• Victor Daniel Rosenthal, Zhilin Jin, Ziad A Memish, Mohammad Abdellatif Daboor, Majeda Afeef Al-Ruzzieh, Najah Hasan Hussien, Ertugrul Guclu, Esra Olmez-Gazioglu, Aziz Ogutlu, Hala Mounir Agha, Amal El-Sisi, Amr Ahmed Fathalla, Dincer Yildizdas, Hacer Yapicioglu Yildizdas, Ferda Ozlu, Ozden Ozgur Horoz, Abeer Aly Omar, Souad Belkebir, Alaa Kanaa, Rawan Jeetawi, Amani Ali El-Kholy, Victor Bayani, Wafaa Alwakil, Safaa Abdulaziz-Alkhawaja, Saleh Fakhr Swar, Tahera Anwar Magray, Ameena Ahmed Alsayegh, and Ruijie Yin.
• Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; International Nosocomial Infection Control Consortium, Miami, FL, USA. Electronic address: victor_rosenthal@inicc.org.
• J Crit Care. 2022 Dec 1; 72: 154149154149.

PurposeThe International Nosocomial Infection Control Consortium (INICC) found a high mortality rate in ICUs of the Middle East (ME). Our goal was to identify mortality risk factor (RF) in ICUs of the ME.MaterialsFrom 08/01/2003 to 02/12/2022, we conducted a prospective cohort study in 236 ICUs of 77 hospitals in 44 cities in 10 countries of ME. We analyzed 16 independent variables using multiple logistic regression.Results66,440 patients, hospitalized during 652,167 patient-days, and 13,974 died. We identified following mortality RF: Age (adjusted odds ratio (aOR):1.02;p < 0.0001) rising risk 2% yearly; length of stay (LOS) (aOR:1.02;p < 0.0001) rising the risk 2% per day; central line (CL)-days (aOR:1.01;p < 0.0001) rising risk 1% per day; mechanicalventilator (MV) utilization-ratio (aOR:14.51;p < 0.0001); CL-associated bloodstream infection (CLABSI) acquisition (aOR):1.49;p < 0.0001); ventilator-associated pneumonia (VAP) acquisition (aOR:1.50;p < 0.0001); female gender (OR:1.14;p < 0.0001); hospitalization at a public-hospital (OR:1.31;p < 0.0001); and medical-hospitalization (aOR:1.64;p < 0.0001). High-income countries showed lowest risk (aOR:0.59;p < 0.0001).ConclusionSome identified RF are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; LOS, CL-use, MV-use, CLABSI, VAP. So, to lower the mortality risk in ICUs, we recommend focusing on strategies to shorten the LOS, reduce CL and MV-utilization, and use evidence-based recommendations to prevent CLABSI and VAP.Copyright © 2022 Elsevier Inc. All rights reserved.

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