부산대학교 도서관

Summary 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. (footnote)[Dagger] ACCCOS Investigators are listed in the Byline: 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 Lynn Piercy, Juan Scribante, Yakob Seman, Elliott 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, Ahmed Tawheed, Mahmoud Gamal, Mohamed El Kassas, Aml Azzam, Neama Ahmed, Yasmin NasrEldin, Omar Abdewahab, Mohamed Elganainy, Omar Elmandouh, Hailu Tamiru Dhufera, Meseret MeGebre, 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, Menbeu Sultan Mohammed, Yemane Gebremedhin, Yoseph Taye, Tamiru Assefa Mebrate, Tirunesh Busha Gemechu, Tigist Tesfaye Bedane, Elias Tewabe Abera, Ayele Teshome, Ernest Aniteye Ernest Aniteye, Christian Owoo Christian Owoo, Alfred Doku, Christian Owoo, Jane Sandra Afriyie-Mensah, Aba Lawson, Christian Owoo, Daniel Akwanfo DYaw Sottie, Emma Addae, Ernest Ofosu-Appiah Ernest Ofosu-Appiah, William Obeng 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 Hassan, Ahmed Msherghi, Ahmad Elmabri Mohammad Bouhuwaish, Vanessa Msosa, Wakisa Mulwafu, Francis Masoo, Singatiya stella Chikumbanje, 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, Adeola Fowotade, Arinola Sanusi, Babatunde Osinaike, Olusola Idowu, Abdullahi Oteikwu Amali, Sanusi Ibrahim, Adamu Abba Adamu, Ibrahim Kida, Job Otokwala, Mahmoud Essam, Olubusola Alagbe-Briggs, Sylvanus Ojum, Fathima Paruk Fathima Paruk, Juan Scribante Juan Scribante, 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, 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, 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