The African Critical Illness Outcomes Study (ACIOS): a point prevalence study of critical illness in 22 nations in Africa

The African Critical Illness Outcomes Study (ACIOS) Investigators

Lancet 2025; 405: 715-724

Summary

Background

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.

Methods

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.

Findings

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.

Interpretation

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.

Funding

National Institute for Health and Care Research (NIHR) Global Health Group in Perioperative and Critical Care (NIHR133850).