Journal Article

Hospital burden of critical illness across global settings: a point prevalence and cohort study in Malawi, Sri Lanka and Sweden

Wellhagen, Andreas, Lipcsey, Miklós, Gerdin Wärnberg, Martin, Rajendra, Surenthirakumaran, Hintze, Christoffer, Bjurling-Sjöberg, Petronella, Mndolo, Kwazizira Samson, Wijesiriwardana, Wageesha, Kodippily, Chamira, Jegathesan, Nalayini, Mbingwani, Isaac, Beane, Abi, Kumwenda-Mwafulirwa, Wezzie, Baker, Tim, Banda, Grace, Castegren, Markus, Hvarfner, Anna, Dzinjalamala, Odala Kamandani, Kalibwe Mkandawire, Annie, Schell, Carl Otto, Sujeewa, Jayasingha Arachchilage, Sjöstedt, Hampus, Kurland, Lisa, Kayambankadzanja, Raphael Kazidule, Kachingwe, Mtisunge, Haniffa, Rashan, Lundborg, Cecilia Stalsby

2025

Overview

IntroductionThe burden of critical illness may have been underestimated. Previous analyses have used data from intensive care units (ICUs) only, and there is a lack of evidence about where in hospitals critically ill patients receive care. This study aims to determine the burden of critical illness among adult inpatients across hospitals in different global settings.MethodsWe performed a prospective, observational, hospital-based, point prevalence and cohort study in countries of different socioeconomic levels: Malawi, Sri Lanka and Sweden. On specific days, all adult in-patients in the eight study hospitals were examined by the study team for the presence of critical illness and followed up for hospital mortality. Patients with at least one severely deranged vital sign were classified as critically ill. The primary outcomes were the presence of critical illness and 30-day hospital mortality. In addition, we determined where the critically ill patients were being cared for and the association between critical illness and 30-day hospital mortality.ResultsAmong 3652 hospitalised patients, we found a point prevalence of critical illness of 12.0% (95% CI 11.0 to 13.1), with a hospital mortality of 18.7% (95% CI 15.3 to 22.6). The crude OR of death of critically ill patients compared with non-critically ill patients was 7.5 (95% CI 5.4 to 10.2). Of the critically ill patients, 96.1% (95% CI 93.9 to 97.6) were cared for in the general wards outside ICUs.ConclusionsThe study has revealed a substantial burden of critical illness in hospitals from different global settings. One in eight hospital in-patients was critically ill, 19% of the critically ill died in hospital, and 96% of the critically ill patients were cared for outside of ICUs. Implementing the most feasible and low-cost critical care in general wards throughout hospitals would impact a large number of high-risk patients and has the potential to improve outcomes across all acute care specialties.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adult / Adults / Aged / Clinical medicine / Cohort analysis / Cohort Studies / Cost of Illness / Critical care / Critical Illness - epidemiology / Critical Illness - mortality / diseases / disorders / Epidemiology / Expenditures / Female / Health policies and all other topics / Health services research / Hospital Mortality / Hospitalization - statistics & numerical data / Hospitals / Humans / Illnesses / Infections / Infections, diseases, disorders, injuries / injuries / Intensive care / Intensive Care Units - statistics & numerical data / Malawi - epidemiology / Male / Middle Aged / Mortality / Original Research / Patients / Prevalence / Prospective Studies / Research methodology / Sri Lanka - epidemiology / Sweden - epidemiology / Vital signs