Underlying diseases and in-hospital mortality of acute respiratory failure patients: Indonesian prospective cohort study

Background: Epidemiologic data of acute respiratory failure (ARF) are limited. This study aims to investigate the underlying diseases and in-hospital mortality of patients with ARF in Indonesia. Materials and Methods: An observational prospective cohort study involving patients with ARF in six hospitals was conducted. Data were collected between January and December 2017. Data on the type of ARF, quick sepsis-related organ failure assessment (qSOFA) score, underlying diseases, and in-hospital mortality were documented. Proportions were compared using Chi-square or Fisher exact tests. Multivariable regression models with variable selection based on a stepwise backward elimination were run to analyze the risk factors for in-hospital mortality. Results: A total of 412 patients (median age: 56-years-old) were included. Most of the subjects were male (66.9%), hypoxemic (55.3%), and acute onset (86.4%). The most commonly encountered underlying diseases were pneumonia (58.7%), chronic obstructive pulmonary disease (25.5%), lung tuberculosis (25.2%), lung cancer (16.5%), noncystic fibrosis bronchiectasis (11.9%), congestive heart failure (10.2%), and chronic kidney disease (CKD) (3.2%). There were 65% of patients received only oxygen therapy, invasive mechanical ventilation was utilized for 30.8% of patients, and 4.1% of patients underwent noninvasive mechanical ventilation. There were 201 (48.79%) in-hospital mortality cases. The risk factors of in-hospital mortality were qSOFA ≥2 (odds ratio [OR]: 2.420, 95% confidence interval [CI] 1.599-3.662; P = 0.000) and CKD (OR: 3.871, 95% CI 1.024-14.631; P = 0.046). Conclusions: Most of the underlying diseases of ARF in Indonesia are communicable diseases. Patients with qSOFA ≥2 and CKD have a higher risk of death during hospitality.