{
  "abstract": "Background Few data regarding the incidence and outcomes of acute hypoxaemic respiratory failure (AHRF) in low- and middle-income countries exist.Methods We undertook a prospective, observational multicentre study at 11 Ugandan hospitals (July 2020–April 2021) to determine the prevalence, aetiology and 28-day all-cause mortality of AHRF (acute shortness of breath plus peripheral oxygen saturation <91% while breathing ambient air) in adults (≥18 years) who required unplanned hospitalisation.Findings 16 747 adults required unplanned hospitalisation during the study period. The median age of study participants was 50 years, and 65.1% were male. The prevalence of AHRF was 4.1%. The predominant causes were pulmonary (46.8%) and extrapulmonary infection (18.3%). Only 38 patients (5.6%) received invasive mechanical ventilation. All-cause mortality 28 days after hospitalisation was 37.9% and associated with the severity of hypoxaemia at presentation (p<0.001). Risk factors for death included oxygen saturation (adjusted relative risk (aRR) 0.96 (95% CI 0.93 to 0.98); p=0.001), the lung injury prediction score (aRR 1.83 (95% CI 1.43 to 2.36); p<0.001), respiratory rate>30 breaths per minute (aRR 2.39 (95% CI 1.34 to 4.26); p=0.003) and age >65 years (aRR 2.09 (95% CI 1.13 to 2.86); p=0.02).Interpretation In the context of the COVID-19 pandemic, the prevalence of AHRF among adults requiring unplanned hospitalisation in Uganda was comparable with that reported by previous single-centre studies. Pulmonary infection was the most common cause of AHRF. The high 28-day mortality may be explained by the severity of the disease at presentation and the limited access to advanced organ support, including invasive mechanical ventilation.",
  "authors": [
    {
      "affiliations": [
        "Anaesthesia and Critical Care, Makerere University, Kampala, Uganda"
      ],
      "name": "Arthur Kwizera"
    },
    {
      "affiliations": [
        "Makerere University, Kampala, Uganda"
      ],
      "name": "Daphne Kabatoro"
    },
    {
      "affiliations": [
        "Makerere University, Kampala, Uganda"
      ],
      "name": "Cornelius Sendagire"
    },
    {
      "affiliations": [
        "Ministry of Health, Brasilia, Brazil",
        "Makerere University College of Health Sciences, Kampala, Uganda"
      ],
      "name": "Jane Nakibuuka"
    },
    {
      "affiliations": [
        "Ministry of Health, Brasilia, Brazil"
      ],
      "name": "Darius Owachi"
    },
    {
      "affiliations": [
        "Entebbe General Hospital, Entebbe, Uganda"
      ],
      "name": "Christopher Nsereko"
    },
    {
      "affiliations": [
        "Mbale Regional Referral Hospital, Mbale, Uganda"
      ],
      "name": "John Paul Ochieng"
    },
    {
      "affiliations": [
        "Mengo Hospital, Kampala, Uganda"
      ],
      "name": "Maria Goretti Nampiina"
    },
    {
      "affiliations": [
        "Rubaga Hospital, Kampala, Uganda"
      ],
      "name": "Mary Jane Nampaawu"
    },
    {
      "affiliations": [
        "Masaka Regional Referral Hospital, Masaka, Uganda"
      ],
      "name": "Dennis Kakaire"
    },
    {
      "affiliations": [
        "Kabale Regional Referral Hospital, Kabale, Uganda"
      ],
      "name": "Morris Baluku"
    },
    {
      "affiliations": [
        "Lacor Hospital, Gulu, Uganda"
      ],
      "name": "Eric Odwar"
    },
    {
      "affiliations": [
        "Mbarara National Referral Hospital, Mbarara, Uganda"
      ],
      "name": "George Kateregga"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care Medicine, Kepler University Hospital, Linz, Austria"
      ],
      "name": "Martin Duenser"
    },
    {
      "affiliations": [
        "Director General Health Services, Republic of Uganda Ministry of Health, Kampala, Uganda"
      ],
      "name": "Charles Olaro"
    },
    {
      "affiliations": [
        "Republic of Uganda Ministry of Health, Kampala, Uganda",
        "University of Oxford Kellogg College, Oxford, UK"
      ],
      "name": "Henry Kyobe-Bosa"
    },
    {
      "affiliations": [
        "Makerere University, Kampala, Uganda"
      ],
      "name": "Bruce J Kirenga"
    },
    {
      "affiliations": [
        "Makerere University, Kampala, Uganda"
      ],
      "name": "Lydia Nakiyingi"
    },
    {
      "affiliations": [
        "Internal Medicine, Makerere University Faculty of Medicine, Kampala, Uganda"
      ],
      "name": "Pauline Byakika-Kibwika"
    },
    {
      "affiliations": [
        "School of Public Heatlh, Makerere University College of Health Sciences, Kampala, Uganda"
      ],
      "name": "Noah Kiwanuka"
    },
    {
      "affiliations": [
        "Makerere University School of Health Sciences, Kampala, Uganda"
      ],
      "name": "David Patrick Kateete"
    },
    {
      "affiliations": [
        "Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda"
      ],
      "name": "Moses Joloba"
    },
    {
      "affiliations": [
        "Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK"
      ],
      "name": "Charlotte Summers"
    },
    {
      "affiliations": [],
      "name": "for the ARISE-Uganda Investigators"
    }
  ],
  "title": "The epidemiology and outcomes of adults with acute hypoxaemic respiratory failure in a low-income country in the context of the COVID-19 pandemic: a prospective, observational, multicentre cohort study",
  "uid": "d4ba07d6-285b-5330-908d-2a447441dcfc"
}