Abstract
Background: Intensive Care Units (ICUs) are critical for managing severe illnesses and contributes a lot in the field of patients’ care. Yet limited data exists on patient demographics and outcomes in tertiary ICU facilities in Bangladesh. Recent years have shown us the importance of ICUs in managing health emergencies.
Objective: This study aims to analyze the demographic profiles, co-morbidities, complications, and outcomes of COVID-19 patients admitted to a tertiary-level ICU in Bangladesh.
Methodology: A retrospective analysis was conducted on 285 patients admitted to the COVID-19 ICU of Bangladesh Specialized Hospital in Dhaka. Data on demographics, co-morbidities, complications, diagnoses, and outcomes were collected and analyzed. Special attention was given to the outcome analysis and relation between co-morbidities and complications.
Results: The study analyzed patient demographics, co-morbidities, and outcomes, revealing that 57.5% were male and 55.1% elderly. Hypertension (67.4%) and diabetes mellitus (DM, 53.7%) and Ischemic Heart Disease 25.6%(73), were the most prevalent co-morbidities, followed by Chronic Kidney Disease 35.1%(100) and Carcinoma 20.4%(58). With pneumonia 47%(134), Shock 43.5%(67), Acute Myocardial Infarction(AMI) 16.5%(47) dyselectrolytemia (17.5%), UTI(Urinary tract infection) 11.2%(32) and Sepsis 7.7%(22) are the most frequent complications. Patient outcomes showed 58.2% improvement, while 20% succumbed to their conditions. A significant association between Diabetes Mellitus and mortality (P < 0.05) was found.
Conclusions: The study highlights the high prevalence of non-communicable diseases and their impact on ICU outcomes. These findings underscore the need for improved management strategies for co-morbid conditions in critical care settings. Diabetes Mellitus, Hypertension and Ischemic Heart Disease likely to contribute more in increasing mortality in ICU settings.
Keywords
ICU, Bangladesh, demographics, outcomes, co-morbidities, critical care, pneumonia, diabetes mellitus
Introduction
Intensive Care Units (ICUs) play a pivotal role in the management of critically ill patients, offering advanced monitoring and therapeutic interventions. Bangladesh has a population of about 152.25 million, making it one of the most populous countries in the world . Intensive care is an emerging but less emphasized concept in Bangladesh. There are about one hundred hospitals with ICU facilities in Bangladesh and 80% of them are located in Dhaka 1. Bangladesh provides mixed services in 68% of its ICUs, managing medical, surgical, gynecological & obstetrics patients 1. Despite their importance, there is limited data on ICU patients’ demographics, co-morbidities, complications, and outcomes in tertiary-level ICU facilities in Bangladesh during COVID-19 pandemic. Infection prevention and control is very crucial for ICU and High Dependency Unit (HDU) functions in health care 2. The recent global health emergencies have further underscored the crucial role of ICUs in saving lives and managing complex medical conditions. This study was conducted to fill the gap by analyzing the patient profiles and outcomes from the COVID-19 ICU of Bangladesh Specialized Hospital in Dhaka.
The primary objective of this study was to analyze the demographic profiles, co-morbidities, complications, and outcomes of patients admitted to a tertiary-level ICU in Bangladesh. Additionally, the study aimed to explore the associations between co-morbidities, complications, and patient outcomes to identify key areas for improving critical care management.
