Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study. Issue 10296 (17th July 2021)

• Record Type: Journal Article
• Authors: Drake, Thomas M; Riad, Aya M; Fairfield, Cameron J; Egan, Conor; Knight, Stephen R; Pius, Riinu; Hardwick, Hayley E; Norman, Lisa; Shaw, Catherine A; McLean, Kenneth A; Thompson, A A Roger; Ho, Antonia; Swann, Olivia V; Sullivan, Michael; Soares, Felipe; Holden, Karl A; Merson, Laura; Plotkin, Daniel; Sigfrid, Louise; de Silva, Thushan I; Girvan, Michelle; Jackson, Clare; Russell, Clark D; Dunning, Jake; Solomon, Tom; Carson, Gail; Olliaro, Piero; Nguyen-Van-Tam, Jonathan S; Turtle, Lance; Docherty, Annemarie B; Openshaw, Peter JM; Baillie, J Kenneth; Harrison, Ewen M; Semple, Malcolm G; Baillie, J Kenneth; Semple, Malcolm G; Openshaw, Peter JM; Carson, Gail; Alex, Beatrice; Bach, Benjamin; Barclay, Wendy S; Bogaert, Debby; Chand, Meera; Cooke, Graham S; Docherty, Annemarie B; Dunning, Jake; da Silva Filipe, Ana; Fletcher, Tom; Green, Christopher A; Harrison, Ewen M; Hiscox, Julian A; Ho, Antonia YW; Horby, Peter W; Ijaz, Samreen; Khoo, Say; Klenerman, Paul; Law, Andrew; Lim, Wei Shen; Mentzer, Alexander J; Merson, Laura; Meynert, Alison M; Noursadeghi, Mahdad; Moore, Shona C; Palmarini, Massimo; Paxton, William A; Pollakis, Georgios; Price, Nicholas; Rambaut, Andrew; Robertson, David L; Russell, Clark D; Sancho-Shimizu, Vanessa; Scott, Janet T; de Silva, Thushan; Sigfrid, Louise; Solomon, Tom; Sriskandan, Shiranee; Stuart, David; Summers, Charlotte; Tedder, Richard S; Thomson, Emma C; Thompson, AA Roger; Thwaites, Ryan S; Turtle, Lance CW; Gupta, Rishi K; Palmieri, Carlo; Swann, Olivia V; Zambon, Maria; Dumas, Marc-Emmanuel; Griffin, Julian; Takats, Zoltan; Chechi, Kanta; Andrikopoulos, Petros; Osagie, Anthonia; Olanipekun, Michael; Liggi, Sonia; Lewis, Matthew; dos Santos Correia, Gonçalo; Sands, Caroline; Takis, Panteleimon; Maslen, Lynn; Hardwick, Hayley; Donohue, Chloe; Griffiths, Fiona; Oosthuyzen, Wilna; Norman, Lisa; Pius, Riinu; Drake, Thomas M; Fairfield, Cameron J; Knight, Stephen R; Mclean, Kenneth A; Murphy, Derek; Shaw, Catherine A; Dalton, Jo; Girvan, Michelle; Saviciute, Egle; Roberts, Stephanie; Harrison, Janet; Marsh, Laura; Connor, Marie; Halpin, Sophie; Jackson, Clare; Gamble, Carrol; Plotkin, Daniel; Lee, James; Leeming, Gary; Law, Andrew; Wham, Murray; Clohisey, Sara; Hendry, Ross; Scott-Brown, James; Greenhalf, William; Shaw, Victoria; McDonald, Sarah E; Keating, Seán; Ahmed, Katie A.; Armstrong, Jane A; Ashworth, Milton; Asiimwe, Innocent G; Bakshi, Siddharth; Barlow, Samantha L; Booth, Laura; Brennan, Benjamin; Bullock, Katie; Catterall, Benjamin WA; Clark, Jordan J; Clarke, Emily A; Cole, Sarah; Cooper, Louise; Cox, Helen; Davis, Christopher; Dincarslan, Oslem; Dunn, Chris; Dyer, Philip; Elliott, Angela; Evans, Anthony; Finch, Lorna; Fisher, Lewis WS; Foster, Terry; Garcia-Dorival, Isabel; Greenhalf, William; Gunning, Philip; Hartley, Catherine; Jensen, Rebecca L; Jones, Christopher B; Jones, Trevor R; Khandaker, Shadia; King, Katharine; Kiy, Robyn T.; Koukorava, Chrysa; Lake, Annette; Lant, Suzannah; Latawiec, Diane; Lavelle-Langham, Lara; Lefteri, Daniella; Lett, Lauren; Livoti, Lucia A; Mancini, Maria; McDonald, Sarah; McEvoy, Laurence; McLauchlan, John; Metelmann, Soeren; Miah, Nahida S; Middleton, Joanna; Mitchell, Joyce; Moore, Shona C; Murphy, Ellen G; Penrice-Randal, Rebekah; Pilgrim, Jack; Prince, Tessa; Reynolds, Will; Ridley, P. Matthew; Sales, Debby; Shaw, Victoria E; Shears, Rebecca K; Small, Benjamin; Subramaniam, Krishanthi S; Szemiel, Agnieska; Taggart, Aislynn; Tanianis-Hughes, Jolanta; Thomas, Jordan; Trochu, Erwan; van