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Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study.
BMJ. 2020 May 22; 369:m1985.BMJ

Abstract

OBJECTIVE

To 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.

DESIGN

Prospective observational cohort study with rapid data gathering and near real time analysis.

SETTING

208 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.

PARTICIPANTS

20 133 hospital inpatients with covid-19.

MAIN OUTCOME MEASURES

Admission to critical care (high dependency unit or intensive care unit) and mortality in hospital.

RESULTS

The 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.

CONCLUSIONS

ISARIC 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 REGISTRATION

ISRCTN66726260.

Authors+Show Affiliations

Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK. Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK.National Institute of Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK. Institute of Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, UK.Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, UK.ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.Centre for Tropical Medicine and International Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK.Medical Research Council University of Glasgow Centre for Virus Research, Glasgow, UK.Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.National Infection Service, Public Health England, London, UK. Faculty of Medicine, Imperial College London, London, UK.National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK.Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK. Roslin Institute, University of Edinburgh, Edinburgh, UK.NIHR 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 m.g.semple@liverpool.ac.uk. Respiratory Medicine, Alder Hey Children's Hospital, Institute in The Park, University of Liverpool, Alder Hey Children's Hospital, Liverpool L12 2AP, UK.No affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

32444460

Citation

Docherty, Annemarie B., et al. "Features of 20 133 UK Patients in Hospital With Covid-19 Using the ISARIC WHO Clinical Characterisation Protocol: Prospective Observational Cohort Study." BMJ (Clinical Research Ed.), vol. 369, 2020, pp. m1985.
Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985.
Docherty, A. B., Harrison, E. M., Green, C. A., Hardwick, H. E., Pius, R., Norman, L., Holden, K. A., Read, J. M., Dondelinger, F., Carson, G., Merson, L., Lee, J., Plotkin, D., Sigfrid, L., Halpin, S., Jackson, C., Gamble, C., Horby, P. W., Nguyen-Van-Tam, J. S., ... Semple, M. G. (2020). Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ (Clinical Research Ed.), 369, m1985. https://doi.org/10.1136/bmj.m1985
Docherty AB, et al. Features of 20 133 UK Patients in Hospital With Covid-19 Using the ISARIC WHO Clinical Characterisation Protocol: Prospective Observational Cohort Study. BMJ. 2020 May 22;369:m1985. PubMed PMID: 32444460.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. AU - Docherty,Annemarie B, AU - Harrison,Ewen M, AU - Green,Christopher A, AU - Hardwick,Hayley E, AU - Pius,Riinu, AU - Norman,Lisa, AU - Holden,Karl A, AU - Read,Jonathan M, AU - Dondelinger,Frank, AU - Carson,Gail, AU - Merson,Laura, AU - Lee,James, AU - Plotkin,Daniel, AU - Sigfrid,Louise, AU - Halpin,Sophie, AU - Jackson,Clare, AU - Gamble,Carrol, AU - Horby,Peter W, AU - Nguyen-Van-Tam,Jonathan S, AU - Ho,Antonia, AU - Russell,Clark D, AU - Dunning,Jake, AU - Openshaw,Peter Jm, AU - Baillie,J Kenneth, AU - Semple,Malcolm G, AU - ,, Y1 - 2020/05/22/ PY - 2020/5/24/entrez PY - 2020/5/24/pubmed PY - 2020/5/29/medline SP - m1985 EP - m1985 JF - BMJ (Clinical research ed.) JO - BMJ VL - 369 N2 - OBJECTIVE: To 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. DESIGN: Prospective observational cohort study with rapid data gathering and near real time analysis. SETTING: 208 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. PARTICIPANTS: 20 133 hospital inpatients with covid-19. MAIN OUTCOME MEASURES: Admission to critical care (high dependency unit or intensive care unit) and mortality in hospital. RESULTS: The 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. CONCLUSIONS: ISARIC 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 REGISTRATION: ISRCTN66726260. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/32444460/full_citation L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=32444460 DB - PRIME DP - Unbound Medicine ER -