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.
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.
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DOI：
10.1016/s0140-6736(21)00441-4
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发表时间：
2021-05-22
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通讯作者：
African COVID-19 Critical Care Outcomes Study (ACCCOS) Investigators
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作者：
African COVID-19 Critical Care Outcomes Study (ACCCOS) Investigators
非洲重症COVID-19患者的数据一直不足。非洲COVID-19重症监护结局研究（ACCCOS）旨在确定哪些资源、合并症和重症监护干预与该患者人群的死亡率相关。ACCCOS研究是一项在10个非洲国家（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）64家医院的疑似或确诊COVID-19感染的成年人（年龄≥ 18岁）中进行的多中心、前瞻性、观察性队列研究。主要结局为30天时的住院死亡率。我们研究了与这些成人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）。本研究注册于ClinicalTrials.gov，NCT 04367207。2020年5月至12月，6779名患者被转介到重症监护。其中，3752例（55.3%）患者入院，来自10个国家64家医院的3140例（83.7%）患者参与（平均年龄55.6岁; 3118例参与者中有1890例[60.6%]为男性）。医院中位重症监护医师为2名（IQR 1-4），57个研究中心中有49个（86%）的所有患者均可使用脉搏血氧仪。入院30天内的住院死亡率为48.2%（95%CI 46.4 - 50.0; 3077例患者中有1483例）。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）;慢性肾脏疾病（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（单因素[1·44; 1·01-2·04]、双因素[2·0; 1·33-2·99]和三因素[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24小时内心跳呼吸骤停（4·43; 2·25-8·73）;以及血管加压药需求（3·67; 2·77-4·86）。类固醇治疗与生存率相关（0.55; 0.37 - 0.81）。女性的结局无差异（0.86; 0.69 - 1.06）。非洲国家的COVID-19重症患者死亡率高于亚洲、欧洲、北美和南美的研究报告。死亡率的增加与重症监护资源不足，以及合并HIV/AIDS、糖尿病、慢性肝病和肾病以及入院时器官功能障碍的严重程度有关。ACCCOS得到了南部非洲重症监护协会的部分资助。
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. 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. 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). 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. The ACCCOS was partially supported by a grant from the Critical Care Society of Southern Africa.