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

当前位置： X-MOL 学术 › Lancet › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

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 ( IF 168.9 ) Pub Date : 2021-05-21 , DOI: 10.1016/s0140-6736(21)00441-4
Bruce M Biccard , Pragasan Dean Gopalan , Malcolm Miller , William Lance Michell , David Thomson , Adesoji Ademuyiwa , Ernest Aniteye , Greg 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 Macleod , Zelalem Mekonnen , Mervyn Mer , Atilio Morais , Vanessa Msosa , Wakisa Mulwafu , Andrew Ndonga , Zipporah Ngumi , Akinyinka Omigbodun , Christian Owoo , Fathima Paruk , Jenna Louise Piercy , Yakob Seman , Elliott H Taylor , Dawid van Straaten , Mahmoud Elfiky , Maher Fawzy , Ahmed Awad , Hend Hussein , Mahmoud Shaban , Merihan Elbadawy , Ahmed O Elmehrath , Ahmed Cordie , Mohamed Elganainy , Mostafa El-Shazly , Mahmoud Essam , Omar A. Abdelwahab , Aboubakr Ali , Aliae Mohamed Hussein , Emad Zarief kamel , Fatma A. Monib , Islam Ahmed , Mahmoud M. Saad , Mohammed Ali Al-Quossi , Nashwa Rafaat , Islam Galal , Beshoui labib , Dalia Omran Omran , Maher Fawzy , Mahmoud Elfiky , Ahmed Azzam , Mohammed Azab , Sherief Ghozy , Ahmed Tawheed , Mahmoud Gamal , Mohamed El Kassas , Aml Azzam , Neama Ahmed , Yasmin NasrEldin , Ali Abdelsalam , Omar Abdewahab , Mohamed Elganainy , Omar Elmandouh , Hailu Tamiru Dhufera , Meseret Gebre , Abebe Genetu Bayih , Fitsum Kifle , Zelalem 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 Sandra Afriyie-Mensah , Aba Lawson , Christian Owoo , Daniel Akwanfo Sottie , Emma Addae , Ernest Ofosu-Appiah , William Obeng , Andrew Ndonga , Zipporah Ngumi , Andrew Ndonga , Anne Mugera , Caesar Bitta , Mohamed Elfagieh , Muhammed Elhadi , Mohammed Abdalraheem Huwaysh , Mohammed Mahdi Ali Yahya , Alsnosy Abdullah Khalefa Mohammed , Amrajaa Alsalihin Mohammed Majeed , Amkhatirah Emad Mousay Mohammed , Elsalhein Majeed , Abdurraouf A Abusalama , Ehab Altayr , Taha Abubaker , Akram Mohammed Alkaseek , Butaina Abdulhafith , Zainab Alziyituni , Marwa F Gamra , Mohamed Muftah Anaiba , Samer Khel , Mohammed Abdelkabir , Saedah Abdeewi , Safia Adam , Abdulmueti Alhadi , Ahmed Alsoufi , Muhannad Binnawara , Ahmed Msherghi , Ahmad Elmabri Mohammad Bouhuwaish , Ahmed SA Taher , Vanessa Msosa , Wakisa Mulwafu , Francis Masoo , Singatiya Stella Chikumbanje , Palesa Chisala , Delia Mabedi , Atilio Morais , Antonio Carlos , Atilio Morais , Cesaltina Lorenzoni , Jorge Mambo , Isabel Isabel Chissaque , Mouzinho Mouzinho Saide , Maman Sani Chaibou , Maikassoua Mamane , Foumakoye Amadou , Adesoji Ademuyiwa Adesoji Ademuyiwa , Akinyinka Omigbodun Akinyinka Omigbodun , Ademola Adeyeye , Akinola Akinmade , Yakubu Momohsani , John Bamigboye , Donald Orshio , Erdoo Suckie Isamade , Henry Embu , Samuel Nuhu , Samuel Ojiakor , Ahmed Nuhu , Salisu Kwayabura , Adeola Fowotade , Arinola Sanusi , Babatunde Osinaike , Olusola Idowu , Olukemi Adekanmbi , Abdullahi Oteikwu Amali , Sanusi Ibrahim , Adamu Abba Adamu , Ibrahim Kida , Job Otokwala , Mahmoud Essam , Olubusola Alagbe-Briggs , Sylvanus Ojum , Fathima Paruk , Juan Scribante , Ismail Sikander Kalla , Aurence Mdladla , Tebogo Mabotja , Ria Naidoo , Roel Matos-Puig , Arisha Ramkillawan , Michelle Smith , Christel Arnold-Day , David Thomson , Greg Calligaro , Ivan Joubert , Jagga Jagga , Jenna Piercy , Lance Michell , Liam Devenish , Malcolm Miller , Nicole Fernandes , Pragasan Dean 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 , Candice Louw , Alida Theron , Ryan Herselman , Jannes Badenhorst , Godfrey Moletsane , Helene Loots , Frans Christiaan 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 , Veneshree Govender

