Long-term Outcomes and Associated factors among Intensive Care Unit Survivors in a Low- income Country: A Multicenter Prospective Cohort study

Abstract

Background Post-ICU survivors face higher mortality and often require costly rehabilitation or palliative care, such as occupational therapy, physiotherapy and hospice yet there is a lack of data quantifying the demand for these services, particularly in developing countries like Uganda. Moreover, a critical knowledge gap persists regarding long-term outcomes and predictors among post-ICU survivors. Our study aimed to ascertain the 90-day mortality rate, evaluate functional status, and identify risk factors for mortality among patients discharged from three tertiary hospital ICUs in Uganda. Methods We conducted a multicenter prospective cohort study that tracked 121 adult patients discharged from three tertiary hospital intensive care units for three months. Data collection utilized open data kit (ODK) software. Follow-up involved telephone assessments by trained research assistants on days 30, 60, and 90 post-discharge, evaluating vital and physical functional status with the Karnofsky Performance status tool. The study's primary outcomes included mortality at 90 days post-ICU discharge and the physical functional status of ICU survivors. Cox regression analysis using Stata version 15 was used to determine the factors associated with 90-day mortality. Results A total of 18/121 died following discharge from the ICU giving a mortality rate of 14.9% (95% CI: 9.5%- 22.5%). Approximately 36.36% achieved a normal physical functional status. 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 High 90-day mortality is observed in post-ICU patients, particularly those with elevated intracranial pressure, acute kidney injury, and prior renal replacement therapy. The fact that nearly two-thirds of patients fail to attain a normal functional status after 90 days highlights the need for post-ICU rehabilitation services.