Risk factors for mortality over 18 years in 317 ICUs in 9 Asian countries: The impact of healthcare-associated infections

Objective:To identify risk factors for mortality in intensive care units (ICUs) in Asia.Design:Prospective cohort study.Setting:The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vi...

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Published in:Infection control and hospital epidemiology Vol. 44; no. 8; pp. 1261 - 1266
Main Authors: Rosenthal, Victor Daniel, Jin, Zhilin, Rodrigues, Camilla, Myatra, Sheila Nainan, Divatia, Jigeeshu Vasishth, Biswas, Sanjay K., Shrivastava, Anjana Mahesh, Kharbanda, Mohit, Nag, Bikas, Mehta, Yatin, Sarma, Smita, Todi, Subhash Kumar, Bhattacharyya, Mahuya, Bhakta, Arpita, Gan, Chin Seng, Low, Michelle Siu Yee, Bt Madzlan Kushairi, Marissa, Chuah, Soo Lin, Wang, Qi Yuee, Chawla, Rajesh, Jain, Aakanksha Chawla, Kansal, Sudha, Bali, Roseleen Kaur, Arjun, Rajalakshmi, Davaadagva, Narangarav, Bat-Erdene, Batsuren, Begzjav, Tsolmon, Mohd Basri, Mat Nor, Tai, Chian-Wern, Lee, Pei-Chuen, Tang, Swee-Fong, Sandhu, Kavita, Badyal, Binesh, Arora, Ankush, Sengupta, Deep, Yin, Ruijie
Format: Journal Article
Language:English
Published: New York, USA Cambridge University Press 01.08.2023
Subjects:
Catheters
Disease control
Disease prevention
Health risks
Hospitalization
Hospitals
Medical instruments
Mortality
Mortality risk
Nosocomial infections
Oncology
Original Article
Patients
Pediatrics
Regression analysis
Risk factors
Variables
Ventilation
Ventilators
ISSN:0899-823X, 1559-6834, 1559-6834
Online Access:Get full text
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Summary:Objective:To identify risk factors for mortality in intensive care units (ICUs) in Asia.Design:Prospective cohort study.Setting:The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam.Participants:Patients aged >18 years admitted to ICUs.Results:In total, 157,667 patients were followed during 957,517 patient days, and 8,157 HAIs occurred. In multiple logistic regression, the following variables were associated with an increased mortality risk: central-line–associated bloodstream infection (CLABSI; aOR, 2.36; P < .0001), ventilator-associated event (VAE; aOR, 1.51; P < .0001), catheter-associated urinary tract infection (CAUTI; aOR, 1.04; P < .0001), and female sex (aOR, 1.06; P < .0001). Older age increased mortality risk by 1% per year (aOR, 1.01; P < .0001). Length of stay (LOS) increased mortality risk by 1% per bed day (aOR, 1.01; P < .0001). Central-line days increased mortality risk by 2% per central-line day (aOR, 1.02; P < .0001). Urinary catheter days increased mortality risk by 4% per urinary catheter day (aOR, 1.04; P < .0001). The highest mortality risks were associated with mechanical ventilation utilization ratio (aOR, 12.48; P < .0001), upper middle-income country (aOR, 1.09; P = .033), surgical hospitalization (aOR, 2.17; P < .0001), pediatric oncology ICU (aOR, 9.90; P < .0001), and adult oncology ICU (aOR, 4.52; P < .0001). Patients at university hospitals had the lowest mortality risk (aOR, 0.61; P < .0001).Conclusions:Some variables associated with an increased mortality risk are unlikely to change, such as age, sex, national economy, hospitalization type, and ICU type. Some other variables can be modified, such as LOS, central-line use, urinary catheter use, and mechanical ventilation as well as and acquisition of CLABSI, VAE, or CAUTI. To reduce mortality risk, we shall focus on strategies to reduce LOS; strategies to reduce central-line, urinary catheter, and mechanical ventilation use; and HAI prevention recommendations.
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ISSN:0899-823X
1559-6834
1559-6834
DOI:10.1017/ice.2022.245