Journal article
Patient care and clinical outcomes for patients with COVID-19 infection admitted to African high-care or intensive care units (ACCCOS): a multicentre, prospective, observational cohort study
The Lancet (British edition), Vol.397(10288), pp.1885-1894
05/22/2021
DOI: 10.1016/S0140-6736(21)00441-4
PMCID: PMC8137309
PMID: 34022988
Abstract
Background There have been insufficient data for African patients with COVID-19 who are critically ill. The African COVID-19 Critical Care Outcomes Study (ACCCOS) aimed to determine which resources, comorbidities, and critical care interventions are associated with mortality in this patient population.
Methods The ACCCOS study was a multicentre, prospective, observational cohort study in adults (aged 18 years or older) with suspected or confirmed COVID-19 infection who were referred to intensive care or high-care units in 64 hospitals in ten African countries (ie, Egypt, Ethiopia, Ghana, Kenya, Libya, Malawi, Mozambique, Niger, Nigeria, and South Africa). The primary outcome was in-hospital mortality censored at 30 days. We studied the factors (ie, human and facility resources, patient comorbidities, and critical care interventions) that were associated with mortality in these adult patients. This study is registered on ClinicalTrials.gov, NCT04367207.
Findings From May to December, 2020, 6779 patients were referred to critical care. Of these, 3752 (55.3%) patients were admitted and 3140 (83.7%) patients from 64 hospitals in ten countries participated (mean age 55.6 years; 1890 [60.6%] of 3118 participants were male). The hospitals had a median of two intensivists (IQR 1-4) and pulse oximetry was available to all patients in 49 (86%) of 57 sites. In-hospital mortality within 30 days of admission was 48.2% (95% CI 46.4-50.0; 1483 of 3077 patients). Factors that were independently associated with mortality were increasing age per year (odds ratio 1.03; 1.02-1.04); HIV/AIDS (1.91; 1.31-2.79); diabetes (1.25; 1.01-1.56); chronic liver disease (3.48; 1.48-8.18); chronic kidney disease (1.89; 1.28-2.78); delay in admission due to a shortage of resources (2.14; 1.42-3.22); quick sequential organ failure assessment score at admission ( for one factor [1.44; 1.01-2.04], for two factors [2.0; 1.33-2.99], and for three factors [3.66, 2.12-6.33]); respiratory support (high flow oxygenation [2.72; 1.46-5.08]; continuous positive airway pressure [3.93; 2.13-7.26]; invasive mechanical ventilation [15.27; 8.51-27.37]); cardiorespiratory arrest within 24 h of admission (4.43; 2.25-8.73); and vasopressor requirements (3.67; 2.77-4.86). Steroid therapy was associated with survival (0.55; 0.37-0.81). There was no difference in outcome associated with female sex (0.86; 0.69-1.06).
Interpretation Mortality in critically ill patients with COVID-19 is higher in African countries than reported from studies done in Asia, Europe, North America, and South America. Increased mortality was associated with insufficient critical care resources, as well as the comorbidities of HIV/AIDS, diabetes, chronic liver disease, and kidney disease, and severity of organ dysfunction at admission. Copyright (C) 2021 Elsevier Ltd. All rights reserved.
Details
- Title: Subtitle
- Patient care and clinical outcomes for patients with COVID-19 infection admitted to African high-care or intensive care units (ACCCOS): a multicentre, prospective, observational cohort study
- Creators
- Bruce M. Biccard - Groote Schuur HospitalMalcolm Miller - University of Cape TownWilliam L. Michell - University of Cape TownDavid Thomson - University of Cape TownAdesoji Ademuyiwa - University of LagosErnest Aniteye - Bloomsburg UniversityGreg Calligaro - University of Cape TownMaman Sani Chaibou - Natl Hosp Niamey, Dept Anesthesiol Intens Care & Emergency, Niamey, NigerHailu Tamiru Dhufera - Minist Hlth, Med Serv Directorate Gen, Addis Ababa, EthiopiaMohamed Elfagieh - NCI, Misrata, LibyaMahmoud Elfiky - Cairo UniversityMuhammed Elhadi - University of TripoliMaher Fawzy - Cairo UniversityDavid Fredericks - University of Cape TownMeseret Gebre - Armauer Hansen Research InstituteAbebe Genetu Bayih - Armauer Hansen Research InstituteAnneli Hardy - University of Cape TownIvan Joubert - University of Cape TownFitsum Kifle - Debre Berhan UniversityHyla-Louise Kluyts - Sefako Makgatho Health Sciences UniversityKieran D. M. Macleod - Armauer Hansen Research InstituteZelalem MekonnenMervyn Mer - University of the WitwatersrandAtilio Morais - Hosp Cent Maputo, Dept Cirurgias, Ave Eduardo Mondlane, Maputo, MozambiqueVanessa Msosa - Kamuzu Cent Hosp, POB 149, Lilongwe, MalawiWakisa Mulwafu - Coll Med, Private Bag 360, Blantyre, MalawiAndrew Ndonga - Mater Misericordiae Univ Hosp, Nairobi, KenyaZipporah Ngumi - University of NairobiAkinyinka Omigbodun - University of IbadanChristian Owoo - University of GhanaFathima Paruk - University of PretoriaJenna L. Piercy - University of Cape TownJuan Scribante - University of the WitwatersrandYakob Seman - Med Serv, Minist Hlth, Addis Ababa, EthiopiaElliott H. Taylor - Univ Oxford, Oxford Univ Global Surg Grp, Nuffield Dept Surg Sci, Oxford, EnglandDawid E. A. van StraatenP. Dean Gopalan - University of KwaZulu-NatalAfrican COVID-19 Critical Care Outcomes Study (ACCCOS) InvestigatorsOlusola A Idowu (Contributor) - University College Hospital, Ibadan
- Resource Type
- Journal article
- Publication Details
- The Lancet (British edition), Vol.397(10288), pp.1885-1894
- DOI
- 10.1016/S0140-6736(21)00441-4
- PMID
- 34022988
- PMCID
- PMC8137309
- NLM abbreviation
- Lancet
- ISSN
- 0140-6736
- eISSN
- 1474-547X
- Publisher
- Elsevier
- Number of pages
- 10
- Grant note
- Critical Care Society of Southern Africa
- Language
- English
- Date published
- 05/22/2021
- Academic Unit
- Anesthesia
- Record Identifier
- 9984787458202771
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