Incidence of In-Hospital Mortality and Its Determinants among Intensive Care Unit Patients with Acute Respiratory Distress Syndrome in Ethiopia: A multilevel analysis

Background Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome with substantial morbidity and mortality globally. Body of evidence revealed that the epidemiologic estimates are currently disproportional due to differences in patient populations, risk factors, resources, and practice protocols around the world, and the rate of mortality and its predictors are uncertain in Ethiopia. Method A multi-centre longitudinal study was conducted in Ethiopia from January 2018 to June 2023. After receiving ethical clearance from the Institutional Review Board (IRB) of Dilla University College of Health Science and Medicine, 356 ARDS patients’ records were retrieved with a systematic random sampling technique. A multilevel multivariate analysis was used to control the effect of clustering. A P < 0.05 was taken as statistically significant. Results This study demonstrated that the cumulative mortality rate of patients with ARDS was 59% (95% CI: 53.5 to 63.9). The multilevel multivariable model analysis showed that GCS < 8 (AOR = 7.4; 95% CI: 2.79, 19.75), severe form of ARDS (AOR 4.7 95% CI 1.64, 13.36), invasive ventilation (AOR 3.2, 95% CI 1.56, 6.42), and respiratory comorbidity (AOR 4.9, 95% CI 1.71, 14.32) were independent predictors of in-hospital mortality among patients with ARDS. Conclusion The study revealed that the hospital mortality rate was substantially higher than that of developed nations. The study also highlighted various risk factors that independently predicted in-hospital mortality.The findings of this study call for mitigating strategies to improve ICU care for ARDS patients.