Acute hypoxaemic respiratory failure in a low-income country: a prospective observational study of hospital prevalence and mortality
Introduction Limited data exist on the epidemiology of acute hypoxaemic respiratory failure (AHRF) in low-income countries (LICs). We sought to determine the prevalence of AHRF in critically ill adult patients admitted to a Ugandan tertiary referral hospital; determine clinical and treatment charact...
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/7/1/e000719.full |
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| author | Moses Joloba Charlotte Summers Arthur Kwizera Noah Kiwanuka David Patrick Kateete Jane Nakibuuka Lydia Nakiyingi Cornelius Sendagire Janat Tumukunde Catherine Katabira Ronald Ssenyonga Daphne Kabatoro Diana Atwine |
| author_facet | Moses Joloba Charlotte Summers Arthur Kwizera Noah Kiwanuka David Patrick Kateete Jane Nakibuuka Lydia Nakiyingi Cornelius Sendagire Janat Tumukunde Catherine Katabira Ronald Ssenyonga Daphne Kabatoro Diana Atwine |
| author_sort | Moses Joloba |
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| description | Introduction Limited data exist on the epidemiology of acute hypoxaemic respiratory failure (AHRF) in low-income countries (LICs). We sought to determine the prevalence of AHRF in critically ill adult patients admitted to a Ugandan tertiary referral hospital; determine clinical and treatment characteristics as well as assess factors associated with mortality.Materials and methods We conducted a prospective observational study at the Mulago National Referral and Teaching Hospital in Uganda. Critically ill adults who were hospitalised at the emergency department and met the criteria for AHRF (acute shortness of breath for less than a week) were enrolled and followed up for 90 days. Multivariable analyses were conducted to determine the risk factors for death.Results A total of 7300 patients was screened. Of these, 327 (4.5%) presented with AHRF. The majority (60 %) was male and the median age was 38 years (IQR 27–52). The mean plethysmographic oxygen saturation (SpO2) was 77.6% (SD 12.7); mean SpO2/FiO2 ratio 194 (SD 32) and the mean Lung Injury Prediction Score (LIPS) 6.7 (SD 0.8). Pneumonia (80%) was the most common diagnosis. Only 6% of the patients received mechanical ventilatory support. In-hospital mortality was 77% with an average length of hospital stay of 9.2 days (SD 7). At 90 days after enrolment, the mortality increased to 85%. Factors associated with mortality were severity of hypoxaemia (risk ratio (RR) 1.29 (95% CI 1.15 to 1.54), p=0.01); a high LIPS (RR 1.79 (95% CI 1.79 1.14 to 2.83), p=0.01); thrombocytopenia (RR 1.23 (95% CI 1.11 to 1.38), p=0.01); anaemia (RR 1.15 (95% CI 1.01 to 1.31), p=0.03) ; HIV co-infection (RR 0.84 (95% CI 0.72 to 0.97), p=0.019) and male gender (RR 1.15 (95% CI 1.01 to 1.31) p=0.04).Conclusions The prevalence of AHRF among emergency department patients in a tertiary hospital in an LIC was low but was associated with very high mortality. Pneumonia was the most common cause of AHRF. Mortality was associated with higher severity of hypoxaemia, high LIPS, anaemia, HIV co-infection, thrombocytopenia and being male. |
| format | Article |
| id | doaj-art-1eac361a9b1548d8b09df19f9fb41a99 |
| institution | Kabale University |
| issn | 2052-4439 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Respiratory Research |
| spelling | doaj-art-1eac361a9b1548d8b09df19f9fb41a992024-11-24T21:25:08ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392020-09-017110.1136/bmjresp-2020-000719Acute hypoxaemic respiratory failure in a low-income country: a prospective observational study of hospital prevalence and mortalityMoses Joloba0Charlotte Summers1Arthur Kwizera2Noah Kiwanuka3David Patrick Kateete4Jane Nakibuuka5Lydia Nakiyingi6Cornelius Sendagire7Janat Tumukunde8Catherine Katabira9Ronald Ssenyonga10Daphne Kabatoro11Diana Atwine12Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, UgandaDept of Medicine, University of Cambridge, Cambridge, UK1 Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, UgandaSchool of Public Heatlh, Makerere University College of Health Sciences, Kampala, UgandaDepartment