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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.
Lancet. 2021 07 17; 398(10296):223-237.Lct

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.

Authors+Show Affiliations

Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.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.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.Medical Research Council-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK.Department of Child Life and Health, University of Edinburgh, Edinburgh, UK; Paediatric Infectious Diseases, Royal Hospital for Sick Children, Edinburgh, UK.Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.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.Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.Roslin Institute, University of Edinburgh, Edinburgh, UK; Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.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, London, UK.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 Zoological Science, University of Liverpool, Liverpool, UK; Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; United Kingdom Department of Health and Social Care, London, UK.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.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.National Heart and Lung Institute, Imperial College London, London, UK.Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK. Electronic address: ewen.harrison@ed.ac.uk.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.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

34274064

Citation

Drake, Thomas M., et al. "Characterisation of In-hospital Complications Associated With COVID-19 Using the ISARIC WHO Clinical Characterisation Protocol UK: a Prospective, Multicentre Cohort Study." Lancet (London, England), vol. 398, no. 10296, 2021, pp. 223-237.
Drake TM, Riad AM, Fairfield CJ, et al. Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study. Lancet. 2021;398(10296):223-237.
Drake, T. M., Riad, A. M., Fairfield, C. J., Egan, C., Knight, S. R., Pius, R., Hardwick, H. E., Norman, L., Shaw, C. A., McLean, K. A., Thompson, A. A. R., Ho, A., Swann, O. V., Sullivan, M., Soares, F., Holden, K. A., Merson, L., Plotkin, D., Sigfrid, L., ... Semple, M. G. (2021). Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study. Lancet (London, England), 398(10296), 223-237. https://doi.org/10.1016/S0140-6736(21)00799-6
Drake TM, et al. Characterisation of In-hospital Complications Associated With COVID-19 Using the ISARIC WHO Clinical Characterisation Protocol UK: a Prospective, Multicentre Cohort Study. Lancet. 2021 07 17;398(10296):223-237. PubMed PMID: 34274064.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study. AU - Drake,Thomas M, AU - Riad,Aya M, AU - Fairfield,Cameron J, AU - Egan,Conor, AU - Knight,Stephen R, AU - Pius,Riinu, AU - Hardwick,Hayley E, AU - Norman,Lisa, AU - Shaw,Catherine A, AU - McLean,Kenneth A, AU - Thompson,A A Roger, AU - Ho,Antonia, AU - Swann,Olivia V, AU - Sullivan,Michael, AU - Soares,Felipe, AU - Holden,Karl A, AU - Merson,Laura, AU - Plotkin,Daniel, AU - Sigfrid,Louise, AU - de Silva,Thushan I, AU - Girvan,Michelle, AU - Jackson,Clare, AU - Russell,Clark D, AU - Dunning,Jake, AU - Solomon,Tom, AU - Carson,Gail, AU - Olliaro,Piero, AU - Nguyen-Van-Tam,Jonathan S, AU - Turtle,Lance, AU - Docherty,Annemarie B, AU - Openshaw,Peter Jm, AU - Baillie,J Kenneth, AU - Harrison,Ewen M, AU - Semple,Malcolm G, AU - ,, PY - 2021/01/21/received PY - 2021/03/22/revised PY - 2021/03/29/accepted PY - 2021/7/18/entrez PY - 2021/7/19/pubmed PY - 2021/7/31/medline SP - 223 EP - 237 JF - Lancet (London, England) JO - Lancet VL - 398 IS - 10296 N2 - 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. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/34274064/Characterisation_of_in_hospital_complications_associated_with_COVID_19_using_the_ISARIC_WHO_Clinical_Characterisation_Protocol_UK:_a_prospective_multicentre_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(21)00799-6 DB - PRIME DP - Unbound Medicine ER -