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Ayenew T, Gedfew M, Fetene MG, Workneh BS, Telayneh AT, Edmealem A, Tiruneh BG, Yinges GT, Getie A, Meselu MA. Prevalence of mortality among mechanically ventilated patients in the intensive care units of Ethiopian hospitals and the associated factors: A systematic review and meta-analysis. PLoS One 2024; 19:e0306277. [PMID: 39042621 PMCID: PMC11265714 DOI: 10.1371/journal.pone.0306277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/13/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND In the intensive care unit (ICU), mechanical ventilation (MV) is a typical way of respiratory support. The severity of the illness raises the likelihood of death in patients who require MV. Several studies have been done in Ethiopia; however, the mortality rate differs among them. The objective of this systematic review and meta-analysis is to provide a pooled prevalence of mortality and associated factors among ICU-admitted patients receiving MV in Ethiopian hospitals. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria to conduct a comprehensive systematic review and meta-analysis in this study. We searched PubMed/Medline, SCOPUS, Embase, Hinari, and Web of Science and found 22 articles that met our inclusion criteria. We used a random-effects model. To identify heterogeneity within the included studies, meta-regression and subgroup analysis were used. We employed Egger's regression test and funnel plots for assessing publication bias. STATA version 17.0 software was used for all statistical analyses. RESULTS In this systematic review and meta-analysis, the pooled prevalence of mortality among 7507 ICU-admitted patients from 22 articles, who received MV was estimated to be 54.74% [95% CI = 47.93, 61.55]. In the subgroup analysis by region, the Southern Nations, Nationalities, and Peoples (SNNP) subgroup (64.28%, 95% CI = 51.19, 77.37) had the highest prevalence. Patients with COVID-19 have the highest mortality rate (75.80%, 95% CI = 51.10, 100.00). Sepsis (OR = 6.85, 95%CI = 3.24, 14.46), Glasgow Coma Scale (GCS) score<8 (OR = 6.58, 95%CI = 1.96, 22.11), admission with medical cases (OR = 4.12, 95%CI = 2.00, 8.48), Multi Organ Dysfunction Syndrome (MODS) (OR = 2.70, 95%CI = 4.11, 12.62), and vasopressor treatment (OR = 19.06, 95%CI = 9.34, 38.88) were all statistically associated with mortality. CONCLUSION Our review found that the pooled prevalence of mortality among mechanically ventilated ICU-admitted patients in Ethiopia was considerably high compared to similar studies in the United States (US), China, and other countries. Sepsis, GCS<8, medical cases, MODS, and use of vasopressors were statistically associated with mortality. Clinicians should exercise caution while mechanically ventilating ICU-admitted patients with these factors. However, it should be noted that the exact cause and effect relationship could not be established with this meta-analysis, as the available evidence is not sufficient. Thus, more studies using prospective methods will be required.
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Affiliation(s)
- Temesgen Ayenew
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mihretie Gedfew
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mamaru Getie Fetene
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency Medicine and Critical Care Nursing, University of Gondar, Gondar, Ethiopia
| | - Animut Takele Telayneh
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Afework Edmealem
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bekele Getenet Tiruneh
- Department of Internal Medicine, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | | | - Addisu Getie
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mengistu Abebe Meselu
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Sannathimmappa MB, Marimuthu Y, Al Subhi SMMS, Al Bathari FAMB, Al Balushi MIA, Al Ghammari SIR, Al-Risi ES, Al-Maqbali S, Nambiar V, Al-Shafaee M. Incidence of secondary bacterial infections and risk factors for in-hospital mortality among coronavirus disease 2019 subjects admitted to secondary care hospital: A single-center cross-sectional retrospective study. Int J Crit Illn Inj Sci 2024; 14:94-100. [PMID: 39005973 PMCID: PMC11245142 DOI: 10.4103/ijciis.ijciis_71_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/01/2024] [Accepted: 01/16/2024] [Indexed: 07/16/2024] Open
Abstract
Background This study aims to determine the prevalence of secondary bacterial infections (SBIs) in hospitalized coronavirus disease 2019 (COVID-19) subjects and evaluate their antibiotic susceptibility. The study also sought to identify risk factors for the outcome of SBIs in COVID-19 subjects. Methods This single-center cross-sectional retrospective study was carried out at Sohar Hospital in Oman. The study examined hospitalized COVID-19 subjects diagnosed with SBIs during March 2020-December 2022. The relevant subjects' data were extracted from hospital electronic health records and analyzed using STATA version 14. The Chi-square test or Fisher's exact test was employed for analyzing categorical variables, and P < 0.05 was deemed statistically significant. Results The research encompassed a total of 817 bacteria recovered from various clinical samples of 421 subjects. The older individuals (39.4%) and men (65.6%) experienced bacterial infections more frequently, with bloodstream and respiratory infections being the most common. Gram-negative bacilli (GNB) were responsible for a higher proportion (85.6%) of infections, with Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae being the most common pathogens. Subjects who underwent mechanical ventilation, received corticosteroid therapy, and who had underlying comorbidities, such as diabetes and chronic renal disease, were found to have higher mortality rates. Neutrophilia, elevated C-reactive protein, lymphocytopenia, decreased serum albumin level, sepsis, and pneumonia were found to be independent contributors to mortality. Conclusions SBI is common among COVID-19-hospitalized subjects. GNB were primarily linked to SBI. The severity and the likelihood of SBI increased in subjects undergoing medical interventions and immunosuppressive therapy.
