Acute severe asthma and its predictors of mortality in rural Southwestern Nigeria: a-five year retrospective observational study

Mortality and associated factors among people living with HIV admitted at a tertiary-care hospital in Uganda: a cross-sectional study

BACKGROUND

Hospital admission outcomes for people living with HIV (PLHIV) in resource-limited settings are understudied. We describe in-hospital mortality and associated clinical-demographic factors among PLHIV admitted at a tertiary-level public hospital in Uganda.

METHODS

We performed a cross-sectional analysis of routinely collected data for PLHIV admitted at Kiruddu National Referral Hospital between March 2020 and March 2023. We estimated the proportion of PLHIV who had died during hospitalization and performed logistic regression modelling to identify predictors of mortality.

RESULTS

Of the 5,827 hospitalized PLHIV, the median age was 39 years (interquartile range [IQR] 31-49) and 3,293 (56.51%) were female. The median CD4 + cell count was 109 cells/µL (IQR 25-343). At admission, 3,710 (63.67%) were active on antiretroviral therapy (ART); 1,144 (19.63%) had interrupted ART > 3 months and 973 (16.70%) were ART naïve. In-hospital mortality was 26% (1,524) with a median time-to-death of 3 days (IQR 1-7). Factors associated with mortality (with adjusted odds ratios) included ART interruption, 1.33, 95% confidence intervals (CI) 1.13-1.57, p 0.001; CD4 + counts ≤ 200 cells/µL 1.59, 95%CI 1.33-1.91, p < 0.001; undocumented CD4 + cell count status 2.08, 95%CI 1.73-2.50, p < 0.001; impaired function status 7.35, 95%CI 6.42-8.41, p < 0.001; COVID-19 1.70, 95%CI 1.22-2.37, p 0.002; liver disease 1.77, 95%CI 1.36-2.30, p < 0.001; co-infections 1.53, 95%CI 1.32-1.78, p < 0.001; home address > 20 km from hospital 1.23, 95%CI 1.04-1.46, p 0.014; hospital readmission 0.7, 95%CI 0.56-0.88, p 0.002; chronic lung disease 0.62, 95%CI 0.41-0.92, p 0.019; and neurologic disease 0.46, 95%CI 0.32-0.68, p < 0.001.

CONCLUSION

One in four admitted PLHIV die during hospitalization. Identification of risk factors (such as ART interruption, function impairment, low/undocumented CD4 + cell count), early diagnosis and treatment of co-infections and liver disease could improve outcomes.

A Meta-Analysis on Predictors of Mortality Among Patients Hospitalized for Acute Exacerbation of Asthma

The aim of this meta-analysis is to systematically review published studies and identify clinically important factors predicting mortality among patients hospitalized for acute exacerbation of asthma. This study was a meta-analysis conducted in accordance with the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. A systematic search was carried out on online databases such as PubMed and EMBASE to identify articles on predictors of mortality among patients hospitalized for acute exacerbation of asthma. The search used keywords such as "asthma," "exacerbation," "mortality," and "factors." A total of six articles met the inclusion criteria and were included in the present meta-analysis. The incidence of short-term mortality among patients hospitalized for acute exacerbation of asthma was 6% (95% CI= 3-9%, I-square=99%) with a range of 0.79% to 18% across the studies. The factors significantly associated with short-term mortality in patients hospitalized for acute exacerbation of asthma including diabetes mellitus (RR=2.02, 95% CI: 1.63-2.52, p-value=0.001), pneumonia (RR=3.71, 95% CI: 3.02-4.56, p-value=0.001), and mechanical ventilation (RR: 29.98, 95% CI: 15.46-58.15, p-value=0.001). The present study found that diabetes mellitus, pneumonia, and the use of mechanical ventilation are independently associated with mortality among patients hospitalized for acute exacerbation of asthma. Healthcare professionals need to understand the comorbidities and risk factors associated with mortality in patients hospitalized for acute exacerbation of asthma in order to identify patients who are at increased risk and provide prompt treatment.