Using research to prepare for outbreaks of severe acute respiratory infection. BMJ Global Health 2019;4:e001061. https://doi.org/10.1136/bmjgh-2018-001061
Using research to prepare for outbreaks of severe acute respiratory infection
|Author:||Mich, Vann1; Pho, Yaty1; Bory, Sotharith2,3;|
1Khmer Soviet Friend Hosp, Phnom Penh, Cambodia.
2Calmette Hosp, Phnom Penh, Cambodia.
3Univ Hlth Sci, Phnom Penh, Cambodia.
4Khmer Soviet Friendship Hosp, Phnom Penh, Cambodia.
5Takeo Prov Hosp, Krong Doun Kaev, Cambodia.
6Natl Pediat Hosp, Phnom Penh, Cambodia.
7Turku Univ Hosp, ICU, Turku, Finland.
8Cent Hosp Cent Finland, Jyvaskyla, Finland.
9Tampere Univ Hosp, Tampere, Finland.
10Oulu Univ Hosp, Res Grp Anesthesiol Surg & Intens Care Med, Oulu, Finland.
11South Karelia Cent Hosp, Lappeenranta, Finland.
12CHU Dupuytren, Reanimat Polyvalente, Limoges, France.
13CHU Dupuytren, Inserm CIC 1435, Limoges, France.
14Intens Care Unit, Paris, France.
15Dieppe Gen Hosp, Dieppe, France.
16Ctr Hospitaller Dieppe, Dieppe, France.
17Grp Hosp Paris St Joseph, Paris, France.
18Ctr Hosp Fleyriat, Bourg En Bresse, France.
19Sud Essonne Hosp Etampes, Gen Intens Care Med, Etampes, France.
20Univ Rouen, Rouen Univ Hosp GB, Serv Med Intens & Reanimat, Rouen, France.
21Univ Rouen, Normandie Univ, U1096, Rouen Univ Hosp, Rouen, France.
22Ctr Hosp Fleyriat, Serv Reanimat, Bourg En Bresse, France.
23Grand Hop Est Francilien, Jossigny, France.
24Perth Childrens Hosp, Perth, WA, Australia.
25Royal Darwin Hosp, Tiwi, Australia.
26Rockingham Gen Hosp, Cooloongup, Australia.
27St Vincents Hosp Melbourne, Melbourne, Vic, Australia.
28Concord Hosp, Concord, NH USA.
29King Georges Med Univ, Lucknow, Uttar Pradesh, India.
30Michael Garron Hosp, Toronto, ON, Canada.
31Dalhousie Univ, Halifax, NS, Canada.
32Univ Ottawa, Ottawa, ON, Canada.
33Ottawa Hosp, Ottawa, ON, Canada.
34Ste Justine Hosp & Res Ctr, Montreal, PQ, Canada.
35Joseph Brant Hosp, Burlington, ON, Canada.
36Univ Calgary, Calgary, AB, Canada.
37Humber River Hosp, Toronto, ON, Canada.
38Univ British Columbia, Div Crit Care Med, Pharmacol & Therapeut Dept Med, Dept Anesthesiol, Vancouver, BC, Canada.
39North York Gen Hosp, Toronto, ON, Canada.
40Queens Univ, Kingston, ON, Canada.
41Kingston Hlth Sci Ctr, Kingston, ON, Canada.
42Ctr Hosp Univ Montreal, Montreal, PQ, Canada.
43Univ Sherbrooke, Sherbrooke, PQ, Canada.
44Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada.
45Queen Mary Hosp, Dept Adult Intens Care Unit, Hong Kong, Peoples R China.
46Med Res Inst New Zealand, Wellington, New Zealand.
47Waikato Hosp, Hamilton, New Zealand.
48Middlemore Hosp, Auckland, New Zealand.
49Christchurch Hosp, Christchurch, New Zealand.
50Tauranga Hosp, Tauranga, New Zealand.
51Starship Hosp, Auckland, New Zealand.
52Auckland City Hosp, Dept Crit Care Med, Auckland, New Zealand.