Materials and methods:
A cross-sectional study was conducted between November 2021 and May 2022 at the COVID-19 ICU of Bangladesh Specialized Hospital, located in Shyamoli, Dhaka, aiming to investigate the relationship between demographic characteristics, co-morbidities, complications, and outcomes of critically ill patients. The study utilized secondary data, which was collected from the hospital’s medical records of patients admitted to the ICU during the study period. The inclusion criteria consisted of adult patients aged 18 years and older who were admitted to the ICU for medical emergencies infected with COVID-19 requiring intensive monitoring and treatment. Patients who survived for more than 24 hours after admission were included, ensuring that the data captured patients who could potentially undergo significant changes in their clinical status during the ICU stay. Additionally, patients had to provide consent to participate in the study, either directly or through a legal surrogate, where necessary. Inclusion also required complete demographic, clinical, and laboratory data being available in the hospital’s records. Furthermore, only patients with documented co-morbidities were considered, as these may significantly affect their clinical outcomes. Follow-up data was essential for the study, ensuring that information on patient outcomes—such as ICU/hospital mortality, length of ICU stay, complications, and discharge status—was available for analysis. The exclusion criteria were designed to eliminate patients who would not contribute relevant data or could complicate the interpretation of outcomes. Pediatric patients (<18 years) were excluded, as the study focused on adult ICU populations. Also excluded were patients admitted to step-down or high-dependency units, as these units do not typically provide the same level of intensive care as the ICU. Incomplete or missing clinical records and outcome data led to exclusion to ensure data reliability, as did patients who did not provide consent or whose surrogates declined participation. Additionally, patients who had ICU stays of fewer than 24 hours, unless they expired during that period, were excluded, as their short ICU stay would likely not provide sufficient data to analyze their outcomes accurately. Patients who were admitted primarily for post-surgical monitoring without complications, or those who were terminal and admitted solely for palliative care, were excluded as they did not meet the criteria for intensive care aimed at improving clinical outcomes. Similarly, patients with advanced malignancy, where ICU admission was for comfort care rather than active treatment, were excluded. Finally, patients transferred out of the ICU to another hospital, resulting in lost follow-up data, were also excluded. Data collected from eligible patients were analyzed to examine the demographic profile, the association between co-morbidities (such as hypertension, diabetes, and chronic kidney disease), and complications (like ventilator-associated pneumonia, sepsis, and multi-organ failure) with clinical outcomes. The study aimed to identify potential patterns and risk factors associated with poor outcomes, thus contributing valuable insights into improving patient care and management in the ICU setting.
Statistical Analysis: Data was analyzed using Statistical Package for Social Science (SPSS. Version 27).
Results:
Table: 02- Gender of the Study population.
| Gender | Frequency | Percent |
| Female | 121 | 42.5 |
| Male | 164 | 57.5 |
| Total | 285 | 100.0 |
Table 01 shows that, most of the patients were male 57.5%(164) and females were 42.5%(121).
Table: 02- Age group of the Study population.
| Age group | Frequency | Percent |
| Young | 13 | 4.6 |
| Young adult | 19 | 6.7 |
| Middle-age | 96 | 33.7 |
| Old | 157 | 55.1 |
| Total | 285 | 100.0 |
Table 02 shows that, 55.1%(157) were of old age, 33.7%(96) were middle aged, 6.7%(19) were young aged and only 4.6%(13) were young.
Figure: 01- Age group of the Study population.
Figure 01 shows the percentage of different age groups of the admitted patients.
Table: 03- Co-Morbidity status of Study population.
| Condition | Count | Percentage |
| Diabetes Mellitus | 153 | 53.7 |
| Hypertension | 192 | 67.4 |
| Ischemic Heart Disease | 73 | 25.6 |
| End-Stage Renal Disease | 37 | 13 |
| Chronic Kidney Disease | 100 | 35.1 |
| Chronic Liver Disease | 19 | 6.7 |
| Hypothyroidism | 19 | 6.7 |
| Osteoarthritis | 4 | 1.4 |
| Carcinoma | 58 | 20.4 |
| Bronchial Asthma | 39 | 13.7 |
| Tuberculosis | 5 | 1.8 |
| Dementia | 8 | 2.8 |
Table 03 shows that among 285 patients majority had Hypertension 67.4%(192). And other co-morbidities includes Diabetes mellitus 53.7%(153), Ischemic Heart Disease 25.6%(73), Chronic Kidney Disease 35.1%(100), Carcinoma 20.4%(58), Bronchial Asthma 13.7%(39), End-Stage Renal Disease 13%(37), Chronic Liver Disease 6.7%(19), Hypothyroidism 6.7%(19), Dementia 2.8%(8), Tuberculosis 1.8%(5) and Osteoarthritis 1.4%(4).
