Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.
The African Critical Illness Outcomes Study (ACIOS): A Point Prevalence Study of Critical Illness in 22 Nations in Africa
Background: Critical illness represents a major global healthcare burden and critical care is an essential component of hospital care. There are few data describing the prevalence, treatment and outcomes of critically ill patients in African hospitals.
Methods: International prospective point-prevalence study in acute hospitals across Africa. Investigators examined all in-patients ≥18 years, regardless of location, to assess the co-primary outcomes of critical illness and seven-day mortality. Patients were classified as critically ill if ≥1 vital signs were severely deranged. Data were collected describing available resources and care provided to patients. Data are presented as mean (SD), median (IQR), n (%) and odds ratios (OR) with 95% confidence intervals.
Findings: We included 19872 patients from 180 hospitals in 22 African countries between September and December 2023. The median age was 40 (29-59) years, and 11078/19862 (55·8%) patients were women. There were 967/19780 (4·9%) deaths. On census day, 2461/19743 (12·5%) patients were critically ill, with 1688/2459 (68·6%) cared for in general wards. Among the critically ill, 507/2450 (20·7%) patients died in hospital. Mortality for non-critically ill patients was 458/17205 (2·7%). Critical illness on census day was independently associated with subsequent in-hospital mortality (adjusted OR 7·59 [6·50-8·79]). Of the critically ill patients with respiratory failure, 557/1151 (48·4%) were receiving oxygen, of those with circulatory failure 521/965 (54·0%) were receiving intravenous fluids or vasopressors and of those with low conscious level, 387/784 (49·4%) were receiving an airway intervention or placed in the recovery position.
Interpretation: One in eight patients in hospitals in Africa are critically ill, of whom one in five dies within seven days. Most critically ill patients are cared for in general wards, and most do not receive the essential emergency and critical care treatments they require. Our findings suggest a high incidence of preventable deaths due to critical illness in Africa.
Funding: The study was funded by the National Institute for Health and Care Research (NIHR) Global Health Group in Perioperative and Critical Care (NIHR133850).
Declaration of Interest: RP has received research grants and honoraria from Edwards Lifesciences. All other authors declare that they have no conflict of interest.
Ethical Approval: The primary ethics approval was provided by the Human Research Ethics Committee of the University of Cape Town, South Africa (HREC 260/2023).
Keywords: Critical Care, Critical Illness, Emergency Medicine, Africa, Global Health, Health Services, Vital Signs, Epidemiology, Mortality
Baker, Tim and Scribante, Juan and Elhadi, Muhammed and Ademuyiwa, Adesoji O. and Osinaike, Babatunde and Owoo, Christian and Sottie, Daniel and Khalid, Karima and Hewitt-Smith, Adam and Kwizera, Arthur and Kifle, Fitsum and Mengistu, Degsew Dersso and Firissa, Yared Boru and Gemechu, Tirunesh Busha and Dausab, Gaudencia and Kauta, Unotjari and Sikuvi, Kaveto and Kechiche, Nahla and Ki, Kélan Bertille and Mukenga, Martin and Munlemvo, Dolly Matondo and Bittaye, Mustapha and Jagne, Abubacarr and Omar, Mohamed Abdinor and Ali Daoud, Hassan and Faisal, Mohamed and Elfiky, Mahmoud and Seleke, Mpho and Fadalla, Tarig and Koko, Alshaima and Bedada, Alemayehu and Outsouta, Gilles Niengo and Elombila, Marie and El Adib, Ahmed Rhassane and Essafti, Meryem and Lopes, Dino and Morais, Atilio and Ndarukwa, Pisirai and Handireketi, Newten and Bulamba, Fred and Mrara, Busisiwe and Kluyts, Hyla and Kinnes, Marian and Bedwell, Gillian J. and Duvenage, Hanel and Arendse, Gwendoline and Hannan, Luke and Myer, Landon and Hardy, Anneli and Schell, Carl Otto and Pearse, Rupert M. and Biccard, Bruce and Investigators, Members of the African Critical Illness Outcomes Study (ACIOS), The African Critical Illness Outcomes Study (ACIOS): A Point Prevalence Study of Critical Illness in 22 Nations in Africa. Available at SSRN: https://ssrn.com/abstract=4955306
Download This Paper