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Characteristics and outcomes of patients with COVID-19 at a district general hospital in Surrey, UK.
Knights, Harry; Mayor, Nikhil; Millar, Kristina; Cox, Matthew; Bunova, Evgeniya; Hughes, Morgan; Baker, Jack; Mathew, Sanju; Russell-Jones, David; Kotwica, Aleksandra.
  • Knights H; Royal Surrey County Hospital, Guildford, UK.
  • Mayor N; Royal Surrey County Hospital, Guildford, UK.
  • Millar K; Royal Surrey County Hospital, Guildford, UK.
  • Cox M; Royal Surrey County Hospital, Guildford, UK.
  • Bunova E; Royal Surrey County Hospital, Guildford, UK.
  • Hughes M; Royal Surrey County Hospital, Guildford, UK.
  • Baker J; Royal Surrey County Hospital, Guildford, UK.
  • Mathew S; Royal Surrey County Hospital, Guildford, UK.
  • Russell-Jones D; Royal Surrey County Hospital, Guildford, UK and University of Surrey, Guildford, UK. Harry Knights and Nikhil Mayor contributed equally to this work.
  • Kotwica A; Royal Surrey County Hospital, Guildford, UK a.kotwica@doctors.org.uk.
Clin Med (Lond) ; 20(5): e148-e153, 2020 09.
Article in English | MEDLINE | ID: covidwho-679735
ABSTRACT

BACKGROUND:

This retrospective cohort study aims to define the clinical findings and outcomes of every patient admitted to a district general hospital in Surrey with COVID-19 in March 2020, providing a snapshot of the first wave of infection in the UK. This study is the first detailed insight into the impact of frailty markers on patient outcomes and provides the infection rate among healthcare workers.

METHODS:

Data were obtained from medical records. Outcome measures were level of oxygen therapy, discharge and death. Patients were followed up until 21 April 2020.

RESULTS:

108 patients were included. 34 (31%) died in hospital or were discharged for palliative care. 43% of patients aged over 65 died. The commonest comorbidities were hypertension (49; 45%) and diabetes (25; 23%). Patients who died were older (mean difference ±SEM, 13.76±3.12 years; p<0.0001) with a higher NEWS2 score (median 6, IQR 2.5-7.5 vs median 2, IQR 2-6) and worse renal function (median differences urea 2.7 mmol/L, p<0.01; creatinine 4 µmol/L, p<0.05; eGFR 14 mL/min, p<0.05) on admission compared with survivors. Frailty markers were identified as risk factors for death. Clinical Frailty Scale (CFS) was higher in patients over 65 who died than in survivors (median 5, IQR 4-6 vs 3.5, IQR 2-5; p<0.01). Troponin and creatine kinase levels were higher in patients who died than in those who recovered (p<0.0001). Lymphopenia was common (median 0.8, IQR 0.6-1.2; p<0.005). Every patient with heart failure died (8). 26 (24%) were treated with continuous positive airway pressure (CPAP; median 3 days, IQR 2-7.3) and 9 (8%) were intubated (median 14 days, IQR 7-21). All patients who died after discharge (4; 6%) were care home residents. 276 of 699 hospital staff tested were positive for COVID-19.

CONCLUSIONS:

This study identifies older patients with frailty as being particularly vulnerable and reinforces government policy to protect this group at all costs.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Comorbidity / Cross Infection / Disease Outbreaks / Coronavirus Infections / Frailty Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Clin Med (Lond) Year: 2020 Document Type: Article Affiliation country: Clinmed.2020-0303

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Comorbidity / Cross Infection / Disease Outbreaks / Coronavirus Infections / Frailty Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Clin Med (Lond) Year: 2020 Document Type: Article Affiliation country: Clinmed.2020-0303