Causes and Contributing Factors of In-Hospital and Post-Discharge Mortality Among Patients With Severe Acute Respiratory Infection in Low- and Middle-Income Countries: A Scoping Review.

Background and Aims: Severe acute respiratory infections (SARI) remain a major cause of global morbidity and mortality, with a disproportionate burden in low- and middle-income countries (LMICs). Although in-hospital mortality is frequently reported, deaths occurring after hospital discharge remain poorly documented. We aimed to synthesise the available evidence on the causes and contributing factors of in-hospital and post-discharge mortality among patients hospitalised with SARI in LMICs. Methods: We conducted a scoping review following the Arksey and O'Malley framework and PRISMA-ScR guidelines. PubMed, Web of Science, Scopus, and CINAHL were searched for studies published between January 2000 and October 2025 that reported in-hospital and/or post-discharge mortality among patients with SARI in LMICs. Findings were synthesised narratively to describe factors associated with in-hospital and post-discharge mortality, as well as reported causes of death. Results: Twenty-nine studies from 13 LMICs met the inclusion criteria. All reported in-hospital mortality (range: 0.4%-39.3%), while four reported post-discharge mortality (range: 0.6%-5.7%). Thirteen studies examined factors associated with mortality. In-hospital mortality was associated with older age, male sex, comorbidities, markers of severe clinical presentation, specific respiratory pathogens, and delayed healthcare seeking. Only one study specifically evaluated factors associated with post-discharge mortality, identifying respiratory difficulty, underlying heart disease, and longer hospital stay among children, and chronic obstructive pulmonary disease and intensive care unit admission among adults as risk factors. Pathogen-specific causes of in-hospital death were reported in a single study, and no study reported definitive causes of post-discharge mortality. Conclusion: Evidence on SARI-associated mortality in LMICs is largely confined to in-hospital outcomes, with limited assessment of post-discharge mortality or causes of death. Standardised post-discharge follow-up and systematic cause-of-death reporting are needed to inform clinical care, strengthen surveillance, and support targeted interventions to reduce preventable SARI-associated mortality in LMICs.