Stress Ulcer Prophylaxis and Clinical Outcomes Among Critically Ill Patients at Selected Hospitals in Addis Ababa, Ethiopia: A Multicenter Prospective Cohort Study

Objective Even though acid‐suppressive medications (ASMs) are significantly important in reducing upper gastrointestinal bleeding (UGIB), there are also concerns regarding increased risk of infection and mortality. In Ethiopia, there are no data about the clinical outcomes of ASMs and associated factors in critically ill patients. Thus, this study aimed to assess the use of stress ulcer prophylaxis (SUP) and clinical outcomes, specifically hospital‐acquired infection (HAI) and mortality, in critically ill patients. Thus, the study aims to assess the use of SUP and clinical outcomes in critically ill patients. Methods A multicenter prospective cohort study was conducted in critically ill patients of all ages from September to November 2021. Logistic and Cox regressions were performed to determine predictors of HAI and mortality. Statistical significance was declared at a 95% confidence interval (95% CI) and p ‐value < 0.05. Results A total of 229 patients were prospectively followed. The majority were male adults (153, 66.8%). HAI was diagnosed in 47 patients (29.7%) receiving ASMs, and the overall mortality rate was 80 (34.9%). Multivariable logistic regression analysis revealed that stroke (adjusted odds ratio [AOR] = 3.63, 95% CI: 1.30–10.18, p = 0.014), steroid therapy (AOR = 3.23, 95% CI: 1.45–7.13, p = 0.004), mechanical ventilation (MV) (AOR = 5.41, 95% CI: 1.23–23.85, p = 0.026), and SUP (AOR = 2.95, 95% CI: 1.35–6.45, p = 0.007) were positively associated with HAI during ICU stay. Regarding mortality, MV (AOR = 2.27, 95% CI: 1.14–4.52, p = 0.019) and hypoperfusion (AOR = 2.77, 95% CI: 1.46–5.27, p = 0.002) showed positive associations, whereas being pediatric (AOR = 0.49, 95% CI: 0.25–0.97, p = 0.039) and an ICU stay longer than 1 week (AOR = 0.48, 95% CI: 0.24–0.96, p = 0.039) were negatively associated with mortality. In Cox proportional hazards regression, a surgical diagnosis (adjusted hazard ratio [AHR] = 3.57, 95% CI: 1.10–11.60, p = 0.034) was positively associated with HAI. Hypoperfusion (AHR = 2.68, 95% CI: 1.62–4.43, p < 0.001) and MV (AHR = 2.04, 95% CI: 1.10–3.80, p = 0.025) were positively associated with mortality, while pediatric status (AHR = 0.56, 95% CI: 0.33–0.94, p = 0.028) was negatively associated. Conclusions HAIs occurred in one‐third of patients receiving ASMs. Significant factors associated with HAI included stroke, steroid therapy, MV, surgical diagnosis, and SUP use. MV and hypoperfusion predicted mortality. However, residual confounding by illness severity is a major limitation; causality should not be inferred.