of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, UgandaIntensive Care, Mulago National Referral Hospital, Kampala, UgandaInternal Medicine, Makerere University Faculty of Medicine, Kampala, UgandaAnaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, UgandaAnaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, UgandaRespiratory medicine department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United KingdomDepartment of Epidemiology & Biostatistics, College of Health Sciences, Makerere University, Kampala, Uganda1 Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, UgandaOffice of the permanent secretary, Republic of Uganda Ministry of Health, Kampala, UgandaIntroduction Limited data exist on the epidemiology of acute hypoxaemic respiratory failure (AHRF) in low-income countries (LICs). We sought to determine the prevalence of AHRF in critically ill adult patients admitted to a Ugandan tertiary referral hospital; determine clinical and treatment characteristics as well as assess factors associated with mortality.Materials and methods We conducted a prospective observational study at the Mulago National Referral and Teaching Hospital in Uganda. Critically ill adults who were hospitalised at the emergency department and met the criteria for AHRF (acute shortness of breath for less than a week) were enrolled and followed up for 90 days. Multivariable analyses were conducted to determine the risk factors for death.Results A total of 7300 patients was screened. Of these, 327 (4.5%) presented with AHRF. The majority (60 %) was male and the median age was 38 years (IQR 27–52). The mean plethysmographic oxygen saturation (SpO2) was 77.6% (SD 12.7); mean SpO2/FiO2 ratio 194 (SD 32) and the mean Lung Injury Prediction Score (LIPS) 6.7 (SD 0.8). Pneumonia (80%) was the most common diagnosis. Only 6% of the patients received mechanical ventilatory support. In-hospital mortality was 77% with an average length of hospital stay of 9.2 days (SD 7). At 90 days after enrolment, the mortality increased to 85%. Factors associated with mortality were severity of hypoxaemia (risk ratio (RR) 1.29 (95% CI 1.15 to 1.54), p=0.01); a high LIPS (RR 1.79 (95% CI 1.79 1.14 to 2.83), p=0.01); thrombocytopenia (RR 1.23 (95% CI 1.11 to 1.38), p=0.01); anaemia (RR 1.15 (95% CI 1.01 to 1.31), p=0.03) ; HIV co-infection (RR 0.84 (95% CI 0.72 to 0.97), p=0.019) and male gender (RR 1.15 (95% CI 1.01 to 1.31) p=0.04).Conclusions The prevalence of AHRF among emergency department patients in a tertiary hospital in an LIC was low but was associated with very high mortality. Pneumonia was the most common cause of AHRF. Mortality was associated with higher severity of hypoxaemia, high LIPS, anaemia, HIV co-infection, thrombocytopenia and being male.https://bmjopenrespres.bmj.com/content/7/1/e000719.full |
| spellingShingle | Moses Joloba Charlotte Summers Arthur Kwizera Noah Kiwanuka David Patrick Kateete Jane Nakibuuka Lydia Nakiyingi Cornelius Sendagire Janat Tumukunde Catherine Katabira Ronald Ssenyonga Daphne Kabatoro Diana Atwine Acute hypoxaemic respiratory failure in a low-income country: a prospective observational study of hospital prevalence and mortality BMJ Open Respiratory Research |
| title | Acute hypoxaemic respiratory failure in a low-income country: a prospective observational study of hospital prevalence and mortality |
| title_full | Acute hypoxaemic respiratory failure in a low-income country: a prospective observational study of hospital prevalence and mortality |
| title_fullStr | Acute hypoxaemic respiratory failure in a low-income country: a prospective observational study of hospital prevalence and mortality |
| title_full_unstemmed | Acute hypoxaemic respiratory failure in a low-income country: a prospective observational study of hospital prevalence and mortality |
| title_short | Acute hypoxaemic respiratory failure in a low-income country: a prospective observational study of hospital prevalence and mortality |
| title_sort | acute hypoxaemic respiratory failure in a low income country a prospective observational study of hospital prevalence and mortality |
| url | https://bmjopenrespres.bmj.com/content/7/1/e000719.full |
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