(1647) Causes and Outcomes of Shock in Adult and Pediatric Patients in a Rural Kenyan Hospital

Introduction: Shock is a common reason for ICU admission worldwide and is associated with high mortality. Studies in high-income countries report up to 45% mortality rate for septic shock, the most common cause of shock in children and adults, and up to 70% mortality in Africa. Our objective is to describe the clinical patterns and outcomes of shock in adult and pediatric patients requiring vasopressor infusion in a rural Kenyan hospital.

Methods: This prospective, observational study is being conducted at Kijabe Hospital, a 360-bed tertiary care teaching hospital in rural Kenya. All patients (adult, obstetric, pediatric) receiving intravenous vasopressor infusions who are admitted to the ICU or high-dependency unit (HDU) were enrolled within 24hr of initiation of vasopressor infusion. Consecutive enrollment began in October 2023 and is ongoing. Demographic, physiologic, laboratory, therapeutic, and outcome data are being collected.

Results: 153 patients were enrolled between October 2023 and July 2024. Most were adults (n=128, 84%), and 24 (16%) were children. Median age was 54 years (IQR 34-70) and 43% (n=66) were male. 126 patients (82%) were cared for by the Medical service and 26 (17%) were cared for by the Surgical service. Median lowest mean arterial pressure in the 12 hours prior to study enrollment was 56mmHg (IQR 49-62). Of the 137 patients who had a GCS recorded at the time of enrollment, 85 (62%) had a GCS < 15 and 52 (38%) had a normal GCS of 15. Septic shock was the most common cause of shock, with 112 patients (73%), followed by cardiogenic (n=33, 22%), hypovolemic (n=19, 12%), non-septic distributive (n=15, 10%), undifferentiated (n=8, 5%), and hemorrhagic (n=5, 3%). Mortality was very high, with 93 people dying in the hospital (65% of those discharged by the analysis date) and 47 people (33%) discharged home.

Conclusions: Shock, especially septic shock, is common in this rural Kenyan hospital. Patients with shock have a very high mortality rate, consistent with rates previously described in Africa, despite care at a well-staffed tertiary referral hospital. Future research to improve the quality of care and outcomes of patients with shock in rural Kenya is needed.