Survival status and predictors of mortality among mechanically ventilated COVID-19 patients in Addis Ababa COVID-19 Care Centers, Ethiopia: A survival analysis

Abstract

Background: The COVID-19 pandemic has caused stress on the health care system of many countries worldwide. To accommodate the growing number of critically ill patients requiring mechanical ventilation, hospitals expanded and tried to meet overwhelming demands. Despite this, outcomes of patients after mechanical ventilation were devastating, with high mortality rates. Therefore, this study investigated the survival status and predictors of mortality among mechanically ventilated COVID-19 patients. Methods: A retrospective cohort study was applied on the patient charts of 496 critically ill and mechanically ventilated COVID-19 patients at intensive care units of Addis Ababa COVID-19 Care Centers from September 2020 to October 2021. Data were collected using a data extraction checklist and entered into Epi data manager. Then, data were transferred to STATA V-14 for cleaning and analysis. The cox-proportional hazard regression model was used for analysis. Covariates with p-value ≤0.20 in the bivariate analysis were fitted to multivariate analysis after the model fitness test. Finally, statistical significance was decided at p-value <0.05, and hazard ratios were used to determine the strength of associations. Results: Of the 496 patients, 63.3% had died. The incidence rate of mortality was 56.7 (95% CI: 50.80, 63.37) per 1,000 person-days of observation, with 5534 person-day observations recorded. Advanced age (>60 years old) (adjusted hazard ratio (AHR)=1.86; 95% CI: 1.09, 3.15) and being invasively ventilated (AHR=2.02; 95% CI: 1.25, 3.26) were associated with increased risk of mortality. Furthermore, presence of diabetes (AHR=1.50; 95% CI: 1.09, 2.08), shock (AHR=1.99; 95% CI: 1.12, 3.52), and delirium (AHR=1.60; 95% CI: 1.05, 2.44) were significantly associated with increased mortality. Conclusions: Clear directions are needed in the recommendation of non-invasive versus invasive ventilation, especially among elderly patients. The controversy of when to intubate (early versus late) needs to be clarified as well. Early detection and prompt management of shock is paramount.