An African, multi-centre evaluation of patient care and clinical outcomes for patients with COVID-19 infection admitted to high-care or intensive care units
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Date
2020
Authors
Biccard, BM
Miller, M
Michell, WL
Thomson, D
Ademuyiwa, A
Aniteye, E
Dhufera, HT
Elfagieh, M
Elfiky, M
Elhadi, M
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Abstract
Background: There is little data on critically ill COVID-19 patients in under-resourced environments, and none from Africa. The objectives of this study were to determine resources, patient comorbidities and critical care interventions associated with mortality in critically ill COVID-19 African patients.
Methods: African multicentre, prospective observational cohort study of adult patients referred to intensive care or high-care units with suspected or known COVID-19 infection. Patient follow up was until hospital discharge, censored at 30 days. The study recruited from March to September 2020.
Findings: 1243 patients from 38 hospitals in six countries participated. The hospitals had a median of 2 (interquartile range (IQR) 1-4) intensivists, with a nurse to patient ratio of 1:2 (IQR 1:3 to 1:1). Pulse oximetry was available to all patients in 29/35 (82·9%) sites, and 21/35 (60%) of sites could provide dialysis or proning. The 30-day mortality following critical care admission was 54·7% (95% confidence interval (CI) 51·9-57·6). Factors independently associated with mortality were an increasing age (odds ratio (OR) 1·04, 95% CI 1·02-1·05, p<0·001), a quick SOFA score of 3 (OR 3·61, 95% CI 1·41-9·24, p=0·01), increasing respiratory support defined as the need for continuous positive airway pressure (OR 5·86, 95% CI 1·47-23·35, p=0·01), invasive mechanical ventilation (OR 16·42, 95% CI 4·52-59·65, p<0·001), three organ systems requiring support at admission (OR 5·52, 95% CI 1·13-27·01, p=0·04), cardiorespiratory arrest within 24 hours prior to admission (OR 4·43, 95% CI 1·01-19·54, p=0·05) and vasopressor requirements (OR 2·73, 95% CI 1·71-4·36, p<0·001). Human immunodeficiency virus was not associated with mortality (OR 1·84, 95% CI 0·99-3·40, p=0·05).
Interpretation: Mortality in critically ill COVID-19 African patients is higher than any other region, with an excess mortality of 18 and 29 deaths per 100 patients compared to other regions. Mortality is associated with limited critical care resources and severity of organ dysfunction at admission.
Description
Scholarly articles
Keywords
COVID-19 patients , Patient comorbidities , Critical care interventions , Mortality , African patients , Research Subject Categories::MEDICINE::Surgery
Citation
Biccard, Bruce and Miller, Malcolm Gregory and Michell, William L. and Thomson, David and Ademuyiwa, Adesoji O. and Aniteye, Ernest and Calligaro, Gregory L. and Calligaro, Gregory L. and Dhufera, Hailu Tamiru and Elfiky, Mahmoud and Elhadi, Muhammed and Fawzy, Maher and Fredericks, David and Gebre, Meseret and Bayih, Abebe Genetu and Hardy, Anneli and Joubert, Ivan and Belachew, Fitsum Kifle and Kluyts, Hyla and Macleod, Kieran DM and Mekonnen, Zelalem and Mer, Mervyn and Omigbodun, Akinyinka O. and Owoo, Christian and Paruk, Fathima and Piercy, Jenna and Scribante, Juan and Seman, Yakob and Taylor, Elliott H. and van Straaten, Dawid and Gopalan, P. Dean and Group, ACCCOS Investigators, An African, Multi-Centre Evaluation of Patient Care and Clinical Outcomes for Patients with COVID-19 Infection Admitted to High-Care or Intensive Care Units. Available at SSRN: https://ssrn.com/abstract=3707415 or http://dx.doi.org/10.2139/ssrn.3707415