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

Rosenthal, Victor Daniel and Jin, Zhilin and Rodrigues, Camilla and Myatra, Sheila Nainan and Divatia, Jigeeshu Vasishth and Biswas, Sanjay K. and Shrivastava, Anjana Mahesh and Kharbanda, Mohit and Nag, Bikas and Mehta, Yatin and Sarma, Smita and Todi, Subhash Kumar and Bhattacharyya, Mahuya and Bhakta, Arpita and Gan, Chin Seng and Low, Michelle Siu Yee and Madzlan Kushairi, Marissa and Chuah, Soo Lin and Wang, Qi Yuee and Chawla, Rajesh and Chawla Jain, Aakanksha and Kansal, Sudha and Bali, Roseleen Kaur and Arjun, Rajalakshmi and Davaadagva, Narangarav and Bat-Erdene, Batsuren and Begzjav, Tsolmon and Mat Nor, Mohd Basri and Tai, Chian-Wern and Lee, Pei-Chuen and Tang, Swee-Fong and Sandhu, Kavita and Badyal, Binesh and Arora, Ankush and Sengupta, Deep and Yin, Ruijie (2023) Risk factors for mortality over 18 years in 317 ICUs in 9 Asian countries: the impact of healthcare-associated infections. Infection Control & Hospital Epidemiology, 44 (8). pp. 1261-1266. ISSN 0899-823X E-ISSN 1559-6834

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Abstract

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.

Item Type:	Article (Journal)
Uncontrolled Keywords:	Intensive care unit, International nosocomial infection control consortium, Limited resources countries, Low and middle income countries, Nosocomial pneumonia
Subjects:	R Medicine > RC Internal medicine > RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Anaesthesiology & Intensive Care Kulliyyah of Medicine
Depositing User:	Dr. Mohd Basri Mat Nor
Date Deposited:	30 Oct 2024 12:00
Last Modified:	30 Oct 2024 12:02
URI:	http://irep.iium.edu.my/id/eprint/115402

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