F Mbutiwi Ikwa Ndol1, M Dramaix-Wilmet2, P Meert3, F Lepira Bompeka4, N Nseka Mangani4, M Malengreau5, P Makaula6. 1. Faculté de médecine, université de Kikwit, BP 76, Kikwit, République démocratique du Congo; Département de médecine interne, cliniques universitaires de Kinshasa, université de Kinshasa, Kinshasa XI, République démocratique du Congo. Electronic address: fmbutiwi@yahoo.fr. 2. École de santé publique, université libre de Bruxelles (ULB), 1070 Bruxelles, Belgique. 3. Service des urgences, cliniques universitaires Saint-Luc, université catholique de Louvain, 1200 Bruxelles, Belgique. 4. Département de médecine interne, cliniques universitaires de Kinshasa, université de Kinshasa, Kinshasa XI, République démocratique du Congo. 5. Faculté de santé publique, université catholique de Louvain, 1200 Bruxelles, Belgique. 6. École de santé publique, université libre de Bruxelles (ULB), 1070 Bruxelles, Belgique; Service RHM, hôpitaux Iris-sud, 1040 Bruxelles, Belgique.
Abstract
BACKGROUND: The management of medical emergencies is poorly organized in the Democratic Republic of Congo. In addition, the mortality of patients attending the medical emergency unit of Kinshasa University Hospital is relatively high, with death of patients occurring rather early. To date, factors associated with this mortality have been poorly elucidated. This study aimed to identify predictive factors of all-cause mortality in patients admitted to the medical emergency unit of the Kinshasa University Hospital. METHODS: Analytical prospective study of all patients admitted from 15th January to 15th February 2011 in the emergency unit of the internal medicine department of Kinshasa University Hospital (427 patients). Among these patients, 13 were dead at arrival and were excluded from this study. The 414 patients included were followed until discharge from the hospital. Demographic, clinical, biological, diagnostic, therapeutical and evolutive data were collected. Four multivariate logistic regression models were used to identify risk factors associated with mortality. RESULTS: Patients' median age was 40 years (interquartile range, 28-58 years), 54.5% were male, and 15.9% had a life-threatening pathological condition on admission. The overall mortality was 12.3%. According to multivariate analyses, transfer from other health care structures (OR: 3.5; 95% CI: 1.7-7.1), Glasgow Coma Scale score less than 14 on admission (OR: 11.1; 95% CI: 4.7-26.3), high creatinine level (OR: 4.2; 95% CI: 1.8-9.7), presence of cardiovascular (OR: 2.9; 95% CI: 1.5-5.7), renal (OR: 7.4; 95% CI: 3.2-17.3), hematologic and/or respiratory (OR: 6.1; 95% CI: 1.7-21.4) diseases, presence of sepsis and/or meningitis and encephalitis (OR: 5.2; 95% CI: 1.6-17.0) were significantly associated with a high risk of death. However, the Glasgow Coma Scale score less than 14 on admission and renal disease were the only predictive factors of mortality remaining after including demographic, clinical, diagnostic and therapeutical variables in the logistic regression model. CONCLUSION: Our study showed that transfer from another health care structure, low Glasgow Coma Scale score on admission, high creatinine level, cardiovascular, renal, hematologic and/or respiratory diseases, sepsis and/or meningitis and encephalitis were associated with an increased risk of death in Kinshasa University Hospital patients admitted in the medical emergency unit.
BACKGROUND: The management of medical emergencies is poorly organized in the Democratic Republic of Congo. In addition, the mortality of patients attending the medical emergency unit of Kinshasa University Hospital is relatively high, with death of patients occurring rather early. To date, factors associated with this mortality have been poorly elucidated. This study aimed to identify predictive factors of all-cause mortality in patients admitted to the medical emergency unit of the Kinshasa University Hospital. METHODS: Analytical prospective study of all patients admitted from 15th January to 15th February 2011 in the emergency unit of the internal medicine department of Kinshasa University Hospital (427 patients). Among these patients, 13 were dead at arrival and were excluded from this study. The 414 patients included were followed until discharge from the hospital. Demographic, clinical, biological, diagnostic, therapeutical and evolutive data were collected. Four multivariate logistic regression models were used to identify risk factors associated with mortality. RESULTS:Patients' median age was 40 years (interquartile range, 28-58 years), 54.5% were male, and 15.9% had a life-threatening pathological condition on admission. The overall mortality was 12.3%. According to multivariate analyses, transfer from other health care structures (OR: 3.5; 95% CI: 1.7-7.1), Glasgow Coma Scale score less than 14 on admission (OR: 11.1; 95% CI: 4.7-26.3), high creatinine level (OR: 4.2; 95% CI: 1.8-9.7), presence of cardiovascular (OR: 2.9; 95% CI: 1.5-5.7), renal (OR: 7.4; 95% CI: 3.2-17.3), hematologic and/or respiratory (OR: 6.1; 95% CI: 1.7-21.4) diseases, presence of sepsis and/or meningitis and encephalitis (OR: 5.2; 95% CI: 1.6-17.0) were significantly associated with a high risk of death. However, the Glasgow Coma Scale score less than 14 on admission and renal disease were the only predictive factors of mortality remaining after including demographic, clinical, diagnostic and therapeutical variables in the logistic regression model. CONCLUSION: Our study showed that transfer from another health care structure, low Glasgow Coma Scale score on admission, high creatinine level, cardiovascular, renal, hematologic and/or respiratory diseases, sepsis and/or meningitis and encephalitis were associated with an increased risk of death in Kinshasa University Hospital patients admitted in the medical emergency unit.