A Study to Determine the Aetiologies, Clinical Features and Short Term Outcome of Patients Treated in Medicine ICU

INTRODUCTION: Intensive care unit is a specialized area dedicated for management of critically ill patients. The outcome of a patient treated in an ICU depends on several factors including the underlying aetiology, severity at presentation, other co-morbidities as well as the facilities available in the ICU. Therefore, knowledge of various etiologies, leading to ICU admission of a patient plays an important role in predicting the patient outcome in the ICU. AIM OF THE STUDY: The main aim of our study is to determine the aetiologies, clinical features and short term outcome of patients treated in Medicine Intensive Care Unit. It is a prospective; hospital based observational and analytical study which was done on 500 patients admitted in the Medicine ICU of NEIGRIHMS for a period of 1 year i.e. 1st October 2022 to 30th September 2023. RESULTS: A male predominance was observed in our study with a Male to Female ratio of 1.5:1. The age of the patients ranged from 18 to 89 years with a mean age of 49.64 + 17.25 years. The overall mortality, in our study was found to be 41.2%. Mortality rates were seen to be higher among males (51.48%) and to those who belonged to the age group of >60 years (53.97%). Majority of the patients in our study were admitted in the ICU for less than 7 days and the mortality among them was found to be 48.24%. The most common etiology with which patients were admitted to ICU were found to be Renal diseases (20.54%), followed by respiratory diseases 18.97%, liver diseases 15.18% and neurological diseases 13.84%. The association between different system involvement and the outcome was found to be statistically significant. The patients with sepsis and/or septic shock were observed to have significantly high mortality rates of 90.54% and 59.3% respectively. The various co-morbidities found in our patients included Hypertension (most common), diabetes mellitus, heart disease, chronic kidney and liver disease. Upon the analysis of the association of mortality with median of various clinical and biochemical parameters along with mortality predictors, it was found that blood pressure (SBP, DBP and MAP), pulse rate and GCS of the patient at the time of presentation were significantly associated with the outcome of the patient. A univariate analysis of the same revealed higher odds of mortality among patients with hypotension, respiratory failure, coma, thrombocytopenia, anemia, low serum bicarbonate and high serum lactate. However, a multivariate analysis revealed presence of low serum bicarbonate, requirement of ventilatory support and a SOFA score >5 as independent predictors of mortality. CONCLUSION: Our study showed the main mortality predictors for the critically ill patients admitted with medical diseases to the intensive care unit were a SOFA score > 5 (p < 0.001), presence of hypotension (p 0.012), coma (p < 0.001), low bicarbonate levels (p 0.02) and requiring ventilator support (p < 0.001). High lactate levels, requirement of renal replacement therapy and an APACHE II score >20 had no significant association to the overall patient mortality. Thus, SOFA score hypotension, coma, low bicarbonate levels, and requiring ventilator support can be considered as independent predictors of mortality among the critically ill patients.