Статья

Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study

Annemarie B DochertyCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UKEwen M. HarrisonCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UKChristopher GreenInstitute of Microbiology and Infection, University of Birmingham, Birmingham, UKHayley HardwickInstitute of Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UKRiinu PiusCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UKLisa NormanCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UKKarl HoldenInstitute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UKJonathan M. ReadCentre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, UKFrank DondelingerCentre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, UKGail CarsonISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UKLaura MersonISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UKJames LeeISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UKDaniel PlotkinISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UKLouise SigfridISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UKSophie HalpinLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UKClare JacksonLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UKCarrol GambleLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UKPeter HorbyCentre for Tropical Medicine and International Health, Nuffield Department of Medicine, University of Oxford, Oxford, UKJonathan S. Nguyen‐Van‐TamDivision of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UKAntonia HoMedical Research Council University of Glasgow Centre for Virus Research, Glasgow, UKClark D RussellQueen's Medical Research Institute, University of Edinburgh, Edinburgh, UKJake DunningFaculty of Medicine, Imperial College London, London, UKPeter OpenshawNational Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UKJ. Kenneth BaillieIntensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UKMalcolm G. SempleNIHR 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 [email protected]

2020en

ABI

Аннотация

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.

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Идентификаторы

DOI: 10.1136/bmj.m1985

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Цитирований: 2Использованных источников: 0

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