Analisis Hubungan Karakteristik Pasien Unit Perawatan Intensif dengan Mortalitas Pasien di Rumah Sakit Adam Malik Medan

Abstract

Introduction: The Intensive Care Unit (ICU) is a vital hospital unit that treats critically ill patients with physiological instability or organ failure. ICU mortality rates remain a concern, and this study aims to analyze the characteristics of ICU patients related to mortality at Adam Malik General Hospital in Medan. The general objective of this study is to determine the relationship between patient characteristics and UPI mortality, with specific objectives including analyzing the number of deceased patients, characteristics (gender, age, type of disease, type of bacteria, admission pathway, antibiotic use, tracheostomy time, and SOFA score) and their relationship with mortality, the relationship between the most common diseases and mortality, microorganism culture results with mortality, patient origin with mortality, type of antibiotics given with mortality, tracheostomy time with mortality, and SOFA score with mortality. Methods: This study employed a descriptive analytic cross-sectional design, conducted from February to April 2025 at Adam Malik General Hospital in Medan. Secondary data from medical records of UPI patients during the 2022-2024 period were used as samples, totaling 100 samples (considering a 10% dropout rate) selected by total sampling. Inclusion criteria included medical records of patients over 18 years old admitted to the UPI, while exclusion criteria were incomplete medical records and readmitted patients. Data were processed and statistically analyzed using SPSS software. Results: Patient characteristics showed that most patients were admitted to the UPI via referral from other hospitals (132 patients). Fluoroquinolone antibiotics were the most frequently used (118 patients, 10.83%). There were 100 cases (25.6%) of Multidrug Resistance Organisms (MDRO). 140 deceased patients had a SOFA score range of 10-11, with no significant difference (P 0.35). The highest mortality was observed in patients >65 years old (31.43%) and males (57.14%), often associated with respiratory diseases. Most deceased patients had a length of stay of 1-3 days (68.57%) and did not use ventilators (97.14%). Non-surgical patients had the highest mortality, with septic shock, acute myocardial infarct, and chronic heart failure as the primary diagnoses. An APACHE II score of 25-29 was found in 34.28% of deceased patients. Discussion: ICU mortality is multifactorial and serves as an indicator of service quality. The UPI mortality rate in Indonesia reaches 27.6%, predominantly caused by septic shock, chronic heart failure, and myocardial infarction. Male patients and those aged 51- 60 years exhibited higher mortality. Prolonged Mechanical Ventilation (PMV) correlated with high mortality due to the risk of nosocomial infections and higher APACHE scores. The absence of tracheostomy and delayed tracheostomy also increased mortality, while early tracheostomy improved survival. Lung diseases and Klebsiella pneumoniae infections were the leading causes of mortality. Patients referred from external hospitals had the highest mortality rates, possibly due to differences in the quality of care. Initial antibiotic use of levofloxacin showed the highest mortality, but cephalosporins also exhibited a high mortality ratio, indicating resistance. Higher SOFA scores were associated with increased mortality, reflecting more severe organ dysfunction. Keyword : ICU, Mortality, Characteristic