TY - JOUR
AU - Drake, Thomas M.
AU - Riad, Aya M
AU - Fairfield, Cameron J.
AU - Egan, Conor
AU - Knight, Stephen R.
AU - Pius, Riinu
AU - Hardwick, Hayley E.
AU - Norman, Lisa
AU - Shaw, Catherine A
AU - McLean, Kenneth A.
AU - Thompson, A A Roger
AU - Ho, Antonia
AU - Swann, Olivia V
AU - Sullivan, Michael
AU - Soares, Felipe
AU - Holden, Karl A.
AU - Merson, Laura
AU - Plotkin, Daniel
AU - Sigfrid, Louise
AU - de Silva, Thushan I.
AU - Girvan, Michelle
AU - Jackson, Clare
AU - Russell, Clark D.
AU - Dunning, Jake
AU - Solomon, Tom
AU - Carson, Gail
AU - Olliaro, Piero L.
AU - Nguyen-Van-Tam, Jonathan S.
AU - Turtle, Lance C.W.
AU - Docherty, Annemarie B.
AU - Openshaw, Peter J.M.
AU - Baillie, J. Kenneth
AU - Harrison, Ewen M.
AU - Semple, Malcolm G.
AU - Baillie, J. Kenneth
AU - Semple, Malcolm G.
PY - 2021
DA - July
TI - Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study
JO - The Lancet
EP - 237
VL - 398
IS - 10296
DO - http://dx.doi.org/10.1016/S0140-6736(21)00799-6
AB - Background: COVID-19 is a multisystem disease and patients who survive might have in-hospital complications. These complications are likely to have important short-term and long-term consequences for patients, health-care utilisation, health-care system preparedness, and society amidst the ongoing COVID-19 pandemic. Our aim was to characterise the extent and effect of COVID-19 complications, particularly in those who survive, using the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK. Methods: We did a prospective, multicentre cohort study in 302 UK health-care facilities. Adult patients aged 19 years or older, with confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 were included in the study. The primary outcome of this study was the incidence of in-hospital complications, defined as organ-specific diagnoses occurring alone or in addition to any hallmarks of COVID-19 illness. We used multilevel logistic regression and survival models to explore associations between these outcomes and in-hospital complications, age, and pre-existing comorbidities. Findings: Between Jan 17 and Aug 4, 2020, 80 388 patients were included in the study. Of the patients admitted to hospital for management of COVID-19, 49·7% (36 367 of 73 197) had at least one complication. The mean age of our cohort was 71·1 years (SD 18·7), with 56·0% (41 025 of 73 197) being male and 81·0% (59 289 of 73 197) having at least one comorbidity. Males and those aged older than 60 years were most likely to have a complication (aged ≥60 years: 54·5% [16 579 of 30 416] in males and 48·2% [11 707 of 24 288] in females; aged &lt;60 years: 48·8% [5179 of 10 609] in males and 36·6% [2814 of 7689] in females). Renal (24·3%, 17 752 of 73 197), complex respiratory (18·4%, 13 486 of 73 197), and systemic (16·3%, 11 895 of 73 197) complications were the most frequent. Cardiovascular (12·3%, 8973 of 73 197), neurological (4·3%, 3115 of 73 197), and gastrointestinal or liver (0·8%, 7901 of 73 197) complications were also reported. Interpretation: Complications and worse functional outcomes in patients admitted to hospital with COVID-19 are high, even in young, previously healthy individuals. Acute complications are associated with reduced ability to self-care at discharge, with neurological complications being associated with the worst functional outcomes. COVID-19 complications are likely to cause a substantial strain on health and social care in the coming years. These data will help in the design and provision of services aimed at the post-hospitalisation care of patients with COVID-19. Funding: National Institute for Health Research and the UK Medical Research Council.
PB - Elsevier
UR - http://eprints.gla.ac.uk/247282/
KW - Coronavirus (COVID-19)
KW - Hospital care
ER