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

BMJ, The - Trang m1985
Annemarie B Docherty1,2, Ewen M Harrison1, Christopher Green3, Hayley Hardwick4,5, Riinu Pius1, Lisa Norman1, Karl Holden6, Jonathan M. Read7, Frank Dondelinger7, Gail Carson8, Laura Merson8,9, James Lee8, Daniel Plotkin8, Louise Sigfrid8, Sophie Halpin10, Clare Jackson10, Carrol Gamble10, Peter Horby11, Jonathan S. Nguyen‐Van‐Tam12, Antonia Ho13, Jordan J. Clark14, Jake Dunning15,16, Peter Openshaw17, J. Kenneth Baillie2,18, Malcolm G. Semple19,20
1Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
2Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK
3Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
4Institute of Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
5National Institute of Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK
6Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
7Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, UK
8ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
9Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
10Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
11Centre for Tropical Medicine and International Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
12Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
13Medical Research Council, University of Glasgow Centre for Virus Research, Glasgow, UK
14Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
15Faculty of Medicine, Imperial College London, London, UK
16National Infection Service, Public Health England, London, UK
17National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
18Roslin Institute, University of Edinburgh, Edinburgh, UK
19NIHR Health Protection Research Unit in Emerging and Zoonotic Infections and Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
20Respiratory Medicine, Alder Hey Children's Hospital, Institute in The Park, University of Liverpool, Alder Hey Children's Hospital, Liverpool L12 2AP, UK

Tóm tắt

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.

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