Patterns of admission and outcome of patients Admitted to the intensive care unit in jimma medical Center, Ethiopia

Abstract

Background: The intensive care unit (ICU) is a specialized environment designed for the care of critically ill patients, offering advanced medical and nursing support and improved monitoring capabilities during severe organ system failure. Despite its importance, global annual deaths from critical illness reach approximately 45 million, with ICU mortality rates in Africa ranging from 32.9% to 54%, and a national prevalence of 40% in Ethiopia. Given the uncertainty regarding ICU mortality and disease patterns in local settings, this study investigates the admission trends and clinical outcomes of adult patients admitted to the adult ICU at Jimma Medical Center. Object: The study aims to evaluate the admission patterns and outcomes of adult patients in the intensive care unit of Jimma Medical Center in Ethiopia over one year. Methods: This study is a retrospective cross-sectional analysis of 244 patients admitted to the adult intensive care unit at Jimma Medical Centre from January to December 2024. Participants were selected using systematic random sampling, and data were collected from patient charts and processed in SPSS version 27.0. Descriptive statistics were utilized, and multivariable binary logistic regression was conducted to identify independent factors associated with in-hospital death, with a significance threshold set at P < 0.05. Results: This study analyzes 244 ICU patients, revealing a slight male predominance (52%) with a mean age of 38.09 years. The most common admission sources were the emergency department and operating room, primarily for conditions like septic shock, delayed awakening, and severe malaria. Hypoxia was prevalent in 58.6% of cases, while 19.3% had a Glasgow Coma Scale (GCS) score below 8. Laboratory findings showed that 47.7% exhibited elevated white blood cell counts. Additionally, 63% had elevated blood urea nitrogen levels, and sodium abnormalities were common, with 29.5% having hyponatremia and 52.1% having hypernatremia. The ICU stay of patients involves various therapeutic interventions, with mechanical ventilation (49.4%) and gastrointestinal ulcer prophylaxis (79.4%) being the most common. Major complications include aspiration pneumonia, infection, and hypotension, contributing to an overall mortality rate of 36.9%. Risk factors strongly impacting outcomes include gender, septic shock, severe malaria, Glasgow Coma Scale (GCS) scores, and aspiration pneumonia, with female patients having i a 4.6-fold increased mortality risk. The case fatality rates are particularly high for septic shock (86.7%) and severe malaria (65.4%). Conclusion: This study examines 244 ICU patients, revealing the common admissions including septic shock, severe malaria, and delayed awakening. A significant number of patients had comorbidities, including diabetes and hypertension. The patients had significant levels of hypoxia, leukocytosis, and various electrolyte imbalances. Though interventions included mechanical ventilation, GI, and DVT prophylaxis, the overall mortality rate was high, with high case fatality rates linked to septic shock and severe malaria. Being female, level of GCS scores, and aspiration pneumonia were associated with increased mortality among ICU patients.