Spencer Stephen A, Malowa Florence, McCarty David, Joekes Elizabeth, Phulusa Jacob, Chinoko Beatrice, Kaimba Sylvester, Keyala Lucy, Mandala Peter, Mkandawire Mercy, Mlongoti Matthew, Mnesa Bright, Mukatipa Albert, Mijumbi Rhona, Nyirenda Mulinda, Sawe Hendry R, Henrion Marc, Augustine Daniel X, Oxborough David, Worrall Eve, Limbani Felix, Dark Paul, Gordon Stephen B, Rylance Jamie, Morton Ben
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi.
Wellcome Open Res. 2024 Apr 17;9:205. doi: 10.12688/wellcomeopenres.21041.1. eCollection 2024.
Hospital admission due to breathlessness carries a significant burden to patients and healthcare systems, particularly impacting people in low-income countries. Prompt appropriate treatment is vital to improve outcomes, but this relies on accurate diagnostic tests which are of limited availability in resource-constrained settings. We will provide an accurate description of acute breathlessness presentations in a multicentre prospective cohort study in Malawi, a low resource setting in Southern Africa, and explore approaches to strengthen diagnostic capacity.
Primary objective: Delineate between causes of breathlessness among adults admitted to hospital in Malawi and report disease prevalence. Secondary objectives Determine patient outcomes, including mortality and hospital readmission 90 days after admission; determine the diagnostic accuracy of biomarkers to differentiate between heart failure and respiratory infections (such as pneumonia) including brain natriuretic peptides, procalcitonin and C-reactive protein.
This is a prospective longitudinal cohort study of adults (≥18 years) admitted to hospital with breathlessness across two hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Chiradzulu, Malawi. Patients will be consecutively recruited within 24 hours of emergency presentation and followed-up until 90 days from hospital admission. We will conduct enhanced diagnostic tests with robust quality assurance and quality control to determine estimates of disease pathology. Diagnostic case definitions were selected following a systematic literature search.
This study will provide detailed epidemiological description of adult hospital admissions due to breathlessness in low-income settings, which is currently poorly understood. We will delineate between causes using established case definitions and conduct nested diagnostic evaluation. The results have the potential to facilitate development of interventions targeted to strengthen diagnostic capacity, enable prompt and appropriate treatment, and ultimately improve both patient care and outcomes.
因呼吸急促入院给患者和医疗系统带来了沉重负担，对低收入国家的人群影响尤为严重。及时进行恰当治疗对于改善治疗效果至关重要，但这依赖于准确的诊断测试，而在资源有限的环境中，此类测试的可用性有限。我们将在马拉维（非洲南部一个资源匮乏地区）进行的一项多中心前瞻性队列研究中，准确描述急性呼吸急促的表现，并探索加强诊断能力的方法。
主要目的：明确马拉维住院成人呼吸急促的病因，并报告疾病患病率。次要目的：确定患者的治疗结果，包括入院90天后的死亡率和再次入院情况；确定生物标志物区分心力衰竭和呼吸道感染（如肺炎）的诊断准确性，这些生物标志物包括脑钠肽、降钙素原和C反应蛋白。
这是一项对两家医院中因呼吸急促入院的成年人（≥18岁）进行的前瞻性纵向队列研究：1）马拉维布兰太尔的伊丽莎白女王中央医院；2）马拉维奇拉祖卢的奇拉祖卢区医院。患者将在急诊就诊后24小时内连续入组，并随访至入院后90天。我们将进行强化诊断测试，并进行严格的质量保证和质量控制，以确定疾病病理学的评估结果。诊断病例定义是在系统的文献检索后选定的。
本研究将提供低收入环境下因呼吸急促住院成人的详细流行病学描述，目前对此了解甚少。我们将使用既定的病例定义区分病因，并进行嵌套式诊断评估。研究结果有可能促进针对性干预措施的制定，以加强诊断能力，实现及时恰当的治疗，并最终改善患者护理和治疗效果。
