Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study
File(s)
Published version
Author(s)
Type
Journal Article
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.
Date Issued
2020-05-22
Date Acceptance
2020-05-15
Citation
BMJ, 2020, 369 (4), pp.1-12
ISSN
1759-2151
Publisher
BMJ Publishing Group Ltd
Start Page
1
End Page
12
Journal / Book Title
BMJ
Volume
369
Issue
4
Copyright Statement
© 2020 The Author(s). This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.
Sponsor
Wellcome Trust
Wellcome Trust
Medical Research Council (MRC)
Medical Research Council (MRC)
Medical Research Council (MRC)
Imperial College Healthcare NHS Trust- BRC Funding
GlaxoSmithKline Services Unlimited
Commission of the European Communities
National Institute for Health Research
National Institute for Health Research
UKRI MRC COVID-19 Rapid Response Call
Identifier
https://www.bmj.com/content/369/bmj.m1985
Grant Number
090382/Z/09/Z
090382/Z/09/Z
MR/R502121/1
MR/R005982/1
MR/R005982/1
RDA02
PO 3000941762
806776
NIHR201385
NIHR200927
MC_PC19025
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
RISK-FACTORS
ILLNESS
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Betacoronavirus
COVID-19
Child
Child, Preschool
Comorbidity
Coronavirus Infections
Critical Care
Female
Hospitalization
Humans
Infant
Infant, Newborn
Male
Middle Aged
Pandemics
Pneumonia, Viral
Prospective Studies
Respiration, Artificial
Risk Factors
SARS-CoV-2
Sex Factors
United Kingdom
Young Adult
ISARIC4C investigators
Humans
Pneumonia, Viral
Coronavirus Infections
Respiration, Artificial
Critical Care
Hospitalization
Risk Factors
Prospective Studies
Age Factors
Comorbidity
Sex Factors
Adolescent
Adult
Aged
Aged, 80 and over
Middle Aged
Child
Child, Preschool
Infant
Infant, Newborn
Female
Male
Young Adult
Pandemics
United Kingdom
Betacoronavirus
COVID-19
SARS-CoV-2
Notes
elocation-id: m1985
Publication Status
Published
Date Publish Online
2020-05-22