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Changes in in-hospital mortality in the first wave of COVID-19: a multicentre prospective observational cohort study using the WHO Clinical Characterisation Protocol UK.
Docherty, Annemarie B; Mulholland, Rachel H; Lone, Nazir I; Cheyne, Christopher P; De Angelis, Daniela; Diaz-Ordaz, Karla; Donegan, Cara; Drake, Thomas M; Dunning, Jake; Funk, Sebastian; García-Fiñana, Marta; Girvan, Michelle; Hardwick, Hayley E; Harrison, Janet; Ho, Antonia; Hughes, David M; Keogh, Ruth H; Kirwan, Peter D; Leeming, Gary; Nguyen Van-Tam, Jonathan S; Pius, Riinu; Russell, Clark D; Spencer, Rebecca G; Tom, Brian Dm; Turtle, Lance; Openshaw, Peter Jm; Baillie, J Kenneth; Harrison, Ewen M; Semple, Malcolm G.
  • Docherty AB; Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK. Electronic address: annemarie.docherty@ed.ac.uk.
  • Mulholland RH; The Breathe Hub, University of Edinburgh, Edinburgh, UK.
  • Lone NI; Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
  • Cheyne CP; Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK.
  • De Angelis D; MRC Biostatistics Unit, University of Cambridge, Cambridge, UK.
  • Diaz-Ordaz K; London School of Hygiene & Tropical Medicine, London, UK.
  • Donegan C; 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.
  • Drake TM; Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK.
  • Dunning J; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK.
  • Funk S; London School of Hygiene & Tropical Medicine, London, UK.
  • García-Fiñana M; Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK.
  • Girvan M; Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, 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.
  • Harrison J; Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
  • Ho A; MRC University of Glasgow Centre for Virus Research, Glasgow, UK.
  • Hughes DM; Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK.
  • Keogh RH; London School of Hygiene & Tropical Medicine, London, UK.
  • Kirwan PD; MRC Biostatistics Unit, University of Cambridge, Cambridge, UK.
  • Leeming G; Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK.
  • Nguyen Van-Tam JS; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.
  • Pius R; Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK.
  • Russell CD; The Usher Institute, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
  • Spencer RG; 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.
  • Tom BD; MRC Biostatistics Unit, University of Cambridge, Cambridge, 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.
  • Openshaw PJ; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK.
  • Baillie JK; Roslin Institute, University of Edinburgh, Edinburgh, UK.
  • Harrison EM; Centre for Medical Informatics, University of Edinburgh, Edinburgh, 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; Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK.
Lancet Respir Med ; 9(7): 773-785, 2021 07.
Article in English | MEDLINE | ID: covidwho-1337040
Semantic information from SemMedBD (by NLM)
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ABSTRACT

BACKGROUND:

Mortality rates in hospitalised patients with COVID-19 in the UK appeared to decline during the first wave of the pandemic. We aimed to quantify potential drivers of this change and identify groups of patients who remain at high risk of dying in hospital.

METHODS:

In this multicentre prospective observational cohort study, the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK recruited a prospective cohort of patients with COVID-19 admitted to 247 acute hospitals in England, Scotland, and Wales during the first wave of the pandemic (between March 9 and Aug 2, 2020). We included all patients aged 18 years and older with clinical signs and symptoms of COVID-19 or confirmed COVID-19 (by RT-PCR test) from assumed community-acquired infection. We did a three-way decomposition mediation analysis using natural effects models to explore associations between week of admission and in-hospital mortality, adjusting for confounders (demographics, comorbidities, and severity of illness) and quantifying potential mediators (level of respiratory support and steroid treatment). The primary outcome was weekly in-hospital mortality at 28 days, defined as the proportion of patients who had died within 28 days of admission of all patients admitted in the observed week, and it was assessed in all patients with an outcome. This study is registered with the ISRCTN Registry, ISRCTN66726260.

FINDINGS:

Between March 9, and Aug 2, 2020, we recruited 80 713 patients, of whom 63 972 were eligible and included in the study. Unadjusted weekly in-hospital mortality declined from 32·3% (95% CI 31·8-32·7) in March 9 to April 26, 2020, to 16·4% (15·0-17·8) in June 15 to Aug 2, 2020. Reductions in mortality were observed in all age groups, in all ethnic groups, for both sexes, and in patients with and without comorbidities. After adjustment, there was a 32% reduction in the risk of mortality per 7-week period (odds ratio [OR] 0·68 [95% CI 0·65-0·71]). The higher proportions of patients with severe disease and comorbidities earlier in the first wave (March and April) than in June and July accounted for 10·2% of this reduction. The use of respiratory support changed during the first wave, with gradually increased use of non-invasive ventilation over the first wave. Changes in respiratory support and use of steroids accounted for 22·2%, OR 0·95 (0·94-0·95) of the reduction in in-hospital mortality.

INTERPRETATION:

The reduction in in-hospital mortality in patients with COVID-19 during the first wave in the UK was partly accounted for by changes in the case-mix and illness severity. A significant reduction in in-hospital mortality was associated with differences in respiratory support and critical care use, which could partly reflect accrual of clinical knowledge. The remaining improvement in in-hospital mortality is not explained by these factors, and could be associated with changes in community behaviour, inoculum dose, and hospital capacity strain.

FUNDING:

National Institute for Health Research and the Medical Research Council.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Hospital Mortality / COVID-19 Type of study: Controlled clinical trial / Etiology study / Clinical Practice Guide / Incidence study / Observational study / Prognostic study / Randomized controlled trials / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Lancet Respir Med Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Hospital Mortality / COVID-19 Type of study: Controlled clinical trial / Etiology study / Clinical Practice Guide / Incidence study / Observational study / Prognostic study / Randomized controlled trials / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Lancet Respir Med Year: 2021 Document Type: Article