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Affiliation(s)
- Mohan Bilikallahalli Sannathimmappa
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Oman
| | - Yamini Marimuthu
- Department of Community Medicine, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | | | | | - Mariya Ibrahim Ahmed Al Balushi
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Oman
| | - Sara Ibrahim Rashid Al Ghammari
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Oman
| | | | | | - Vinod Nambiar
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Oman
| | - Mohammad Al-Shafaee
- Dean, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Oman
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Venkatram S, Dileep A, Fortuzi K, Allena N, Diaz-Fuentes G. Comparison of patients admitted to an inner-city intensive care unit across 3 COVID-19 waves. Medicine (Baltimore) 2023; 102:e33069. [PMID: 36827070 PMCID: PMC9949371 DOI: 10.1097/md.0000000000033069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
To expand our limited knowledge of COVID-19-related outcomes in patients admitted to inner-city intensive care unit (ICU across multiple infection waves. This retrospective study compared patients admitted to the ICU in Bronx, NY, during 3 COVID-19 waves (March 2020 to February 2022). Outcomes included in hospital mortality, length of stay (LOS), use of mechanical ventilation, and discharge disposition. The study included 716 patients (343, 276, and 97 in the first, second, and third COVID-19 waves, respectively). The number of days on mechanical ventilation and LOS were lower in the first wave. Of the 345 discharged patients, 37% went home directly, whereas 11% were discharged to a skill nursing facility. More patients went home during the second and third waves. Mortality decreased from the first to the third waves (57%-37%; P < .001). Predictors of mortality included age, male gender, COPD, shock, acute kidney injury (AKI), dialysis requirement, and mechanical ventilation. The decreased mortality and better discharge disposition of these inner-city patients during the second and third waves is encouraging, as this population historically had a high COVID-19-related mortality risk.
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Affiliation(s)
- Sindhaghatta Venkatram
- Associate Professor of Clinical Medicine, Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA
- * Correspondence: Sindhaghatta Venkatram, Associate Professor of Clinical Medicine, Division of Pulmonary and Critical Care Medicine, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, USA (e-mail: )
| | - Arundhati Dileep
- Pulmonary Fellow, Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA
| | - Ked Fortuzi
- Pulmonary Fellow, Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, NY, USA
| | - Nishant Allena
- Resident Department of Medicine, BronxCare Health System, Bronx, NY, USA
| | - Gilda Diaz-Fuentes
- Associate Professor, Clinical Medicine, Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA
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Do Mechanically Ventilated COVID-19 Patients Present a Higher Case-Fatality Rate Compared With Other Infectious Respiratory Pandemics? A Systematic Review and Meta-Analysis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2022. [DOI: 10.1097/ipc.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Assal HH, Abdel-hamid HM, Magdy S, Salah M, Ali A, Elkaffas RH, Sabry IM. Predictors of severity and mortality in COVID-19 patients. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [PMCID: PMC8959282 DOI: 10.1186/s43168-022-00122-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Due to limited capacity, health care systems worldwide have been put in challenging situations since the emergence of COVID-19. To prioritize patients who need hospital admission, a better understanding of the clinical predictors of disease severity is required. In the current study, we investigated the predictors of mortality and severity of illness in COVID-19 from a single center in Cairo, Egypt. Methods This retrospective cohort study included 175 patients hospitalized with COVID-19 pneumonia and had positive real-time polymerase chain reaction (RT-PCR) results for SARS-CoV-2 from 1 May 2020 to 1 December 2020. Severe COVID-19 was defined as requiring high-flow oxygen (flow rate of more than 8 L/min or use of high flow oxygen cannula), noninvasive ventilation, or invasive mechanical ventilation at any time point during the hospitalization. We used univariate and multivariate regression analyses to examine the differences in patient demographics and clinical and laboratory data collected during the first 24 h of hospitalization related to severe disease or death in all 175 patients. Results Sixty-seven (38.3%) of the study subjects had a severe or critical disease. Elevated d-dimer, leukocytosis, and elevated CRP were found to be independent predictors of severe disease. In-hospital mortality occurred in 34 (19.4%) of the cases. Elevated TLC, urea, the use of invasive mechanical ventilation, and the presence of respiratory bacterial co-infection were found to be independently associated with mortality. Conclusion Clinical and laboratory data of COVID-19 patients at their hospital admission may aid clinicians in the early identification and triage of high-risk patients.
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Zochios V, Lau G, Conway H, Yusuff HO. Protecting the Injured Right Ventricle in COVID-19 Acute Respiratory Distress Syndrome: Can Clinicians Personalize Interventions and Reduce Mortality? J Cardiothorac Vasc Anesth 2021; 35:3325-3330. [PMID: 34247924 PMCID: PMC8178062 DOI: 10.1053/j.jvca.2021.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/30/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Vasileios Zochios
- Department of Critical Care Medicine, University Hospitals Birmingham National Health Service Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Birmingham Acute Care Research, Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - Gary Lau
- Department of Cardiac Anesthesia and Intensive Care, University Hospitals Leicester National Health Service Trust, Glenfield Hospital, Leicester, UK
| | - Hannah Conway
- Department of Cardiac Anesthesia and Intensive Care, University Hospitals Leicester National Health Service Trust, Glenfield Hospital, Leicester, UK
| | - Hakeem O Yusuff
- Department of Cardiac Anesthesia and Intensive Care, University Hospitals Leicester National Health Service Trust, Glenfield Hospital, Leicester, UK; University of Leicester, Leicester, UK
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