Determinants of in-Hospital Mortality in a Gastroenterology Unit in Côte d’Ivoire (West Africa): An Advocacy for a Social Security Policy

Abstract

Background: The in-hospital mortality is a major concern in Africa. The study is aimed at providing the determinants of in-hospital mortality of patients admitted in the gastroenterology and medicine unit (GMU) of the teaching hospital of Yopougon (Abidjan, Ivory Coast). Patients and Methods: A retrospective cohort of 341 patients (males: 53%, mean age: 43 years) admitted in the GMU during 2009 were studied. Socio-demographic, clinical, biological characteristics of patients were retrieved. Survival probability and determinants of in-hospital mortality were respectively determined by the Kaplan Meier curve and Cox model. Results: Among the 341 patients admitted, 79 (23.2%) died in the GMU. The in-hospital mortality rate was 4.3 (95%IC: 3.3-5.2) death per 100 patients-day. The main diagnoses were HIV/AIDS (15%), cirrhosis (14.4%), hepatocellular carcinoma (13.5%), tuberculosis (12.6%) and gastroenteritis (7.9%). Survival probabilities were higher in patients with Financial support (FS) to face medical fees (log rank test = 10.7, P=.001), with no comorbidities (log rank test= 4.5, P=.03) compared to those without, and when diagnoses were established than unknown (log rank test=11. 5, P=.001). In multivariate analysis, prothrombin time <65% (aHR=2.6, P=.02), creatinine level (aHR: 1.02, P=.02), HIV/AIDS or tuberculosis (aHR=0.44, P=.01), non malignant digestive diseases (aHR=0.34, P=.01) and FS (aHR=0.45, P<.02) were significantly associated with mortality in GMU. Conclusion: This study demonstrated that patients with HIV/AIDS or tuberculosis, non malignant digestive diseases or FS had a better outcome. However those with impairment of renal and liver functions had a high risk of death in the GMU.