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.

中文翻译：

入住非洲高级护理或重症监护病房 (ACCCOS) 的 COVID-19 感染患者的患者护理和临床结果：一项多中心、前瞻性、观察性队列研究

背景

非洲 COVID-19 重症患者的数据不足。非洲 COVID-19 重症监护结果研究 (ACCCOS) 旨在确定哪些资源、合并症和重症监护干预措施与该患者群体的死亡率相关。

方法

ACCCOS 研究是一项多中心、前瞻性、观察性队列研究，研究对象为疑似或确诊 COVID-19 感染的成人（18 岁或以上），他们被转诊到非洲 10 个国家（即，埃及、埃塞俄比亚、加纳、肯尼亚、利比亚、马拉维、莫桑比克、尼日尔、尼日利亚和南非）。主要结局是 30 天时截尾的院内死亡率。我们研究了与这些成年患者死亡率相关的因素（即人力和设施资源、患者合并症和重症监护干预措施）。本研究已在 ClinicalTrials.gov 注册，NCT04367207。

发现

2020 年 5 月至 12 月，6779 名患者被转诊至重症监护室。其中，3752 名（55·3%）患者入院，来自 10 个国家的 64 家医院的 3140 名（83·7%）患者参与（平均年龄 55·6 岁；3118 名参与者中有 1890 名 [60·6%] 为男性） . 这些医院有两名重症监护医生 (IQR 1–4) 的中位数，57 个地点中有 49 个 (86%) 的所有患者都可以使用脉搏血氧仪。入院后 30 天内的院内死亡率为 48·2%（95% CI 46·4–50·0；3077 名患者中有 1483 名）。与死亡率独立相关的因素是每年增加的年龄（比值比 1·03；1·02–1·04）；艾滋病毒/艾滋病（1·91；1·31–2·79）；糖尿病 (1·25; 1·01–1·56)；慢性肝病（3·48；1·48–8·18）；慢性肾病 (1·89; 1·28–2·78)；由于资源短缺而延迟入院（2·14；1·42–3·22）；入院时快速序贯器官衰竭评估评分（一个因素 [1·44；1·01–2·04]，两个因素 [2·0；1·33–2·99]，三个因素 [3· 66, 2·12–6·33]); 呼吸支持（高流量氧合 [2·72；1·46–5·08]；持续气道正压通气 [3·93；2·13–7·26]；有创机械通气 [15·27；8·51– 27·37]); 入院后 24 小时内出现心跳呼吸骤停 (4·43; 2·25–8·73)；和升压药的需求 (3·67; 2·77–4·86)。类固醇治疗与生存相关（0·55；0·37–0·81）。与女性相关的结果没有差异 (0·86; 0·69–1·06)。有创机械通气[15·27; 8·51–27·37]); 入院后 24 小时内出现心跳呼吸骤停 (4·43; 2·25–8·73)；和升压药的需求 (3·67; 2·77–4·86)。类固醇治疗与生存相关（0·55；0·37–0·81）。与女性相关的结果没有差异 (0·86; 0·69–1·06)。有创机械通气[15·27; 8·51–27·37]); 入院后 24 小时内出现心跳呼吸骤停 (4·43; 2·25–8·73)；和升压药的需求 (3·67; 2·77–4·86)。类固醇治疗与生存相关（0·55；0·37–0·81）。与女性相关的结果没有差异 (0·86; 0·69–1·06)。