Epidemiology and Outcomes of Critical Illness and Novel Predictors of Mortality in an Ethiopian Medical Intensive Care Unit

Low- and middle-income countries (LMICs) bear most of the global burden of critical illness. Managing this burden requires improved understanding of epidemiology and outcomes in LMIC intensive care units (ICUs), including LMIC-specific mortality prediction scores. This study was a retrospective observational study at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, examining all consecutive medical ICU admissions from June 2014 to April 2015. The primary outcome was ICU mortality; secondary outcomes were prolonged ICU stay and prolonged mechanical ventilation. ICU mortality prediction models were created using multivariable logistic regression and compared with the Mortality Probability Model-II (MPM-II). Associations with secondary outcomes were examined with multivariable logistic regression. There were 198 admissions during the study period; mortality was 35%. Age, shock on admission, mechanical ventilation, human immunodeficiency virus, and Glasgow Coma Scale ≤8 were associated with ICU mortality. The receiver operating characteristic curve for this 5-factor model had an AUC of 0.8205 versus 0.7468 for MPM-II, favoring the simplified new model. Mechanical ventilation and lack of shock were associated with prolonged ICU stays. Mortality in an LMIC medical ICU was high. This study examines an LMIC medical ICU population, showing a simplified prediction model may predict mortality as well as complex models.

Retrospective evaluation of fluid overload and relationship to outcome in critically ill dogs

OBJECTIVE

To determine if critically ill dogs have an increased risk of fluid overload (FO) during hospitalization compared to less ill dogs, and to determine if FO is associated with increased mortality during hospitalization.

DESIGN

Observational, case-control study.

SETTING

University teaching hospital.

ANIMALS

Thirty-four critically ill dogs and 15 comparatively healthy stable postoperative dogs with neuro-orthopedic disease.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Data recorded included underlying disease, body weight, and APPLEfast score at admission, single-day and composite APPLEfull scores during hospitalization, total fluid volume administered (L), total fluid volume output (L), and outcome. Percent FO (%FO) was calculated using the equation 100 × ([fluid volume administered - fluid volume lost]/1000 mL/L) - (% dehydration at admission), with fluid volume expressed as mL/kg of baseline body weight. Critically ill dogs developed greater %FO during hospitalization compared to stable postoperative dogs (12.1 ± 11.7% vs 0.5 ± 5.2%, P = 0.001), and half (8 out of 16) of the dogs with %FO ≥ 12% died. Composite APPLEfull scores were weakly positively correlated with %FO, whereas APPLEfast and single-day APPLEfull scores recorded at admission were not. The odds ratio for death was 1.08 for every percent increase in FO during hospitalization (95% confidence limits 1.012-1.59, P = 0.02).

CONCLUSIONS

Critically ill dogs are at increased risk for FO during hospitalization, and a weak but significant association exists between %FO, illness severity, and mortality. Prospective studies are warranted to confirm the findings of this retrospective study.