Lancet. 2025 Mar 1;405(10480):715-724. doi: 10.1016/S0140-6736(24)02846-0.
Critical illness represents a major global health-care burden and critical care is an essential component of hospital care. There are few data describing the prevalence, treatment, and outcomes of critically ill patients in African hospitals.
This was an international, prospective, point prevalence study in acute hospitals across Africa. Investigators examined all inpatients aged 18 years or older, regardless of location, to assess the coprimary outcomes of critical illness and 7-day mortality. Patients were classified as critically ill if at least one vital sign was severely deranged. Data were collected for the available resources at each hospital and care provided to patients.
We included 19 872 patients from 180 hospitals in 22 African countries or territories between September, 2023 and December, 2023. The median age was 40 (IQR 29-59) years, and 11 078/19 862 (55·8%) patients were women. There were 967/19 780 (4·9%) deaths. On census day, 2461/19 743 (12·5%) patients were critically ill, with 1688/2459 (68·6%) cared for in general wards. Among the critically ill, 507/2450 (20·7%) patients died in hospital. Mortality for non-critically ill patients was 458/17 205 (2·7%). Critical illness on census day was independently associated with subsequent in-hospital mortality (adjusted odds ratio 7·72 [6·65-8·95]). Of the critically ill patients with respiratory failure, 557/1151 (48·4%) were receiving oxygen; of the patients with circulatory failure, 521/965 (54·0%) were receiving intravenous fluids or vasopressors; and of patients with low conscious level, 387/784 (49·4%) were receiving an airway intervention or placed in the recovery position.
One in eight patients in hospitals in Africa are critically ill, of whom one in five dies within 7 days. Most critically ill patients are cared for in general wards, and most do not receive the essential emergency and critical care treatments they require. Our findings suggest a high burden of critical illness in Africa and that improving the care of critically ill patients would have the potential to save many lives.
National Institute for Health and Care Research (NIHR) Global Health Group in Perioperative and Critical Care (NIHR133850).
危重病是全球主要的医疗负担，重症监护是医院护理的重要组成部分。关于非洲医院危重病患者的患病率、治疗情况和结局的数据很少。
这是一项在非洲各地急性医院开展的国际性、前瞻性、现患率研究。研究人员检查了所有18岁及以上的住院患者，无论其所在位置，以评估危重病和7天死亡率这两个共同主要结局。如果至少一项生命体征严重紊乱，患者被分类为危重病患者。收集了每家医院的可用资源以及为患者提供的护理的数据。
在2023年9月至2023年12月期间，我们纳入了来自22个非洲国家或地区180家医院的19872例患者。中位年龄为40（四分位间距29 - 59）岁，11078/19862（55.8%）例患者为女性。有 967/19780（4.9%）例患者死亡。在普查日，2461/19743（12.5%）例患者为危重病患者，其中1688/2459（68.6%）例在普通病房接受护理。在危重病患者中，507/2450（20.7%）例患者在医院死亡。非危重病患者的死亡率为458/17205（2.7%）。普查日的危重病与随后的院内死亡率独立相关（调整后的优势比为7.72 [6.65 - 8.95]）。在患有呼吸衰竭的危重病患者中，557/1151（48.4%）例正在接受吸氧；在患有循环衰竭的患者中，521/965（54.0%）例正在接受静脉输液或血管活性药物治疗；在意识水平低下的患者中，387/784（49.4%）例正在接受气道干预或处于恢复体位。
非洲医院中八分之一的患者为危重病患者，其中五分之一在7天内死亡。大多数危重病患者在普通病房接受护理，且大多数未接受他们所需的基本急救和重症护理治疗。我们的研究结果表明非洲危重病负担很高，改善危重病患者的护理有可能挽救许多生命。
国家卫生与保健研究所（NIHR）围手术期和重症监护全球健康组（NIHR133850）。
