Browsing by Author "Chaibou, M. S."

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    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
    (Elsevier B.V., 2021) Biccard, B. M.; Gopalan, P. D.; Miller, M.; Michell, W. L.; Thomson, D.; Ademuyiwa, A.; Aniteye, E.; Calligaro, G.; Chaibou, M. S.; Dhufera, H. T.; Fowotade, A.
    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.
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    The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications.
    (Elsevier Ltd., 2018) Kluyts, H. L.; Le Manach, Y.; Munlemvo, D. M.; Madzimbamuto, F.; Basenero, A.; Coulibaly, Y.; Rakotoarison, S.; Gobin, V.; Samateh, A. L.; Chaibou, M. S.; Omigbodun, A. O.; Amanor-Boadu, S. D.; Tumukunde, J.; Madiba, T. E.; Pearse, R. M.; Biccard, B. M.
    Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high6income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799(4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.