A multilevel analysis of mortality and determinants among patients with acute respiratory distress syndrome in Ethiopia

Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome with substantial morbidity and mortality globally. Body of evidence revealed that the epidemiologic estimates are currently disproportional due to differences in patient populations, risk factors, resources, and practice protocols around the world, and the rate of mortality and its predictors are uncertain in Ethiopia. A multi-centre retrospective cohort study was conducted in Ethiopia from January 2018 to June 2023. After receiving ethical clearance from the Institutional Review Board (IRB) of Dilla University College of Health Science and Medicine, 356 ARDS patients’ records were retrieved with a systematic random sampling technique. A multilevel multivariate analysis was used to control the effect of clustering. A P < 0.05 was taken as statistically significant. This study demonstrated that the cumulative mortality rate of patients with ARDS was 59% (95% CI: 53.5 to 63.9). The multilevel multivariable model analysis showed that GCS < 8 (AOR = 7.4; 95% CI: 2.79, 19.75), severe form of ARDS (AOR 4.7 95% CI 1.64, 13.36), invasive ventilation (AOR 3.2, 95% CI 1.56, 6.42), and respiratory comorbidity (AOR 4.9, 95% CI 1.71, 14.32) were independent predictors of in-hospital mortality among patients with ARDS. The study revealed that the in-hospital mortality rate was substantially higher than that of developed nations. This study identified that low Glasgow Coma Scale (GCS) scores, severity of ARDS, ventilation type, and comorbidity were independent predictors of mortality in patients with ARDS. The findings of this study call for mitigating strategies to improve ICU care for ARDS patients.