1. In-hospital mortality within 30 days of admission for COVID-19 was 48% (vs. global mortality 31.5%).
2. Increased age, underlying comorbidities and delay in admission were associated with an increased mortality rate among African patients.
Evidence Rating Level: 2 (Good)
Study Rundown: The COVID-19 pandemic has exposed long-standing inequities in healthcare. Critically ill patients hospitalized with COVID-19 are assumed to have poorer health outcomes in Africa than in other continents due to squalid living conditions and scarce resources. Until now, few studies have explored the impact of critical care resources on COVID-19 mortality in Africa. The African COVID-19 Critical Care Outcomes Study (ACCCOS) aimed to determine which critical care resources, patient comorbidities, and hospital interventions were associated with mortality among hospitalized COVID-19 patients. The primary outcome was in-hospital mortality at 30 days, and the secondary outcome was association of key factors (human and facility resources, patient comorbidities, and critical care interventions) with mortality in patients with COVID-19. According to results, increased mortality was associated with insufficient critical care resources, underlying comorbidities (HIV/AIDS, diabetes, chronic liver disease, kidney disease), and severity of organ dysfunction. This study was strengthened by a large sample size, with patients from ten African countries whose risk of mortality was assessed based on individual factors. It provides valuable insight into the impact of critical care resources on overall health outcomes in this population.
In-depth [prospective cohort]: From May 7 to Dec 18, 2020, 6779 patients were assessed for eligibility across 64 hospitals in 10 African countries. Included patients were aged ≥18 and admitted to a high-care or intensive care unit with suspected or confirmed COVID-19. Patient follow-up occurred until hospital discharge, or at 30 days if the patient was still in hospital. Altogether, 3752 (55%) patients were admitted, and 3140 (84%) patients were included in the analysis. The mean patient age was 55.6 years (standard deviation [SD] 16.1) and majority (61%) were male.
On admission, 2995 (95%) of 3140 patients tested positive for SARS-CoV-2. The primary outcome of in-hospital mortality within 30 days was 48% (95% confidence interval [CI] 46-50, 1483 of 3077 patients). Of the 1594 patients alive, 261 (16%) remained in hospital at 30 days while the remaining 1333 (86%) were discharged home. With regards to the secondary outcome, a diagnosis of chronic liver disease (odds ratio [OR] 3.48, 95% CI 1.48-8.18), HIV/AIDS (OR 1.91, 95% CI 1.31-2.79), chronic kidney disease (OR 1.89, 95% CI 1.28-2.78), and diabetes (OR 1.25, 95% CI 1.01-1.56) increased the risk of mortality among patients hospitalized with COVID-19. In addition, other factors such as need for respiratory support (high flow oxygenation [OR 2.72, 95% CI 1.46-5.08]; continuous positive airway pressure [OR 3.93, 95% CI 2.13-7.26]; invasive mechanical ventilation [OR 15.27, 95% CI 8.51-27.37]), cardiorespiratory arrest within 24 h of admission (OR 4.43, 95% CI 2.25-8.73), vasopressor requirements (OR 3.67, 95% CI 2.77-4.86), delay in admission due to shortage of resources (OR 2·14; 95% CI 1·42–3·22), and age (OR 1.03, 95% CI 1.02-1.04) contributed to an increased mortality risk. Findings from this study suggest that mortality among COVID-19 patients may be higher in Africa than in other continents due to a lack of critical care resources.
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