Critically ill COVID-19 patients in Africa: it is time for quality registry data – Authors' reply
Authors: Bruce M Biccard, David Thomson, Malcolm Miller, Elliott H Taylor, P Dean Gopalan
Journal: The Lancet (2021)

Luigi Pisani and colleagues highlight the potential and needed role of critical care registries in the COVID-19 pandemic response in low-income and middle-income countries (LMICs). Registry data are a powerful tool when operationalised at scale.1Ranzani OT Bastos LSL Gelli JGM et al.Characterisation of the first 250 000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data.Lancet Respir Med. 2021; 9: 407-418Summary Full Text Full Text PDF PubMed Scopus (251) Google Scholar However, despite funded collaborative efforts, the existing registries in LMICs alone have been insufficient in providing an adequate pandemic response, lamented as recently as May, 2021.2GloPID-RUKCDRCOVID-19 Clinical Research Coalition Cross-Working Group on COVID-19 Research in LMICsPriorities for COVID-19 research response and preparedness in low-resource settings.Lancet. 2021; 397: 1866-1868Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar In contrast, the African Perioperative Research Group (APORG), an unfunded network, pivoted to respond to the pandemic in Africa. By April, 2020, the African COVID-19 Critical Care Outcomes Study (ACCCOS) was established, and through funding of the Critical Care Society of southern Africa, the data management of the study was supported. Simple pragmatic research with a clear question and few datapoints generated data documenting outcomes with explanatory variables. These data can now be used for risk stratification during the third wave3The African COVID-19 Critical Care Outcomes Study (ACCCOS) InvestigatorsPatient 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.Lancet. 2021; 397: 1885-1894Summary Full Text Full Text PDF PubMed Scopus (111) Google Scholar with the ACCCOS risk stratification calculator available on the APORG website. Early ACCCOS findings were available in October, 2020,4Biccard BM Miller MG Michell WL et al.An African, multi-centre evaluation of patient care and clinical outcomes for patients with COVID-19 infection admitted to high-care or intensive care units.SSRN. 2020; (published online Oct 22.)https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3707415Crossref Google Scholar and these findings were the largest peer reviewed cohort of COVID-19 outcomes from LMICs at the time of the meta-analysis, exceeding the published data from all other LMICs.3The African COVID-19 Critical Care Outcomes Study (ACCCOS) InvestigatorsPatient 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.Lancet. 2021; 397: 1885-1894Summary Full Text Full Text PDF PubMed Scopus (111) Google Scholar ACCCOS acknowledged and highlighted various challenges facing critical care research in Africa.3The African COVID-19 Critical Care Outcomes Study (ACCCOS) InvestigatorsPatient 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.Lancet. 2021; 397: 1885-1894Summary Full Text Full Text PDF PubMed Scopus (111) Google Scholar The true burden of disease is often poorly measured, as shown by the 3027 (44·7%) patients referred for critical care support but not admitted in ACCCOS.3The African COVID-19 Critical Care Outcomes Study (ACCCOS) InvestigatorsPatient 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.Lancet. 2021; 397: 1885-1894Summary Full Text Full Text PDF PubMed Scopus (111) Google Scholar A single data source cannot determine the relative importance of functionality or resource limitation on the mortality reported in ACCCOS. This is partly because the true denominator is not easily gauged during a pandemic when the normal baselines are disrupted, because the availability and definitions of a critical care bed change due to demand. Pragmatic research is agile to respond to some of these challenges, which might be more difficult for a registry response, especially where registry penetration is poor. Going forward, initiatives such as the Critical Care Africa network provide a well thought out technological platform for centres in Africa to collect data relevant to their critical care practice to inform clinical research and quality improvement. Data harmonising efforts will allow more informed study of results within their context. Collaboration between networks is necessary to leverage the differing strengths of these networks, to provide a rapid, comprehensive understanding of drivers of outcomes, especially during a pandemic. We declare no competing interests. Critically ill COVID-19 patients in Africa: it is time for quality registry dataThe African COVID-19 Critical Care Outcomes Study (ACCCOS) Investigators are to be commended for providing the first multinational study reporting epidemiological, management, and outcome data of critically ill COVID-19 patients in Africa.1 However, this important effort lags behind other international cohorts in timing and included less than half of the countries expected by the study investigators.1,2 Full-Text PDF 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 studyMortality 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. Full-Text PDF