IN-HOSPITAL OUTCOMES AND PREDICTORS OF OUTCOMES AMONG PATIENTS WITH HYPERTENSIVE CRISIS TREATED AT PUBLIC HOSPITALS IN HARARI REGIONAL STATE, EASTERN ETHIOPIA

Abstract

Background: Hypertensive crisis is defined as a severe raise in blood pressure with systolic blood pressure (SBP) > 180 mmHg and/or diastolic blood pressure (DBP) > 120 mmHg. Since it poses substantial cardiovascular morbidity and mortality, identifying predictors of in-hospital outcomes is crucial for effective management. However, there is a dearth of information regarding in-hospital outcomes, in terms of mortality and length of hospital stay, and predictors of outcomes of patients with hypertensive crisis in Harari Regional State, Eastern Ethiopia. Objective: To determine in-hospital outcomes and predictors of outcomes among patients with hypertensive crisis treated at public hospitals in Harari Regional State, Eastern Ethiopia from October 1 to 31, 2022. Methods: An institutional-based retrospective cohort study was conducted from October 1 to 31, 2022. The medical records of 328 patients with hypertensive crisis treated at two public hospitals between September 1, 2017 and August 31, 2022 were reviewed. Cox proportional hazards regression was modeled to determine predictors of mortality in hypertensive crisis. Negative binomial regression was used to identify predictors of length of hospital stay. The significance of the association was declared using a 95% confidence level and a p-value < 0.05. Results: The in-hospital mortality rate among hypertensive crisis patients was 18.94 (95% confidence interval (CI): 12.08–29.70) per 1000 person-day observation. The median (IQR) length of hospital stay of these patients was 10 (4–120) hours. Age ≥ 65 years (adjusted hazard ratio (AHR): 3.30; 95% CI: 1.17– 9.33); increment in initial SBP (AHR: 1.040; 95% CI: 1.014– 1.066); and having acute brain-related damage (AHR: 4.02; 95% CI: 1.48–10.88) were predictors of in-hospital mortality in these patients. Rural residence (adjusted incident-rate ratio (IRR): 1.34; 95% CI: 1.03–1.75); having history of medication discontinuation (adjusted IRR: 1.59; 95% CI: 1.16–2.18); comorbidity (adjusted IRR: 1.90; 95% CI: 1.49–2.43); acute brain related damage (adjusted IRR: 13.32; 95% CI: 9.22–19.24), acute cardiac-related damage (adjusted IRR: 7.40; 95% CI: 4.90–11.16); and acute kidney injury (adjusted IRR: 7.64; 95% CI: 5.46–10.69) were predictors of length of hospital stay. Conclusion: In-hospital mortality occurred in more than one out of twenty patients with hypertensive crisis. Age, residence, initial SBP, a history of medication discontinuation, comorbidity, acute brain-related damage, acute cardiac-related damage, and acute kidney injury were predictors of in-hospital outcomes of these patients. Thus, it is necessary to develop strategies that allow early screening and follow-up of patients at risk