坦桑尼亚农村高依赖病房的诊断与重症监护结果：一项前瞻性队列研究。
Diagnoses and critical care outcomes in a rural Tanzanian high dependency unit: A prospective cohort study.
作者信息
Katende Andrew, Rossier Julie, Mlula Chipegwa, Chitimbwa Christamonica, Mtula Martin E, Mafole Elibariki S, Wilson Lulu, Mutasingwa Samuel S, Mahundi Evance, Kipalaunga Mohamed K, Myovela Victor, Mbawala Caspar, Faustine Fanuel, Mbunda Geofrey, Gingo Winfrid, Kitila Faraja, Mwasongwe Ipyana, Bucher Claudia, Paris Daniel H, Zoller Thomas, Okuma James, Weisser Maja, Rohacek Martin
机构信息
Department of Interventions and Clinical trials, Ifakara Health Institute, Ifakara, United Republic of Tanzania.
Heart and Lung Clinic and High Dependency Unit, St. Francis Regional Referral Hospital, Ifakara, United Republic of Tanzania.
出版信息
PLoS One. 2025 Jun 18;20(6):e0324640. doi: 10.1371/journal.pone.0324640. eCollection 2025.
BACKGROUND
Data on rural sub-Saharan African high-dependency units (HDU) are lacking. We describe patient's characteristics, diagnoses, and outcomes of patients admitted to a Tanzanian HDU, and identified factors associated with in-hospital mortality.
METHODS
This prospective single-center cohort study was conducted in the HDU of a Tanzanian rural referral hospital. All patients admitted to the HDU were eligible. Descriptive analyses, and univariate and multivariate modeling to identify predictors of in-hospital mortality were done. Kaplan-Meier survival curves were employed to estimate mortality rates over time. The area under the receiver operating characteristic curve was used to assess the predictive accuracy of early warning scores.
RESULTS
From April 4th 2023 to March 29th 2024, 491 patients were included and followed-up until hospital discharge. Median age was 46 years (IQR 29-65); 259 (53%) were females. Most common diagnoses were sepsis (N = 96, 20%), arterial hypertension (N = 91, 19%), diabetes mellitus (N = 84, 17%), acute kidney injury (N = 66, 13%), decompensated heart failure (N = 64, 13%), aspiration pneumonia (N = 60, 12%), and stroke (N = 59, 12%). Mortality during HDU- and hospital stay was 30%(N = 146) and 37%(N = 182), respectively. 54% of patients with sepsis, 51% with stroke, 65% with aspiration pneumonia and 27% with heart failure died in the HDU. Predictors of in-hospital mortality were age ≥ 45 years versus 18-44 (adjusted Hazard Ratio (aHR) 1.56, 95% CI 1.07-2.28, p = 0.03), blood pressure <90mmHg (aHR 2.33, 95%CI 1.48-3.81, p < 0.001), Glasgow Coma Scale score ≤8 versus 14-15 (aHR 2.13, 95%CI 1.24-3.64, p = 0.02) and oxygen saturation at room air < 90% (aHR 1.62, 95%CI 1.04-2.51, p = 0.03). The area under the curve predicting in-hospital mortality was 0.69 (95%CI 0.65-0.73) for the NEWS- and UVA scores, 0.66 (95%CI 0.62-0.70) for the MEWS-, and 0.65 (95%CI 0.61-0.69) for the qSOFA score.
CONCLUSION
Sepsis and non-communicable diseases were the most common diagnoses. Scores predicted in-hospital mortality with a moderate accuracy.
背景
撒哈拉以南非洲农村地区高依赖单元（HDU）的数据匮乏。我们描述了坦桑尼亚一个HDU收治患者的特征、诊断情况及转归，并确定了与院内死亡相关的因素。
方法
这项前瞻性单中心队列研究在坦桑尼亚一家农村转诊医院的HDU进行。所有入住该HDU的患者均符合条件。进行了描述性分析以及单变量和多变量建模以确定院内死亡的预测因素。采用Kaplan-Meier生存曲线来估计随时间推移的死亡率。使用受试者工作特征曲线下面积来评估早期预警评分的预测准确性。
结果
2023年4月4日至2024年3月29日，纳入491例患者并随访至出院。中位年龄为46岁（四分位间距29 - 65岁）；259例（53%）为女性。最常见的诊断为脓毒症（N = 96，20%）、动脉高血压（N = 91，19%）、糖尿病（N = 84，17%）、急性肾损伤（N = 66，13%）、失代偿性心力衰竭（N = 64，13%）、吸入性肺炎（N = 60，12%）和卒中（N = 59，12%）。HDU住院期间和住院期间的死亡率分别为30%（N = 146）和37%（N = 182）。脓毒症患者中有54%、卒中患者中有51%、吸入性肺炎患者中有65%以及心力衰竭患者中有27%在HDU死亡。院内死亡的预测因素为年龄≥45岁对比18 - 44岁（调整后风险比（aHR）1.56，95%置信区间1.07 - 2.28，p = 0.03）、血压<90mmHg（aHR 2.33，95%置信区间1.48 - 3.81，p < 0.001）、格拉斯哥昏迷量表评分≤8对比14 - 15（aHR 2.13，95%置信区间1.24 - 3.64，p = 0.02）以及室内空气下氧饱和度<90%（aHR 1.62，95%置信区间1.04 - 2.51，p = 0.03）。用于预测院内死亡的曲线下面积，NEWS和UVA评分为0.69（95%置信区间0.65 - 0.73），MEWS评分为0.66（95%置信区间0.62 - 0.70），qSOFA评分为0.65（95%置信区间0.61 - 0.69）。
结论
脓毒症和非传染性疾病是最常见的诊断。评分对院内死亡的预测准确性中等。
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