Table: 04- Complications of the Study population.
| Diagnosis | Count | Percentage |
| Pneumonia | 134 | 47 |
| Shock Septic shock-16.1%(46) Cardiogenic-4.2%(12) | 67 | 43.5 |
| Aspiration Pneumonia | 7 | 2.5 |
| Urinary tract infection | 32 | 11.2 |
| Sepsis | 22 | 7.7 |
| Acute respiratory distress syndrome | 7 | 2.5 |
| Acute Kidney Injury | 21 | 7.4 |
| Acute kidney injury on chronic kidney disease | 33 | 11.6 |
| Dyselectrolytemia Hyponatremia-6%(17) | 50 | 17.5 |
| Pancreatitis | 3 | 1.1 |
| Stroke Acute Intracerebral Hemorrhage -4.9%(14) | 28 | 9.8 |
| Encephalopathy Metabolic-8.8%(25) | 34 | 11.9 |
| Gastrointestinal Bleeding | 25 | 8.8 |
| Heart Failure | 1 | 0.4 |
| Acute Myocardial Infection | 47 | 16.5 |
Table 04 shows that, The complications of the patients admitted were Pneumonia 47%(134), Different kinds of Shock 43.5%(67). Among them majority was Septic shock 16.1%(46). Acute Myocardial Infarction(AMI) 16.5%(47), Dyselectrolytemia 17.5%(50), Urinary tract infection 11.2%(32), Hyponatremia 6%(17), Sepsis 7.7%(22) and Aspiration Pneumonia 2.5%(7), Encephalopathy 11.9%(34)-where most were Metabolic Encephalopathy 8.8%(25), Acute kidney injury on chronic kidney disease 11.6%(33), Only Acute kidney injury 7.4%(21), Stroke 9.8%(28)-where most were Acute Intracerebral Hemorrhage 4.9%(14), Gastrointestinal bleeding 8.8%(25), ARDS 2.5%(7), Pancreatitis 1.1%(3) and Heart Failure(HF) 0.4%(1).
N.B. There were four patients who suffered Cardiac arrest and survived.
Table: 05- Therapeutic outcome of the study population.
| Outcome | Frequency | Percent |
| Discharge Against Medical Advice | 45 | 15.8 |
| Died | 57 | 20.0 |
| Improved and shifted to Inpatient Department | 166 | 58.2 |
| Transferred to Covid-19 ward | 17 | 6.0 |
| Total | 285 | 100.0 |
Table 05 shows that, Among total 285 patients 58.2%(166) patients were improved after getting treatment and transferred to IPD, 15.8%(45) were Discharge Against Medical Advice, 6%(17) patients were transferred to Covid-19 hospitals and 20%(57) patients died.
Figure:02- Therapeutic outcome of the study population.
Figure 02 shows the therapeutic outcome of the study populations.
Table:06- Association between DM and Death of patients.
| Diabetes Mellitus | Died | Lived | Total | |
| NO | Count | 34 | 98 | 132 |
| % of Total | 11.9% | 34.4% | 46.3% | |
| YES | Count | 23 | 130 | 153 |
| % of Total | 8.1% | 45.6% | 53.7% | |
| TOTAL | Count | 57 | 228 | 285 |
| % of Total | 20.0% | 80.0% | 100.0% | |
| Pearson Chi-Square value | 5.094 | df=1 | P-value | 0.024* |
*Significant at 95% confidence interval.
Table 06 shows that, Among total 285 patients, 53.7%(153) had Diabetes mellitus. Among them 8.1%(23) died where 45.6%(130) lived. Which was statistically significant at 95% confidence interval (P-value <0.05). And 46.3%(132) patients didn’t had Diabetes mellitus where 11.9%(34) died.
Figure:03- Association between Diabetes Mellitus and Death of patients.
Figure 03 shows the association between Diabetes mellitus patients and the rate of Death among them.
Discussion
COVID-19 had affected majority of the world’s population in various ways. A statistical evaluation in essential for the critical patients admitted in ICU during that period. The study showed that a significant majority of ICU admissions were male (57.5%) and elderly (55.1%), highlighting a potential gender disparity and a growing burden of critical illness among the aging population infected with COVID-19. This finding corresponds to 3 and 4 in 2018 and 2015 respectively. These results are in line with findings from other regions, where aging populations are more likely to require ICU care due to the increased prevalence of chronic conditions. The elderly are more susceptible to severe health complications, and as life expectancy continues to rise in Bangladesh.
