Assessment of long-term outcomes among ICU survivors from Uganda's Intensive Care Units: A prospective cohort study

Abstract

Background: Post-Intensive Care Unit (ICU) survivors still experience higher mortality than the general population and often require long-term costly specialised rehabilitation or palliative care, such as occupational therapy, physiotherapy and hospice. Additionally, there is a paucity of data quantifying the demand for post-ICU rehabilitative services in terms of occurrence of survival outcomes in developing countries like Uganda. A knowledge gap exists regarding long-term outcomes and predictors among post-ICU survivors after hospital discharge Therefore we sought to determine the 90-day mortality rate, functional status and risk factors for mortality among patients discharged from three tertiary hospital Intensive Care Units in Uganda. Methods: We conducted a multicenter prospective cohort study that followed up 121 adult patients discharged from three tertiary hospital intensive care units for three months. Data was collected electronically using open data kit (ODK) software and then exported to Stata version 15 for analysis. Participants were followed up via telephone call by research assistants on days 30,60 and 90 post discharge to assess vital status and physical functional status. The primary outcomes were mortality at 90 days post ICU discharge and the physical functional status of ICU survivors. Results: A total of 18/121 patients (6 from Mulago hospital [public] and 12 from Nsambya [PNFP] hospital) died following discharge from the ICU, resulting in a mortality rate of 14.9% (95% CI: 9.5%- 22.5%). Approximately 36.36% of the study participants achieved a normal physical functional status. Cox regression analysis showed that factors associated with 90-day mortality included raised intracranial pressure (HR 1.92, 95% CI 1.763-2.787, p=0.04), acute kidney injury (HR 4.13, 95% CI 2.163-7.890, p<0.001) and renal replacement therapy (HR 3.34, 95% CI 2.210-5.060, p<0.001) Conclusion: There is high mortality at 14.9% of patients discharged from the ICU at 90-days. Approximately 1 in 3 (36.36%) of patients achieved a normal functional status post 90-days of ICU discharge. Patients who had raised intracranial pressure, acute kidney injury and received renal replacement therapy during their ICU stay had a higher likelihood of mortality at 90 days post ICU discharge. The findings underscore the need for a larger prospective cohort to ascertain long term sequelae and their determinants among ICU survivors in Uganda.