Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study.
Lancet
; 398(10296): 223-237, 2021 07 17.
Article
in English
| MEDLINE | ID: covidwho-1313499
ABSTRACT
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, 80â388 patients were included in the study. Of the patients admitted to hospital for management of COVID-19, 49·7% (36â367 of 73â197) had at least one complication. The mean age of our cohort was 71·1 years (SD 18·7), with 56·0% (41â025 of 73â197) being male and 81·0% (59â289 of 73â197) 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% [16â579 of 30â416] in males and 48·2% [11â707 of 24â288] in females; aged <60 years 48·8% [5179 of 10â609] in males and 36·6% [2814 of 7689] in females). Renal (24·3%, 17â752 of 73â197), complex respiratory (18·4%, 13â486 of 73â197), and systemic (16·3%, 11â895 of 73â197) complications were the most frequent. Cardiovascular (12·3%, 8973 of 73â197), neurological (4·3%, 3115 of 73â197), and gastrointestinal or liver (0·8%, 7901 of 73â197) 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.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Comorbidity
/
Clinical Protocols
/
Hospital Mortality
/
COVID-19
/
Hospitalization
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Topics:
Long Covid
Limits:
Aged
/
Female
/
Humans
/
Male
Country/Region as subject:
Europa
Language:
English
Journal:
Lancet
Year:
2021
Document Type:
Article
Affiliation country:
S0140-6736(21)00799-6
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