Evaluating Mortality and Survival Patterns Among ICU Patients: Evidence from Two Years of Data at Jazan General Hospital

Intensive care units (ICUs) are central to the treatment of acutely ill patients, providing advanced supervision and life-sustaining care for those with life-threatening illnesses [1,2]. Though critical care practices have continued to improve, ICU mortality is still a significant health issue in the world, which indicates the intensity of illness, complexity of care, and inconsistency of patient-related and system-related variables [3,4]. Knowledge of mortality and survival rates in ICU patients is critical for assessing how effectively care is delivered, how resources are used, and how patients are affected, especially in limited-resource or high-demand healthcare settings [5].

 

Previous research has consistently shown that ICU outcomes depend on a combination of sociodemographic factors, clinical conditions, and treatment-related factors [6,7]. Age and gender have been extensively reported as significant predictors of survival, with older age groups having higher mortality rates due to greater comorbidity and reduced physiological reserve [8]. Strong predictors of mortality include admission source, ICU length of stay, and mechanical ventilation, which often reflect illness severity and late onset [9]. Moreover, organ- or system-based patterns of involvement can be useful for assessing disease burden and stratifying patients' prognosis in the critical care unit [10].

 

In Saudi Arabia, particularly in the southern regions, ICU mortality trends are relatively scarce, even as critical care services are on the rise. Jazan General Hospital serves a heterogeneous population with diverse socio-demographic factors and clinical presentations, making it a valuable setting to assess ICU outcomes. Generating local evidence is important because mortality and risk factor trends may differ from those in other areas, driven by differences in population characteristics, access to healthcare services, and clinical practices.

 

Based on this, the study was conducted to assess the mortality and survival rates of ICU patients at Jazan General Hospital over 2 years. By analyzing socio-demographic variables, admission site, ICU length of stay, mechanical ventilation, and system involvement, the study aims to identify factors that significantly impact patient outcomes.

Study design and setting:

The study used a retrospective observational design to assess mortality and survival rates among patients admitted to the intensive care unit at Jazan General Hospital.

 

Study Population and Criteria:

Medical records were reviewed to collect data for two years, covering all eligible adult ICU admissions during the study period. The target population was adult patients admitted to the ICU for medical or surgical reasons. For patients with multiple ICU admissions, only the first admission was included in the analysis. Incomplete records and patients missing essential outcome variables were excluded to ensure data reliability and analytical validity.

 

Data collection:

A structured data-collection form specifically designed for this study was used to gather data. These data were collected using the hospital's electronic health record system, Vida. The database contained routinely collected administrative data, health histories, discharge summaries, age, sex, and ICD-10 (International Classification of Diseases, 10th Revision) diagnoses.

 

The socio-demographic variables were age, gender, and marital status. The dependent variables included clinical and admission-related variables, the source of ICU admission, ICU length of stay, mechanical ventilation requirement, and the reported system involvement, which was classified by the primary organ system involved. The SOFA score was assessed within the first 24 hours after ICU admission. The outcome was defined as survivors and non-survivors; a survivor was transferred out of the intensive care unit, and a non-survivor was dead at the time of discharge from the intensive care unit.

 

Statistical data analysis:

Data were entered and analyzed using the Statistical Package for the Social Sciences (Version 27.0, SPSS Inc., Chicago, IL, USA). Descriptive statistics, including means or medians for continuous variables and frequencies and percentages for categorical variables, summarized patient characteristics. Relationships with mortality were evaluated using inferential statistical tests, namely independent t-tests for continuous variables and chi-square and Fisher's exact tests for categorical variables. To identify independent predictors of intensive care unit mortality, a multivariate regression analysis was performed.

 

Ethical Considerations

The hospital's Ethics Committee and Institutional Review Board (IRB) approved it (No. 2510). For these ICU patients, these data are used secondarily.  At all times, patient confidentiality was maintained. Because the study was retrospective, direct patient consent might not have been necessary, but ethical standards were adhered to when handling the data.

Of the 998 ICU admissions included in the analysis, most patients survived their ICU stay. Of these, 242 (24.2%) died in the intensive care unit, and 756 (75.7%) were discharged alive.

 

There was a strong, significant correlation between ICU mortality and patient age. The reference group was the youngest patients, aged ≤ 30 years, who had the lowest mortality rate (6.0%) and the highest survival. Mortality increased with age, reaching 46.5% in patients aged 71 to 90 years and 48.3% in those over 90. Mortality risk increased significantly with age, with patients over 90 years having the highest risk (OR: 14.64, 95% CI: 6.0335.53; p<0.001).

