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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

2021; Elsevier BV; Volume: 397; Issue: 10288 Linguagem: Inglês

10.1016/s0140-6736(21)00441-4

1474-547X

Bruce Biccard, PD Gopalan, Malcolm Miller, W L Michell, David Thomson, Adesoji Ademuyiwa, Ernest Aniteye, G Calligaro, Maman Sani Chaibou, Hailu Tamiru Dhufera, Mohamed Elfagieh, Mahmoud Elfiky, Muhammed Elhadi, Maher Fawzy, David Fredericks, Meseret Gebre, Abebe Genetu Bayih, Anneli Hardy, Ivan Joubert, Fitsum Kifle, Hyla‐Louise Kluyts, Kieran DM Macleod, Z. A. Mekonnen, Mervyn Mer, Atílio Morais, Vanessa Msosa, Wakisa Mulwafu, Andrew Ndonga, Zipporah Ngumi, Akinyinka Omigbodun, Christian Owoo, Fathima Paruk, J Piercy, Yakob Seman, Elliott H Taylor, Dawid van Straaten, Mahmoud Elfiky, Maher Fawzy, Ahmed K. Awad, Hend Hussein, Mahmoud Shaban, Merihan Elbadawy, Ahmed O. Elmehrath, Ahmed Cordie, Mohamed Elganainy, Mostafa Elshazly, Mahmoud Essam, Omar Ahmed Abdelwahab, Aboubakr Ali, Aliae Mohamed Hussein, Emad Zarief Kamel, Fatma A. Monib, Islam Ahmed, Mahmoud Saad, Mohammed Ali Al-Quossi, Nashwa Rafaat, Islam Galal, Beshoui labib, Dalia Omran Omran, Maher Fawzy, Mahmoud Elfiky, Ahmed Y. Azzam, Mohammed A. Azab, Sherief Ghozy, Ahmed Tawheed, Mahmoud Gamal, Mohamed El‐Kassas, Aml Azzam, Neama Ahmed, Yasmin K. Nasr‐Eldin, Ali M. Abdelsalam, Omar Abdewahab, Mohamed Elganainy, Omar Elmandouh, Hailu Tamiru Dhufera, Meseret Gebre, Abebe Genetu Bayih, Fitsum Kifle, Z. A. Mekonnen, Yakob Seman, Abebe Addisie, Akine Eshete, Fitsum Kifle, Kokeb Desita, Hiruy Araya, Yared Agidew, Addisu Desalegn Andabo, Emnet Tesfaye, Elias Ali Yesuf, Gelaw Hailemariam, Habtamu Sime, Dame Fikadu Keneni, Menbeu Sultan Mohammed, Yemane Gebremedhin, Yoseph Taye, Tamiru Assefa Mebrate, Tirunesh Busha Gemechu, Tigist Tesfaye Bedane, Elias Tewabe Abera, Ayele Teshome, Ernest Aniteye, Christian Owoo, Alfred Doku, Christian Owoo, Jane Afriyie-Mensah, Aba Lawson, Christian Owoo, Daniel Sottie, Emma Addae, Ernest Ofosu-Appiah, William Obeng, Andrew Ndonga, Zipporah Ngumi, Andrew Ndonga, Anne N Mugera, Caesar Bitta, Mohamed Elfagieh, Muhammed Elhadi, Mohammed Huwaysh, Mohammed Mahdi Ali Yahya, Alsnosy Abdullah Khalefa Mohammed, Amrajaa Alsalihin Mohammed Majeed, Amkhatirah Emad Mousay Mohammed, Elsalhein Majeed, Abdurraouf Abusalama, Ehab Altayr, Taha Abubaker, Akram Alkaseek, Butaina Abdulhafith, Zainab Alziyituni, Marwa Gamra, Mohamed Anaiba, Samer Khel, Mohammed Abdelkabir, Saedah Abdeewi, Safia Adam, Abdulmueti Alhadi, Ahmed Alsoufi, Muhannad Binnawara, Ahmed Msherghi, Ahmad Bouhuwaish, Ahmed Sa Taher, Vanessa Msosa, Wakisa Mulwafu, Francis Masoo, Singatiya Stella Chikumbanje, Palesa Chisala, Delia Mabedi, Atílio Morais, Antonio Carlos, Atílio Morais, Cesaltina Lorenzoni, Jorge Mambo, Isabel Isabel Chissaque, Mouzinho Saide, Maman Sani Chaibou, Maikassoua Mamane, Foumakoye Amadou, Adesoji Ademuyiwa Adesoji Ademuyiwa, Akinyinka Omigbodun, Ademola Adeyeye, Akinola Akinmade, Yakubu Momohsani, John Bamigboye, Donald Orshio, Erdoo S. Isamade, Henry Y. Embu, Samuel Nuhu, Samuel Ojiakor, Ahmed Nuhu, Salisu Aliyu Kwayabura, Adeola Fowotade, Arinola Sanusi, Babatunde Osinaike, Olusola Idowu, Olukemi Adekanmbi, Abdullahi Oteikwu Amali, Sanusi Ibrahim, Adamu Abba Adamu, Ibrahim Musa Kida, Job Otokwala, Mahmoud Essam, Olubusola Alagbe-Briggs, Sylvanus Ojum, Fathima Paruk, Juan Scribante, Ismail Kalla, Aurence Mdladla, Tebogo Mabotja, Ria Devi Naidoo, Roel Matos‐Puig, Arisha Ramkillawan, Michelle Smith, Christel Arnold-Day, David Thomson, G Calligaro, Ivan Joubert, M Jagga, J Piercy, Lance Michell, Liam Devenish, Malcolm Miller, Nicole Fernandes, PD Gopalan, Santosh Pershad, Nicola Grabowski, Mapule Rammego, Sabelo Zwane, Masikhanyise Elizabeth Dhlamini, Matthew Neuhoff, Tobisa Fodo, Anthony Usenbo, Busisiwe Mrara, Freddy Kabambi, Estie Cloete, Leonel De Caires, Roger Dickerson, C. Louw, Alida Theron, Ryan Herselman, Jannes Badenhorst, Godfrey Moletsane, Helene Loots, F Vorster, Fathima Paruk, Julian Chausse, Matthew Neuhoff, Melinda Sebastian, Nicola Grabowski, Paul Rheeder, Wesley van Hougenhouck-Tulleken, Carin Snyman, Durotolu Adeleke, Jovan Esterhuizen, Leoni de Man, Matema Mosola, Pieter van der Linde, Reinier Swart, Shaun Maasdorp, Tina Martins, V Govender,

COVID-19 Impact on Reproduction

Summary 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. Funding The ACCCOS was partially supported by a grant from the Critical Care Society of Southern Africa.