53Yonsei Univ, Seoul, South Korea.
54Hanyang Univ, Guri Hosp, Seoul, South Korea.
55Hallym Univ, Kangnam Sacred Hosp, Chunchon, South Korea.
56Lnje Univ, Coll Med, Sanggye Paik Hosp, Gimhae, South Korea.
57Chonbuk Natl Univ Hosp, Jeonju, South Korea.
58Yonsei Univ, Wonju Coll Med, Seoul, South Korea.
59Univ Pittsburgh, Sch Med, Pittsburgh, PA 15260 USA.
60Univ N Carolina, Chapel Hill, NC 27515 USA.
61Univ Oxford, Clin Res Unit, Oxford, England.
62Natl Hosp Trop Dis, Nguyen Kinh, London, England.
63Natl Hosp Trop Dis, London, England.
64Columbia Univ, Coll Phys & Surg, New York, NY 10027 USA.
65Univ Rwanda, Coll Med & Hlth Sci, Kigali, Rwanda.
66Univ Rwanda, Dept Anesthesia Emergency Med & Crit Care, Kigali, Rwanda.
67CHUB, Butare, Rwanda.
68King Saud Bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Riyadh, Saudi Arabia.
69Inst Pasteur Madagascar, Antananarivo, Madagascar.
70Univ Hosp Joseph Raseta Befelatanana, Antananarivo, Madagascar.
71Inst Nacl Ciencias Med & Nutr Salvador SubiriAin, Mexico City, DF, Mexico.
72Inst Nacl Enfermedades Respiratorias Ismael Cosio, Mexico City, DF, Mexico.
73Hosp Cent Dr Ignacio Morones Prieto, San Luis Potosi, Mexico.
74Inst Nacl Ciencias Med & Nutr Salvador Zubiren, Mexico City, DF, Mexico.
75Univ Liverpool, Inst Infect & Global Hlth, Clin Infect Microbiol & Immunol, Liverpool, Merseyside, England.
76Malawi Liverpool Wellcome Trust, Clin Res Programme, Blantyre, Malawi.
77Kijabe Mission Hosp, Kijabe, Kenya.
78Imperial Coll Healthcare NHS Trust, GBR, London, England.
79Univ Hong Kong, Queen Mary Hosp, Hong Kong, Peoples R China.
80Univ Hong Kong, Sch Publ Hlth, Hong Kong, Peoples R China.
81Keimyung Univ, Dongsan Hosp, Dept Med, Daegu, South Korea.
82Fondat Merieux, Lyon, France.
83King Saud Bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Intens Care Dept, King Abdulaziz Med City, Riyadh, Saudi Arabia.
84Univ Washington, Seattle, WA 98195 USA.
85Harvard Med Sch, Boston, MA 02115 USA.
86Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA.
87Auckland City Hosp, Cardiothorac & Vasc ICU, Auckland, New Zealand.
88Univ Paris Saclay, AP HP, Raymond Poincare Hosp, Unievrs Versailles SOY, Paris, France.
89Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada.
90Dept Pediat, Vancouver, BC, Canada.
91Univ Coll Dublin, Dublin, Ireland.
92Monash Univ, Clayton, Vic, Australia.
93Monash Univ, Sch Publ Hlth & Prevent Med, Clayton, Vic, Australia.
94Univ Liverpool, Liverpool, Merseyside, England.
95Monash Univ, Australian & New Zealand Intens Care Res Ctr, Clayton, Vic, Australia.
96Univ Helsinki, Helsinki, Finland.
97Helsinki Univ Hosp, Helsinki, Finland.
98Univ Helsinki, Cent Hosp, Helsinki, Finland.
99Auckland City Hosp DCCM 82, Auckland, New Zealand.
100Univ Oxford, Oxford, England.
101Univ Southern Calif, Los Angeles, CA USA.
102Imperial Coll London, London, England.
103Hop Univ Paris Ctr, Site Cochin, Paris, France.
104ASAN Med Ctr, Seoul, South Korea.
105St Michaels Hosp, Toronto, ON, Canada.