 

Gender did not significantly correlate with mortality. Male and female patients had comparable survival rates, with no discernible difference in mortality (24.9% and 23.5%, respectively). The ICU results were significantly correlated with marital status. The reference group consisted of single patients with the lowest mortality rate (8.0). On the other hand, the mortality rate for patients who were married, divorced, or widowed exhibited an upward trend, with the mortality rate for widowed patients standing at 46.6%. These were statistically significant, and widowed patients had noticeably higher odds of dying (OR: 10.08, 95% CI: 5.7217.76; p<0.001). The mortality rate was similar between rural and urban patients, so residence status was not a significant factor. Even though the mortality rate was marginally lower in 2024 than in 2023, there was no statistically significant variation in mortality across admission Table 1 

 

P-values indicate statistical significance at p < 0.05

 

There was statistically significant in mortality rate across admission months. The mortality was higher in some months specially in March and June, at 39.0, 38.6 respectively. August on the other hand had the lowest mortality rate at 2.8. This result indicates the ICU mortality rate during the study period exhibit seasonal variation (Figure 1).

 

Figure 1: The relation between the date of admission per month and the mortality rate

 

ICU results showed a significant correlation with the source of admission. Patients admitted to medical wards or referred from other hospitals had a higher death rate than those who visited the emergency room. The highest mortality rate (42.6%) and a significantly higher risk of death (OR: 3.28, 95% CI: 2.29-2.294.69; p<0.001) were observed among patients referred from other hospitals. ICU length of stay was also strongly correlated with mortality. Patients who spent more than 10 days in the ICU had the highest mortality rate (50.0) and a significantly higher risk of death than those who stayed for ≤ 2 days (OR: 4.4, 95% CI: 2.79-6.92; p<0.001). Likewise, hospital length of stay was significantly associated with outcome, with lower mortality among patients who stayed 6–10 days than among those who stayed for very short periods. Mortality was strongly predicted by mechanical ventilation status. Mechanically ventilated patients had a significantly higher mortality rate of 62.1, compared with 7.9 among non-ventilated patients. A 19-fold increase in mortality was associated with mechanical ventilation (OR: 19.15, 95% CI: 13.3427.4-27.4; p<0.001). The classification of a disease as communicable or non-communicable did not significantly correlate with mortality; however, patients with communicable diseases had a higher mortality rate (Table 2).

 

Statistical significance is indicated by p-values <0.05     

 

Figure 2 shows the trends for infectious and communicable diseases; genitourinary, obstetrical, and gynecological diseases; cardiovascular diseases; respiratory diseases; gastroenterology and liver diseases; nephrology; endocrinology; neurology; self-harm; orthopedics; surgery; dermatology; and other conditions. A significant number of admissions were due to respiratory disease (234 [23.45%]), and 3.84% of those cases had mortality. Cardiovascular disease (118 [11.82%]) was the next most common cause of admission, and 1.12% of those cases had mortality.

 

Figure 2. System involvement: total cases and mortality

 

Greater mortality was strongly associated with pulmonary and neurological reasons for ICU admission. The mortality rate was 39.5% among patients admitted for pulmonary causes, three times higher than among those with other causes (OR: 3.02, 95% CI: 2.224.08; p<0.001). Similar results were observed for neurological causes, which were also associated with higher mortality (38.4%; OR: 1.72, 95% CI: 1.132.63; p<0.001). The association with mortality in this cohort was not statistically significant for infectious causes and cardiovascular admissions. Notably, all patients admitted to the hospital because of self-harm survived, indicating that the mortality risk among this group is considerably lower (Table 3).

 

P-values indicate statistical significance at p < 0.05.

 

Several comorbidities were strongly associated with higher ICU mortality. Hypertension was associated with a mortality of 32.1% and an odds ratio of 2.0 (95% CI 1.52-2.74, p=0.001). Increased mortality was also observed with ischemic heart disease. Patients with solid malignancies and chronic liver disease had the highest mortality rates, exceeding 50%, and both disorders were significantly associated with death. Conversely, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and hematological malignancies were not significantly associated with mortality. Although the mortality proportion was higher in immunosuppressed patients, the association was not statistically significant. Overall, the comorbidity trend showed a higher mortality rate, but the combined relationship was not statistically significant (Table 4).

 

Statistical significance is indicated by p-values < 0.05.

This research paper presents an in-depth analysis of mortality and survival rates among ICU patients admitted to Jazan General Hospital over two years and identifies demographic, clinical, and system-related variables that significantly influence ICU patient outcomes. The ICU mortality rate of 24.2% aligns with regional and international studies, where ICU mortality typically ranges from 20% to 30%, reflecting the high acuity and complexity of the critically ill population [11]. These results are consistent with several previous studies conducted in Saudi Arabia, including the study by Shaabi L et al. in Southwest Saudi Arabia, which reported an ICU mortality rate of 29.4% [12], and the study by Rosenthal V et al. among 10 Middle Eastern countries, including Saudi Arabia, that reported an ICU mortality rate of 21.0% [13].

