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. 2023 Aug;44(8):1261-1266.
doi: 10.1017/ice.2022.245. Epub 2022 Oct 24.

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

Victor Daniel Rosenthal  1   2 , Zhilin Jin  1 , Camilla Rodrigues  3 , Sheila Nainan Myatra  4 , Jigeeshu Vasishth Divatia  4 , Sanjay K Biswas  4 , Anjana Mahesh Shrivastava  4 , Mohit Kharbanda  5 , Bikas Nag  5 , Yatin Mehta  6 , Smita Sarma  6 , Subhash Kumar Todi  7 , Mahuya Bhattacharyya  7 , Arpita Bhakta  7 , Chin Seng Gan  8 , Michelle Siu Yee Low  8 , Marissa Bt Madzlan Kushairi  8 , Soo Lin Chuah  8 , Qi Yuee Wang  8 , Rajesh Chawla  9 , Aakanksha Chawla Jain  9 , Sudha Kansal  9 , Roseleen Kaur Bali  9 , Rajalakshmi Arjun  10 , Narangarav Davaadagva  10 , Batsuren Bat-Erdene  10 , Tsolmon Begzjav  10 , Mat Nor Mohd Basri  11 , Chian-Wern Tai  12 , Pei-Chuen Lee  12 , Swee-Fong Tang  12 , Kavita Sandhu  13 , Binesh Badyal  13 , Ankush Arora  13 , Deep Sengupta  13 , Ruijie Yin  1
Affiliations

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

Victor Daniel Rosenthal et al. Infect Control Hosp Epidemiol. 2023 Aug.

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.

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