106Ciberes & Vall dHebron Univ Hosp, Barcelona, Spain.
107KEMRI Wellcome Trust Res Programme, Kilifi, Kenya.
108Toronto Invas Bacterial Dis Network, Toronto, ON, Canada.
109Intens Care Natl Audit & Res Ctr, Oxford, England.
110Univ Edinburgh, Roslin Inst, Edinburgh, Midlothian, Scotland.
111Infect Dis Data Observ, Oxford, England.
112Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Med, Oxford, England.
113Natl Univ Singapore, Singapore, Singapore.
114Essex & Herts Air Ambulance Trust, Earls Colne, Essex, England.
115Kobe Univ Hosp, Kobe, Hyogo, Japan.
116WHO, Geneva, Switzerland.
117Univ Oxford, Nuffield Dept Med, Oxford, England.
118Univ Andres Bello, Santiago, Chile.
119Ctr Dis Control & Prevent, Influenza Div, Atlanta, GA USA.
120Univ Queensland Ctr, Brisbane, Qld, Australia.
121Univ Edinburgh, Queens Med Res Inst, Edinburgh, Midlothian, Scotland.
122Univ Athens, Med Sch, Athens, Greece.
123River Hosp, Alexandria Bay, NY USA.
124Univ Hlth Network TGH MOT, Toronto, ON, Canada.
125Univ Manchester, Manchester, Lancs, England.
126Mt Sinai Hosp, William Osler Hlth Ctr, New York, NY 10029 USA.
|Online Access:||PDF Full Text (PDF, 0.4 MB)|
|Persistent link:|| http://urn.fi/urn:nbn:fi-fe202003117820
|Publish Date:|| 2020-03-11
Severe acute respiratory infections (SARI) remain one of the leading causes of mortality around the world in all age groups. There is large global variation in epidemiology, clinical management and outcomes, including mortality. We performed a short period observational data collection in critical care units distributed globally during regional peak SARI seasons from 1 January 2016 until 31 August 2017, using standardised data collection tools. Data were collected for 1 week on all admitted patients who met the inclusion criteria for SARI, with follow-up to hospital discharge. Proportions of patients across regions were compared for microbiology, management strategies and outcomes. Regions were divided geographically and economically according to World Bank definitions. Data were collected for 682 patients from 95 hospitals and 23 countries. The overall mortality was 9.5%. Of the patients, 21.7% were children, with case fatality proportions of 1% for those less than 5 years. The highest mortality was in those above 60 years, at 18.6%. Case fatality varied by region: East Asia and Pacific 10.2% (21 of 206), Sub-Saharan Africa 4.3% (8 of 188), South Asia 0% (0 of 35), North America 13.6% (25 of 184), and Europe and Central Asia 14.3% (9 of 63). Mortality in low-income and low-middle-income countries combined was 4% as compared with 14% in high-income countries. Organ dysfunction scores calculated on presentation in 560 patients where full data were available revealed Sequential Organ Failure Assessment (SOFA) scores on presentation were significantly associated with mortality and hospital length of stay. Patients in East Asia and Pacific (48%) and North America (24%) had the highest SOFA scores of >12. Multivariable analysis demonstrated that initial SOFA score and age were independent predictors of hospital survival. There was variability across regions and income groupings for the critical care management and outcomes of SARI. Intensive care unit-specific factors, geography and management features were less reliable than baseline severity for predicting ultimate outcome. These findings may help in planning future outbreak severity assessments, but more globally representative data are required.
BMJ global health
|Article number:||UNSP e001061|
|Type of Publication:||
A1 Journal article – refereed
|Field of Science:||
3126 Surgery, anesthesiology, intensive care, radiology
We acknowledge support from the National Health and Medical Research Council in Australia, the Australia New Zealand Intensive Care Society Clinical Trials Group and the Seventh Framework Program in Europe, which have facilitated the progress that has been made for central project infrastructure. Data collection was funded locally by local research coordinators and investigators, including the International Respiratory and Severe Illness Center, University of Washington. The funding sources have no role in the study design, data collection or report writing.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0