 

Age was found to be one of the best predictors of mortality, with a clear stepwise increase in the death rate with age. Patients aged 71 years and older had significantly higher mortality, and the odds of death were higher than in younger patients. This observation is consistent with the extensive literature on critical care, which indicates that older age is associated with decreased physiological reserve, increased comorbidities, and greater intolerance to critical illness and invasive procedures [14-16]. Age-related mortality gradients have been observed to be similar across large multicentre ICU studies in various healthcare systems [17,18].

 

In this study, gender was not significantly associated with ICU mortality, consistent with several reports showing that, in the presence of disease severity and comorbidities, sex alone is not a significant determinant of ICU outcomes [19-21]. Marital status was significantly associated with outcomes, with widowed and divorced patients having higher mortality than single patients. Although marital status is not a direct clinical variable, prior research has shown that social support, living conditions, and delayed healthcare-seeking behaviors can influence disease severity at presentation and subsequent outcomes, especially among older and widowed individuals [22].

 

The seasonal variation in mortality, as shown in the monthly admission analysis, revealed very high rates in some months. Similar seasonal patterns have been reported in ICU populations. They are usually attributed to fluctuations in infectious disease incidence, environmental factors, extreme temperatures, and additional strain on healthcare systems during peak periods [23]. The source of admission was a significant determinant of outcome. Mortality was markedly higher among patients referred from other hospitals and those admitted from medical wards than among those admitted to the emergency department. This observation aligns with existing evidence that inter-hospital transfers often involve more acutely ill patients or late referrals, both of which are linked to worse outcomes [24].

 

The ICU length of stay was significantly correlated with mortality, particularly when it exceeded 10 days. Prolonged ICU admissions are often associated with more severe illness, nosocomial infections, and long-term organ support, all of which contribute to higher mortality [25,26]. Similarly, hospital length of stay is an indicator of the multifaceted interplay among disease severity, recovery patterns, and survivorship bias, in which patients who spend more time in the hospital may constitute a more robust subgroup [25].

 

The strongest predictor of mortality in this cohort was mechanical ventilation. The mortality rate among ventilated patients was significantly higher, with almost a nineteen-fold increase in the probability of death. This observation is supported by the existing literature, which generally accepts mechanical ventilation as a surrogate indicator of severe respiratory failure and the overall severity of critical illness [27]. Other complications, such as pneumonia and barotrauma, are also ventilator-associated and increase the risk of mortality [27].

 

Involvement of the respiratory and neurological systems contributed to a significant share of ICU admissions and deaths. Respiratory involvement, especially, was linked to the greatest mortality burden, consistent with global data showing that respiratory failure is a major cause of ICU admission and death [9]. Neurological involvement also carries a high mortality rate, indicating a poor prognosis for acute neurological insults, including stroke, traumatic brain injury, and altered consciousness [28].

 

Independent predictors of increased mortality included pulmonary and neurological reasons for ICU hospitalization, consistent with prior research identifying these factors as high-risk for critical care hospitalization [27,28]. Comorbid conditions were also important determinants. Hypertension and ischemic heart disease were associated, consistent with findings that cardiovascular comorbidities increase susceptibility to critical illness and impair recovery [29]. Importantly, patients with solid malignancies and chronic liver disease had especially high mortality rates, consistent with previous research pointing to poor ICU outcomes in patients with advanced malignancy and hepatic dysfunction caused by immune compromise and low physiological reserve [30].

 

This research was also limited in several ways that should be considered when interpreting the results. The retrospective design relied on the accuracy and completeness of medical records, which could have led to missing or misclassified data for the variables. As a single-centre study at Jazan General Hospital, the results may not be fully applicable to other health care facilities with different patient populations, case mix, and ICU resources. Only the available demographic and clinical variables were analysed, and significant disease severity indicators, such as standardized ICU scoring systems or detailed laboratory parameters, were not always recorded and therefore could not be considered. Moreover, because the study was observational, causality could not be determined, and residual confounding by unmeasured factors could have contributed to the observed relationships.

In conclusion, this paper highlights that age, severity-related factors (mechanical ventilation and a long ICU stay), the source of admission, system involvement, and the choice of comorbidities are the major determinants of ICU mortality at Jazan General Hospital. These results align with international evidence and underscore the need to stratify risks early, refer patients promptly, and implement targeted interventions for high-risk patients to improve survival and reduce ICU mortality.

 

Acknowledgement:

My gratitude goes to the ICU team at Jazan General Hospital and the IT support group for facilitating data collection. 

 

Conflicts of Interest: The author states that there are no competing interests.

 

Funding: This study was not funded by outside sources.

 

Abbreviation:

v  ICU: Intensive Care Unit

v  OR: Odd Ratio

v  CI: Confidence Interval

v  HTN: Hypertension

v  IHD: Ischemic Heart Disease

v  COPD: Chronic Obstructive Pulmonary Airway disease

v  CKD: Chronic Kidney Disease

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