vs 50%; p < 0.001), inotropic/vasopressor support (56.7% vs 22.2%; p < 0.001) and renal replacement therapy (14.4% vs 4.2%; p < 0.001). Independent predictors of ICU mortality included mechanical ventilation (HR 3.34, 95% CI 1.48-7.52), sedation/paralysis (HR 2.68, 95% CI 1.39-5.16), inotropes/vasopressor (HR 3.17,95% CI 1.89-5.29) and an HIV positive status (HR 2.28, 95% CI 1.14-4.56). This study provides a comprehensive description of ICU patient characteristics, treatment patterns, and outcomes in Uganda. It not only adds to the global body of knowledge on ICU care in resource-limited settings but also serves as a foundation for future research and policy initiatives aimed at optimizing ICU care in Sub-Saharan Africa.
重症监护病房（ICU）的死亡率随着时间的推移而下降。然而，在低收入和中低收入国家（LMICs），由于对小的单一中心研究中患者特征、治疗和结局的了解有限，ICU 死亡率仍然过高。因此，我们旨在描述乌干达所有 ICU 中收治的患者的特征、治疗和结局。这是一项全国性前瞻性观察研究，纳入了 2018 年 1 月 8 日至 4 月 1 日期间乌干达所有 ICU 中可用每日图表的所有患者。记录了社会人口统计学和临床特征，包括入院后 24 小时内最严重的生命体征，并计算了国家早期预警评分（NEWS-2）和快速序贯器官功能评估（qSOFA）评分。记录了 ICU 期间的 ICU 干预措施，并对患者进行了 ICU 内 28 天的随访。主要结局为 28 天 ICU 死亡率。对 351 名患者进行了分析，平均年龄为 39（24.1）岁，205 名（58.4%）男性，197 名（56%）为外科手术入院。ICU 入院的最常见原因是术后护理（42.9%），214 名（61%）至少有一种合并症，其中高血压 104 名（48.6%）最为常见，HIV 阳性 35 名（10%）。28 天 ICU 死亡率为 90/351（25.6%），中位 ICU 入住时间为 3（1-7）天。最高的死亡概率发生在第 10 天之前，更多的非幸存者接受了机械通气（80%比 34%；p<0.001）、镇静/麻痹（70%比 50%；p<0.001）、正性肌力/血管加压药支持（56.7%比 22.2%；p<0.001）和肾脏替代治疗（14.4%比 4.2%；p<0.001）。ICU 死亡率的独立预测因素包括机械通气（HR 3.34，95%CI 1.48-7.52）、镇静/麻痹（HR 2.68，95%CI 1.39-5.16）、正性肌力/血管加压药（HR 3.17，95%CI 1.89-5.29）和 HIV 阳性状态（HR 2.28，95%CI 1.14-4.56）。本研究全面描述了乌干达 ICU 患者的特征、治疗模式和结局。它不仅增加了全球对资源有限环境中 ICU 护理的知识体系，而且为旨在优化撒哈拉以南非洲地区 ICU 护理的未来研究和政策举措奠定了基础。
