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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

31 Pages Posted: 22 Oct 2020

See all articles by Bruce Biccard

Bruce Biccard

University of Cape Town (UCT) - Department of Anaesthesia and Perioperative Medicine

Malcolm Gregory Miller

University of Cape Town (UCT) - Department of Anaesthesia and Perioperative Medicine

William L. Michell

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, and Senior Scholar, Department of Surgery, Faculty of Health Sciences, University of Cape Town

David Thomson

Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town

Adesoji O. Ademuyiwa

Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital

Ernest Aniteye

Anaesthesia, Cardiothoracic Anaesthetist and Intensivist, Korle-Bu Teaching Hospital and University of Ghana Medical School

Gregory L. Calligaro

University of Cape Town (UCT) - University of Cape Town Lung Institute; University of Cape Town (UCT) - Department of Anaesthesia and Perioperative Medicine

Hailu Tamiru Dhufera

Ministry of Health, Ethiopia

Mahmoud Elfiky

Kasr Al Ainy Faculty of Medicine, Cairo University

Muhammed Elhadi

Faculty of Medicine, University of Tripoli

Maher Fawzy

Faculty of Medicine, Cairo University

David Fredericks

Department of Critical Care Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town

Meseret Gebre

Armauer Hansen Research Institute

Abebe Genetu Bayih

Armauer Hansen Research Institute

Anneli Hardy

Department of Statistical Sciences, Faculty of Science, University of Cape Town

Ivan Joubert

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town

Fitsum Kifle Belachew

Debre Berhan University College of Medicine Department of Anaesthesia

Hyla Kluyts

Department of Anaesthesiology, Sefako Makgatho Health Sciences University

Kieran DM Macleod

Glasgow Royal Infirmary

Zelalem Mekonnen

Armauer Hansen Research Institute

Mervyn Mer

Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand

Akinyinka O. Omigbodun

College of Medicine, University of Ibadan

Christian Owoo

University of Ghana Medical School, Korle Bu Teaching Hospital and University of Ghana Medical Centre

Fathima Paruk

Department of Critical Care, Steve Biko Academic Hospital, Faculty of Health Sciences, University of Pretoria

Jenna Piercy

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town

Juan Scribante

School of Clinical Medicine. Faculty of Health Sciences, University of the Witwatersrand

Yakob Seman

Ministry of Health, Ethiopia

Elliott H. Taylor

Nuffield Department of Surgical Sciences, University of Oxford

Dawid van Straaten

Safe Surgery South Africa, NPC

P. Dean Gopalan

Anaesthesiology & Critical Care, School of Clinical Medicine, University of KwaZulu Natal

ACCCOS Investigators Group

Independent

More...

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.

Trial Registration: This study was registered on ClinicalTrials.gov (NCT04367207).

Funding Statement: African Covid-19 Critical Care Outcomes Study (ACCCOS) was partially supported by a grant from the Critical Care Society of Southern Africa.

Declaration of Interests: We have no competing interests to declare.

Ethics Approval Statement: The primary ethics approval was from the Human Research Ethics Committee of the University of Cape Town (HREC 213/2020)

Keywords: Critical care, COVID-19, public health

Suggested 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 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

Bruce Biccard (Contact Author)

University of Cape Town (UCT) - Department of Anaesthesia and Perioperative Medicine ( email )

Cape Town
South Africa

Malcolm Gregory Miller

University of Cape Town (UCT) - Department of Anaesthesia and Perioperative Medicine ( email )

South Africa

William L. Michell

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, and Senior Scholar, Department of Surgery, Faculty of Health Sciences, University of Cape Town ( email )

David Thomson

Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town

Adesoji O. Ademuyiwa

Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital ( email )

Ernest Aniteye

Anaesthesia, Cardiothoracic Anaesthetist and Intensivist, Korle-Bu Teaching Hospital and University of Ghana Medical School ( email )

Gregory L. Calligaro

University of Cape Town (UCT) - University of Cape Town Lung Institute ( email )

Division of Pulmonology, Department of Medicine,
Groote Schuur Hospital, Observatory
Cape Town, 7925
South Africa
+27 21 404 4435 (Phone)
+27 21 404 7651 (Fax)

University of Cape Town (UCT) - Department of Anaesthesia and Perioperative Medicine

Cape Town
South Africa

Hailu Tamiru Dhufera

Ministry of Health, Ethiopia ( email )

Mahmoud Elfiky

Kasr Al Ainy Faculty of Medicine, Cairo University ( email )

Kasr Al Ainy Faculty of Medicine
Manial
Cairo, 11432
Egypt

Muhammed Elhadi

Faculty of Medicine, University of Tripoli ( email )

Maher Fawzy

Faculty of Medicine, Cairo University ( email )

David Fredericks

Department of Critical Care Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town ( email )

Meseret Gebre

Armauer Hansen Research Institute ( email )

Abebe Genetu Bayih

Armauer Hansen Research Institute ( email )

Anneli Hardy

Department of Statistical Sciences, Faculty of Science, University of Cape Town ( email )

Ivan Joubert

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town ( email )

Fitsum Kifle Belachew

Debre Berhan University College of Medicine Department of Anaesthesia ( email )

Hyla Kluyts

Department of Anaesthesiology, Sefako Makgatho Health Sciences University ( email )

Kieran DM Macleod

Glasgow Royal Infirmary ( email )

Zelalem Mekonnen

Armauer Hansen Research Institute ( email )

Mervyn Mer

Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand ( email )

Akinyinka O. Omigbodun

College of Medicine, University of Ibadan ( email )

Christian Owoo

University of Ghana Medical School, Korle Bu Teaching Hospital and University of Ghana Medical Centre ( email )

Fathima Paruk

Department of Critical Care, Steve Biko Academic Hospital, Faculty of Health Sciences, University of Pretoria ( email )

Jenna Piercy

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town ( email )

Juan Scribante

School of Clinical Medicine. Faculty of Health Sciences, University of the Witwatersrand ( email )

Yakob Seman

Ministry of Health, Ethiopia ( email )

Elliott H. Taylor

Nuffield Department of Surgical Sciences, University of Oxford ( email )

Dawid Van Straaten

Safe Surgery South Africa, NPC ( email )

P. Dean Gopalan

Anaesthesiology & Critical Care, School of Clinical Medicine, University of KwaZulu Natal ( email )

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