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

Rosenthal VD 1 , Jin Z 1 , Rodrigues C 2 , Myatra SN 3 , Divatia JV 3 , Biswas SK 3 Show all authors , Shrivastava AM 3 , Kharbanda M 4 , Nag B 4 , Mehta Y 5 , Sarma S 5 , Todi SK 6 , Bhattacharyya M 6 , Bhakta A 6 , Gan CS 7 , Low MSY 7 , Bt Madzlan Kushairi M 7 , Chuah SL 7 , Wang QY 7 , Chawla R 8 , Jain AC 8 , Kansal S 8 , Bali RK 8 , Arjun R 9 , Davaadagva N 9 , Bat-Erdene B 9 , Begzjav T 9 , Mohd Basri MN 10 , Tai CW 11 , Lee PC 11 , Tang SF 11 , Sandhu K 12 , Badyal B 12 , Arora A 12 , Sengupta D 12 , Yin R 1

Affiliations 

  • 1 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, United States
  • 2 Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
  • 3 Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India
  • 4 Desun Hospital, Kolkata, India
  • 5 Medanta the Medicity, Haryana, India
  • 6 Advanced Medicare Research Institute (AMRI) Hospitals, Kolkata, India
  • 7 University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 8 Indraprastha Apollo Hospitals, New Delhi, India
  • 9 Kerala Institute of Medical Sciences, Trivandrum, India
  • 10 International Islamic University Malaysia, Kuantan Pahang, Malaysia
  • 11 Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
  • 12 Max Super Speciality Hospital, Saket, Delhi, New Delhi, India
Infect Control Hosp Epidemiol, 2023 Aug;44(8):1261-1266.
PMID: 36278508 DOI: 10.1017/ice.2022.245

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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