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Rosenthal VD, Yin R, Valderrama-Beltran SL, Gualtero SM, Linares CY, Aguirre-Avalos G, Mijangos-Méndez JC, Ibarra-Estrada MÁ, Jimenez-Alvarez LF, Reyes LP, Alvarez-Moreno CA, Zuniga-Chavarria MA, Quesada-Mora AM, Gomez K, Alarcon J, Oñate JM, Aguilar-De-Moros D, Castaño-Guerra E, Córdoba J, Sassoe-Gonzalez A, Millán-Castillo CM, Xotlanihua LL, Aguilar-Moreno LA, Ojeda JSB, Tobar IFG, Aleman-Bocanegra MC, Echazarreta-Martínez CV, Flores-Sánchez BM, Cano-Medina YA, Chapeta-Parada EG, Gonzalez-Niño RA, Villegas-Mota MI, Montoya-Malváez M, Cortés-Vázquez MÁ, Medeiros EA, Fram D, Vieira-Escudero D, Jin Z. Multinational Prospective Cohort Study of Mortality Risk Factors in 198 ICUs of 12 Latin American Countries over 24 Years: The Effects of Healthcare-Associated Infections. J Epidemiol Glob Health 2022; 12:504-515. [PMID: 36197596 DOI: 10.1007/s44197-022-00069-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/23/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America. METHODS A prospective cohort study in 198 ICUs of 96 hospitals in 46 cities in 12 Latin American countries to identify mortality risk factors (RF), and data were analyzed using multiple logistic regression. RESULTS Between 07/01/1998 and 02/12/2022, 71,685 patients, followed during 652,167 patient-days, acquired 4700 HAIs, and 10,890 died. We prospectively collected data of 16 variables. Following 11 independent mortality RFs were identified in multiple logistic regression: ventilator-associated pneumonia (VAP) acquisition (adjusted odds ratio [aOR] = 1.17; 95% CI: 1.06-1.30; p < 0.0001); catheter-associated urinary tract infection (CAUTI) acquisition (aOR = 1.34; 95% CI: 1.15-1.56; p < 0.0001); older age, rising risk 2% yearly (aOR = 1.02; 95% CI: 1.01-1.02; p < 0.0001); longer indwelling central line(CL)-days, rising risk 3% daily (aOR = 1.03; 95% CI: 1.02-1.03; p < 0.0001); longer indwelling urinary catheter(UC)-days, rising risk 1% daily (aOR = 1.01; 95% CI: 1.01-1.26; p < 0.0001); higher mechanical ventilation (MV) (aOR = 6.47; 95% CI: 5.96-7.03; p < 0.0001) and urinary catheter-utilization ratio (aOR = 1.19; 95% CI: 1.11-1.27; p < 0.0001); lower-middle level income country (aOR = 2.94; 95% CI: 2.10-4.12; p < 0.0001); private (aOR = 1.50; 95% CI: 1.27-1.77; p < 0.0001) or public hospital (aOR = 1.47; 95% CI: 1.24-1.74; p < 0.0001) compared with university hospitals; medical hospitalization instead of surgical (aOR = 1.67; 95% CI: 1.59-1.75; p < 0.0001); neurologic ICU (aOR = 4.48; 95% CI: 2.68-7.50; p < 0.0001); adult oncology ICU (aOR = 3.48; 95% CI: 2.14-5.65; p < 0.0001); and others. CONCLUSION Some of the identified mortality RFs are unlikely to change, such as the income level of the country, facility ownership, hospitalization type, ICU type, and age. But some of the mortality RFs we found can be changed, and efforts should be made to reduce CL-days, UC-days, MV-utilization ratio, UC-utilization ratio, and lower VAPs and CAUTI rates.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA. .,INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Julio Cesar Mijangos-Méndez
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Miguel Ángel Ibarra-Estrada
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | | | | | - Judith Córdoba
- Hospital del Nino Dr Jose Renan Esquivel, Panama, Panama
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dayana Fram
- Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Lentsck MH, de Oliveira RR, Corona LP, Mathias TADF. Risk factors for death of trauma patients admitted to an Intensive Care Unit. Rev Lat Am Enfermagem 2020; 28:e3236. [PMID: 32074207 PMCID: PMC7021481 DOI: 10.1590/1518-8345.3482.3236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/23/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the risk factors for death of trauma patients admitted to the intensive care unit (ICU). METHOD Retrospective cohort study with data from medical records of adults hospitalized for trauma in a general intensive care unit. We included patients 18 years of age and older and admitted for injuries. The variables were grouped into levels in a hierarchical manner. The distal level included sociodemographic variables, hospitalization, cause of trauma and comorbidities; the intermediate, the characteristics of trauma and prehospital care; the proximal, the variables of prognostic indices, intensive admission, procedures and complications. Multiple logistic regression analysis was performed. RESULTS The risk factors associated with death at the distal level were age 60 years or older and comorbidities; at intermediate level, severity of trauma and proximal level, severe circulatory complications, vasoactive drug use, mechanical ventilation, renal dysfunction, failure to perform blood culture on admission and Acute Physiology and Chronic Health Evaluation II. CONCLUSION The identified factors are useful to compose a clinical profile and to plan intensive care to avoid complications and deaths of traumatized patients.
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Affiliation(s)
- Maicon Henrique Lentsck
- Universidade Estadual de Maringá, Departamento de Enfermagem,
Maringá, PR, Brazil
- Universidade Estadual do Centro-Oeste, Departamento de Enfermagem,
Guarapuava, PR, Brazil
| | - Rosana Rosseto de Oliveira
- Universidade Estadual de Maringá, Departamento de Enfermagem,
Maringá, PR, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal
de Nível Superior (CAPES), Brazil
| | - Ligiana Pires Corona
- Universidade Estadual de Campinas, Faculdade de Ciências Aplicadas,
Campinas, SP, Brazil
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