Hypertension (67.4%) and diabetes mellitus (53.7%) were the most prevalent co-morbidities in this study. In march 2021 it was slightly less, hypertension 43.6% in Bangladeshi 5. In case of diabetes it matches the findings 48.5% in Egypt 6 as there is no relavent study in Bangladesh. These findings are consistent with trends observed in other countries with a high burden of non-communicable diseases (NCDs) 7. The high prevalence of these conditions suggests that Bangladesh’s ICU patients are increasingly affected by chronic health problems, which could exacerbate the severity of acute illnesses. Ischemic heart disease (IHD), chronic kidney disease (CKD), and carcinoma also featured prominently in the demographic profile, further underscoring the critical need for specialized management strategies in ICUs to handle patients with complex multi-morbidities.
The relationship between co-morbidities and ICU outcomes is crucial. Patients with multiple co-morbidities tend to experience more severe complications and require longer ICU stays. This study found that the presence of diabetes mellitus was significantly associated with higher mortality (P < 0.05), a finding that aligns with existing literature on the increased mortality risk associated with diabetes in critical care settings. Diabetes can compromise immune function, exacerbate sepsis, and impair wound healing, making diabetic patients more vulnerable to infections and complications in ICU environments.
Pneumonia (43.5%), urinary tract infections (UTI, 11.2%), and sepsis (7.7%) were the most common complications observed. Supported by Morbidity and Mortality Weekly Report in 2016 in United States 8 The high incidence of pneumonia is concerning, as ventilator-associated pneumonia is a common complication in ICUs, particularly among patients who require mechanical ventilation. The study’s findings also reflect the global concern about sepsis, which remains a leading cause of mortality in ICU settings. Given that sepsis is often linked to underlying conditions such as diabetes, hypertension, and IHD, its high prevalence in this cohort suggests that these conditions exacerbate the risk of septic episodes. In terms of outcomes, 58.2% of patients showed improvement, while 20% succumbed to their conditions during their ICU stay. These findings align with those of similar studies in tertiary-care ICUs across the globe, where the mortality rate tends to be higher among patients with multiple co-morbidities, advanced age, or severe complications like sepsis and multi-organ failure. The mortality rate of 20% is significant and suggests that more aggressive management strategies, particularly for patients with diabetes, hypertension, and IHD, may be needed to improve patient survival rates.
Implications for ICU Care in Bangladesh
This study emphasizes the increasing burden of non-communicable diseases in Bangladesh and the direct impact of these conditions on ICU outcomes. With diabetes and hypertension being common among critically ill patients, it is crucial to implement comprehensive management protocols that address both acute and chronic aspects of patient care. This includes optimizing the management of blood glucose levels, blood pressure, and heart function in critically ill patients to improve overall outcomes. Furthermore, the prevalence of infection-related complications like pneumonia and sepsis highlights the need for stringent infection control protocols and the early use of broad-spectrum antibiotics in patients at high risk. There is also a need for specialized training in critical care, particularly for managing patients with multiple co-morbidities and those at higher risk of developing complications. Lastly, given the relatively high proportion of elderly patients in the ICU, there should be a concerted effort to tailor ICU care for geriatric patients, addressing their unique needs, such as frailty, polypharmacy, and cognitive decline, which can complicate their recovery in the intensive care setting.
Limitations and Future Directions
While this study offers valuable insights, it is limited by its retrospective design and the single-center nature of the research. The findings may not be fully generalizable to other hospitals in Bangladesh, especially those outside Dhaka. Future studies could consider multicenter analyses to provide a broader picture of ICU outcomes across different regions of the country. Additionally, prospective studies examining the effects of specific interventions (e.g., tighter glucose control, early sepsis management) on patient outcomes would provide stronger evidence for improving ICU care strategies.
Conclusion
The demographic and clinical characteristics of ICU patients in Bangladesh emphasize the increasing burden of non-communicable diseases and the associated challenges in managing critically ill patients during COVID-19 pandemic. The high prevalence of co-morbidities such as diabetes, hypertension, and IHD, combined with complications like pneumonia and sepsis, underscores the need for tailored care strategies in ICUs.
Author of this article
Dr. Niamul Kabir Khan Siddique( Asif), MBBS, FCPS(Medicine), BCS (Health), Assistant Professor, Dept. of Medicine, Anwer Khan Modern Medical College Hospital.
Reference
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