Journal Article

Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study

Green, Christopher A, Pius, Riinu, Carson, Gail, Read, Jonathan M, Ho, Antonia, Holden, Karl A, Russell, Clark D, Dondelinger, Frank, Lee, James, Openshaw, Peter JM, Sigfrid, Louise, Jackson, Clare, Gamble, Carrol, Docherty, Annemarie B, Harrison, Ewen M, Merson, Laura, Baillie, J Kenneth, Norman, Lisa, Hardwick, Hayley E, Dunning, Jake, Horby, Peter W, Halpin, Sophie, Semple, Malcolm G, Plotkin, Daniel, Nguyen-Van-Tam, Jonathan S

2020

Overview

AbstractObjectiveTo characterise the clinical features of patients admitted to hospital with coronavirus disease 2019 (covid-19) in the United Kingdom during the growth phase of the first wave of this outbreak who were enrolled in the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO) Clinical Characterisation Protocol UK (CCP-UK) study, and to explore risk factors associated with mortality in hospital.DesignProspective observational cohort study with rapid data gathering and near real time analysis.Setting208 acute care hospitals in England, Wales, and Scotland between 6 February and 19 April 2020. A case report form developed by ISARIC and WHO was used to collect clinical data. A minimal follow-up time of two weeks (to 3 May 2020) allowed most patients to complete their hospital admission.Participants20 133 hospital inpatients with covid-19.Main outcome measuresAdmission to critical care (high dependency unit or intensive care unit) and mortality in hospital.ResultsThe median age of patients admitted to hospital with covid-19, or with a diagnosis of covid-19 made in hospital, was 73 years (interquartile range 58-82, range 0-104). More men were admitted than women (men 60%, n=12 068; women 40%, n=8065). The median duration of symptoms before admission was 4 days (interquartile range 1-8). The commonest comorbidities were chronic cardiac disease (31%, 5469/17 702), uncomplicated diabetes (21%, 3650/17 599), non-asthmatic chronic pulmonary disease (18%, 3128/17 634), and chronic kidney disease (16%, 2830/17 506); 23% (4161/18 525) had no reported major comorbidity. Overall, 41% (8199/20 133) of patients were discharged alive, 26% (5165/20 133) died, and 34% (6769/20 133) continued to receive care at the reporting date. 17% (3001/18 183) required admission to high dependency or intensive care units; of these, 28% (826/3001) were discharged alive, 32% (958/3001) died, and 41% (1217/3001) continued to receive care at the reporting date. Of those receiving mechanical ventilation, 17% (276/1658) were discharged alive, 37% (618/1658) died, and 46% (764/1658) remained in hospital. Increasing age, male sex, and comorbidities including chronic cardiac disease, non-asthmatic chronic pulmonary disease, chronic kidney disease, liver disease and obesity were associated with higher mortality in hospital.ConclusionsISARIC WHO CCP-UK is a large prospective cohort study of patients in hospital with covid-19. The study continues to enrol at the time of this report. In study participants, mortality was high, independent risk factors were increasing age, male sex, and chronic comorbidity, including obesity. This study has shown the importance of pandemic preparedness and the need to maintain readiness to launch research studies in response to outbreaks.Study registrationISRCTN66726260.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group Ltd
• Subject: Adolescent / Adult / Age / Age Factors / Aged / Aged, 80 and over / Asthma / Betacoronavirus / Child / Child, Preschool / Cohort analysis / Comorbidity / Coronary artery disease / Coronavirus Infections - epidemiology / Coronavirus Infections - mortality / Coronaviruses / COVID-19 / Critical Care / Diabetes / Diabetes mellitus / Epidemics / Female / Heart diseases / Hospitalization / Hospitals / Humans / Infant / Infant, Newborn / Infections / Intensive care / Intensive care units / Kidney diseases / Liver diseases / Lung diseases / Male / Mechanical ventilation / Medical research / Middle Aged / Mortality / Obesity / Observational studies / Outbreaks / Pandemics / Pathogens / Patients / Pneumonia, Viral - epidemiology / Pneumonia, Viral - mortality / Portfolio management / Prospective Studies / Public health / Respiration, Artificial / Risk Factors / SARS-CoV-2 / Severe acute respiratory syndrome coronavirus 2 / Sex Factors / United Kingdom - epidemiology / Young Adult