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Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study.
Drake, Thomas M; Riad, Aya M; Fairfield, Cameron J; Egan, Conor; Knight, Stephen R; Pius, Riinu; Hardwick, Hayley E; Norman, Lisa; Shaw, Catherine A; McLean, Kenneth A; Thompson, A A Roger; Ho, Antonia; Swann, Olivia V; Sullivan, Michael; Soares, Felipe; Holden, Karl A; Merson, Laura; Plotkin, Daniel; Sigfrid, Louise; de Silva, Thushan I; Girvan, Michelle; Jackson, Clare; Russell, Clark D; Dunning, Jake; Solomon, Tom; Carson, Gail; Olliaro, Piero; Nguyen-Van-Tam, Jonathan S; Turtle, Lance; Docherty, Annemarie B; Openshaw, Peter Jm; Baillie, J Kenneth; Harrison, Ewen M; Semple, Malcolm G.
  • Drake TM; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Riad AM; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Fairfield CJ; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Egan C; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Knight SR; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Pius R; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Hardwick HE; Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
  • Norman L; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Shaw CA; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • McLean KA; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Thompson AAR; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
  • Ho A; Medical Research Council-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK.
  • Swann OV; Department of Child Life and Health, University of Edinburgh, Edinburgh, UK; Paediatric Infectious Diseases, Royal Hospital for Sick Children, Edinburgh, UK.
  • Sullivan M; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
  • Soares F; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
  • Holden KA; Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK.
  • Merson L; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Plotkin D; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Sigfrid L; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • de Silva TI; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
  • Girvan M; Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
  • Jackson C; Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
  • Russell CD; Roslin Institute, University of Edinburgh, Edinburgh, UK; Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
  • Dunning J; Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Emerging Infections and Zoonoses Unit, National Infection Service, Public Health England, Lond
  • Solomon T; Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Zoolog
  • Carson G; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Olliaro P; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Nguyen-Van-Tam JS; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; United Kingdom Department of Health and Social Care, London, UK.
  • Turtle L; Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
  • Docherty AB; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Openshaw PJ; National Heart and Lung Institute, Imperial College London, London, UK.
  • Baillie JK; Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
  • Harrison EM; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK. Electronic address: ewen.harrison@ed.ac.uk.
  • Semple MG; Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Paediatric Infectious Diseases, Royal Hospital for Sick Children, Edinburgh, UK.
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, 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 <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.
Subject(s)

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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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