Diagnoses and critical care outcomes in a rural Tanzanian high dependency unit: A prospective cohort study

Abstract

Background Data on rural sub-Saharan African high-dependency units (HDU) are lacking. We describe patient’s characteristics, diagnoses, and outcomes of patients admitted to a Tanzanian HDU, and identified factors associated with in-hospital mortality. Methods This prospective single-center cohort study was conducted in the HDU of a Tanzanian rural referral hospital. All patients admitted to the HDU were eligible. Descriptive analyses, and univariate and multivariate modeling to identify predictors of in-hospital mortality were done. Kaplan-Meier survival curves were employed to estimate mortality rates over time. The area under the receiver operating characteristic curve was used to assess the predictive accuracy of early warning scores. Results From April 4th 2023 to March 29th 2024, 491 patients were included and followed-up until hospital discharge. Median age was 46 years (IQR 29−65); 259 (53%) were females. Most common diagnoses were sepsis (N = 96, 20%), arterial hypertension (N = 91, 19%), diabetes mellitus (N = 84, 17%), acute kidney injury (N = 66, 13%), decompensated heart failure (N = 64, 13%), aspiration pneumonia (N = 60, 12%), and stroke (N = 59, 12%). Mortality during HDU- and hospital stay was 30%(N = 146) and 37%(N = 182), respectively. 54% of patients with sepsis, 51% with stroke, 65% with aspiration pneumonia and 27% with heart failure died in the HDU. Predictors of in-hospital mortality were age ≥ 45 years versus 18−44 (adjusted Hazard Ratio (aHR) 1.56, 95% CI 1.07–2.28, p = 0.03), blood pressure <90mmHg (aHR 2.33, 95%CI 1.48–3.81, p < 0.001), Glasgow Coma Scale score ≤8 versus 14−15 (aHR 2.13, 95%CI 1.24–3.64, p = 0.02) and oxygen saturation at room air < 90% (aHR 1.62, 95%CI 1.04–2.51, p = 0.03). The area under the curve predicting in-hospital mortality was 0.69 (95%CI 0.65–0.73) for the NEWS- and UVA scores, 0.66 (95%CI 0.62–0.70) for the MEWS-, and 0.65 (95%CI 0.61–0.69) for the qSOFA score. Conclusion Sepsis and non-communicable diseases were the most common diagnoses. Scores predicted in-hospital mortality with a moderate accuracy.