BMJ global health · 2025
The epidemiology and outcomes of adults with acute hypoxaemic respiratory failure in a low-income country in the context of the COVID-19 pandemic: a prospective, observational, multicentre cohort study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Kwizera Arthur, Kabatoro Daphne, Sendagire Cornelius, Nakibuuka Jane, Owachi Darius, Nsereko Christopher, Ochieng John Paul, Goretti Nampiina Maria, Nampaawu Mary Jane, Kakaire Dennis, Baluku Morris, Odwar Eric, Kateregga George, Duenser Martin, Olaro Charles, Kyobe-Bosa Henry, Kirenga Bruce J, Nakiyingi Lydia, Byakika-Kibwika Pauline, Kiwanuka Noah, Kateete David Patrick, Joloba Moses, Summers Charlotte, ARISE-Uganda Investigators
Аннотация
BACKGROUND: Few data regarding the incidence and outcomes of acute hypoxaemic respiratory failure (AHRF) in low- and middle-income countries exist.
METHODS: We undertook a prospective, observational multicentre study at 11 Ugandan hospitals (July 2020-April 2021) to determine the prevalence, aetiology and 28-day all-cause mortality of AHRF (acute shortness of breath plus peripheral oxygen saturation <91% while breathing ambient air) in adults (≥18 years) who required unplanned hospitalisation.
FINDINGS: 16 747 adults required unplanned hospitalisation during the study period. The median age of study participants was 50 years, and 65.1% were male. The prevalence of AHRF was 4.1%. The predominant causes were pulmonary (46.8%) and extrapulmonary infection (18.3%). Only 38 patients (5.6%) received invasive mechanical ventilation. All-cause mortality 28 days after hospitalisation was 37.9% and associated with the severity of hypoxaemia at presentation (p<0.001). Risk factors for death included oxygen saturation (adjusted relative risk (aRR) 0.96 (95% CI 0.93 to 0.98); p=0.001), the lung injury prediction score (aRR 1.83 (95% CI 1.43 to 2.36); p<0.001), respiratory rate>30 breaths per minute (aRR 2.39 (95% CI 1.34 to 4.26); p=0.003) and age >65 years (aRR 2.09 (95% CI 1.13 to 2.86); p=0.02).
INTERPRETATION: In the context of the COVID-19 pandemic, the prevalence of AHRF among adults requiring unplanned hospitalisation in Uganda was comparable with that reported by previous single-centre studies. Pulmonary infection was the most common cause of AHRF. The high 28-day mortality may be explained by the severity of the disease at presentation and the limited access to advanced organ support, including invasive mechanical ventilation.
METHODS: We undertook a prospective, observational multicentre study at 11 Ugandan hospitals (July 2020-April 2021) to determine the prevalence, aetiology and 28-day all-cause mortality of AHRF (acute shortness of breath plus peripheral oxygen saturation <91% while breathing ambient air) in adults (≥18 years) who required unplanned hospitalisation.
FINDINGS: 16 747 adults required unplanned hospitalisation during the study period. The median age of study participants was 50 years, and 65.1% were male. The prevalence of AHRF was 4.1%. The predominant causes were pulmonary (46.8%) and extrapulmonary infection (18.3%). Only 38 patients (5.6%) received invasive mechanical ventilation. All-cause mortality 28 days after hospitalisation was 37.9% and associated with the severity of hypoxaemia at presentation (p<0.001). Risk factors for death included oxygen saturation (adjusted relative risk (aRR) 0.96 (95% CI 0.93 to 0.98); p=0.001), the lung injury prediction score (aRR 1.83 (95% CI 1.43 to 2.36); p<0.001), respiratory rate>30 breaths per minute (aRR 2.39 (95% CI 1.34 to 4.26); p=0.003) and age >65 years (aRR 2.09 (95% CI 1.13 to 2.86); p=0.02).
INTERPRETATION: In the context of the COVID-19 pandemic, the prevalence of AHRF among adults requiring unplanned hospitalisation in Uganda was comparable with that reported by previous single-centre studies. Pulmonary infection was the most common cause of AHRF. The high 28-day mortality may be explained by the severity of the disease at presentation and the limited access to advanced organ support, including invasive mechanical ventilation.