Tonder, Libby; Wilcock, Eve; Zhang, J. Eunice; Flaherty, Lisa; Maziere, Nicole; Cass, Emily; Doce Carracedo, Alejandra; Carlucci, Nicola; Holmes, Anthony; Massey, Hannah; Murphy, Lee; Wrobel, Nicola; McCafferty, Sarah; Morrice, Kirstie; MacLean, Alan; Adeniji, Kayode; Agranoff, Daniel; Agwuh, Ken; Ail, Dhiraj; Aldera, Erin L.; Alegria, Ana; Angus, Brian; Ashish, Abdul; Atkinson, Dougal; Bari, Shahedal; Barlow, Gavin; Barnass, Stella; Barrett, Nicholas; Bassford, Christopher; Basude, Sneha; Baxter, David; Beadsworth, Michael; Bernatoniene, Jolanta; Berridge, John; Best, Nicola; Bothma, Pieter; Chadwick, David; Brittain-Long, Robin; Bulteel, Naomi; Burden, Tom; Burtenshaw, Andrew; Caruth, Vikki; Chadwick, David; Chambler, Duncan; Chee, Nigel; Child, Jenny; Chukkambotla, Srikanth; Clark, Tom; Collini, Paul; Cosgrove, Catherine; Cupitt, Jason; Cutino-Moguel, Maria-Teresa; Dark, Paul; Dawson, Chris; Dervisevic, Samir; Donnison, Phil; Douthwaite, Sam; Drummond, Andrew; DuRand, Ingrid; Dushianthan, Ahilanadan; Dyer, Tristan; Evans, Cariad; Eziefula, Chi; Fegan, Chrisopher; Finn, Adam; Fullerton, Duncan; Garg, Sanjeev; Garg, Sanjeev; Garg, Atul; Gkrania-Klotsas, Effrossyni; Godden, Jo; Goldsmith, Arthur; Graham, Clive; Hardy, Elaine; Hartshorn, Stuart; Harvey, Daniel; Havalda, Peter; Hawcutt, Daniel B; Hobrok, Maria; Hodgson, Luke; Hormis, Anil; Jacobs, Michael; Jain, Susan; Jennings, Paul; Kaliappan, Agilan; Kasipandian, Vidya; Kegg, Stephen; Kelsey, Michael; Kendall, Jason; Kerrison, Caroline; Kerslake, Ian; Koch, Oliver; Koduri, Gouri; Koshy, George; Laha, Shondipon; Laird, Steven; Larkin, Susan; Leiner, Tamas; Lillie, Patrick; Limb, James; Linnett, Vanessa; Little, Jeff; Lyttle, Mark; MacMahon, Michael; MacNaughton, Emily; Mankregod, Ravish; Masson, Huw; Matovu, Elijah; McCullough, Katherine; McEwen, Ruth; Meda, Manjula; Mills, Gary; Minton, Jane; Mirfenderesky, Mariyam; Mohandas, Kavya; Mok, Quen; Moon, James; Moore, Elinoor; Morgan, Patrick; Morris, Craig; Mortimore, Katherine; Moses, Samuel; Mpenge, Mbiye; Mulla, Rohinton; Murphy, Michael; Nagel, Megan; Nagarajan, Thapas; Nelson, Mark; Norris, Lillian; O'Shea, Matthew K.; Otahal, Igor; Ostermann, Marlies; Pais, Mark; Palmieri, Carlo; Panchatsharam, Selva; Papakonstantinou, Danai; Paraiso, Hassan; Patel, Brij; Pattison, Natalie; Pepperell, Justin; Peters, Mark; Phull, Mandeep; Pintus, Stefania; Singh Pooni, Jagtur; Post, Frank; Price, David; Prout, Rachel; Rae, Nikolas; Reschreiter, Henrik; Reynolds, Tim; Richardson, Neil; Roberts, Mark; Roberts, Devender; Rose, Alistair; Rousseau, Guy; Ryan, Brendan; Saluja, Taranprit; Shah, Aarti; Shanmuga, Prad; Sharma, Anil; Shawcross, Anna; Sizer, Jeremy; Shankar-Hari, Manu; Smith, Richard; Snelson, Catherine; Spittle, Nick; Staines, Nikki; Stambach, Tom; Stewart, Richard; Subudhi, Pradeep; Szakmany, Tamas; Tatham, Kate; Thomas, Jo; Thompson, Chris; Thompson, Robert; Tridente, Ascanio; Tupper-Carey, Darell; Twagira, Mary; Vallotton, Nick; Vancheeswaran, Rama; Vincent-Smith, Lisa; Visuvanathan, Shico; Vuylsteke, Alan; Waddy, Sam; Wake, Rachel; Walden, Andrew; Welters, Ingeborg; Whitehouse, Tony; Whittaker, Paul; Whittington, Ashley; Papineni, Padmasayee; Wijesinghe, Meme; Williams, Martin; Wilson, Lawrence; Sarah, Sarah; Winchester, Stephen; Wiselka, Martin; Wolverson, Adam; Wootton, Daniel G; Workman, Andrew; Yates, Bryan; Young, Peter;
• Is Part Of: Lancet. Volume 398:Issue 10296(2021)
• Page Start: 223
• Page End: 237
• Publication Date: 2021-07-17
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(21)00799-6
• Languages: English
• ISSNs: 0140-6736

Abstract

Summary: 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 (10·8%, 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.