Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK

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Title: Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK
Authors: Bloom, CI
Drake, TM
Docherty, AB
Lipworth, BJ
Johnston, SL
Nguyen-Van-Tam, JS
Carson, G
Dunning, J
Harrison, EM
Baillie, JK
Semple, MG
Leeming, G
Law, A
Wham, M
Clohisey, S
Hendry, R
Child, J
Scott-Brown, J
Greenhalf, W
Shaw, V
Mok, Q
Vincent-Smith, L
Khandaker, S
McDonald, S
Keating, S
Ahmed, KA
Armstrong, JA
Ashworth, M
Asiimwe, IG
Chukkambotla, S
Bakshi, S
Barlow, SL
Visuvanathan, S
Elliott, A
Booth, L
Brennan, B
King, K
Bullock, K
Catterall, BWA
Clark, JJ
Kiy, RT
Koukorava, C
Clark, T
Vuylsteke, A
Lake, A
Bernatoniene, J
Lant, S
Latawiec, D
Lavelle-Langham, L
Lefteri, D
Lett, L
Alex, B
Livoti, LA
Mancini, M
Waddy, S
McDonald, S
Collini, P
Moon, J
McEvoy, L
McLauchlan, J
Metelmann, S
Miah, NS
Middleton, J
Mitchell, J
Moore, SC
Wake, R
Bach, B
Murphy, EG
Penrice-Randal, R
Moore, E
Cosgrove, C
Pilgrim, J
Prince, T
Reynolds, W
Ridley, PM
Sales, D
Greenhalf, W
Shaw, VE
Shears, RK
Small, B
Barclay, WS
Morgan, P
Subramaniam, KS
Cupitt, J
Szemiel, A
Taggart, A
Tanianis-Hughes, J
Walden, A
Thomas, J
Trochu, E
Tonder, LV
Wilcock, E
Zhang, JE
Morris, C
Flaherty, L
Bogaert, D
Cole, S
Maziere, N
Welters, I
Cass, E
Carracedo, AD
Carlucci, N
Holmes, A
Massey, H
Adeniji, K
Mortimore, K
Agranoff, D
Agwuh, K
Ail, D
Whitehouse, T
Fletcher, T
Chand, M
Alegria, A
Angus, B
Ashish, A
Atkinson, D
Bari, S
Moses, S
Barlow, G
Barnass, S
Burtenshaw, A
Barrett, N
Bassford, C
Cutino-Moguel, M
Baxter, D
Cooke, GS
Beadsworth, M
Dark, P
Dawson, C
Mpenge, M
Dervisevic, S
McCullough, K
Donnison, P
Douthwaite, S
DuRand, I
Dushianthan, A
Dyer, T
Cooper, L
Evans, C
Green, CA
Eziefula, C
Khoo, S
Meynert, AM
Fegan, C
Finn, A
Fullerton, D
Garg, S
Garg, S
Garg, A
Gkrania-Klotsas, E
Cox, H
Godden, J
Goldsmith, A
Whittaker, P
Mulla, R
Harrison, EM
Graham, C
Hardy, E
Hartshorn, S
Harvey, D
Havalda, P
Hawcutt, DB
Hobrok, M
Davis, C
Whittington, A
Hodgson, L
Murphy, M
Hormis, A
Jacobs, M
Hiscox, JA
Jain, S
Jennings, P
Kaliappan, A
Kasipandian, V
Kegg, S
Wijesinghe, M
Kelsey, M
Dincarslan, O
Berridge, J
Kendall, J
Kerrison, C
Kerslake, I
Koch, O
Ho, AY
Koduri, G
Koshy, G
Williams, M
Laha, S
Laird, S
Larkin, S
Evans, A
Dunn, C
Leiner, T
Lillie, P
Limb, J
Linnett, V
Little, J
Wilson, L
Horby, PW
MacMahon, M
MacNaughton, E
Mankregod, R
Nagel, M
Masson, H
Dyer, P
Matovu, E
Nagarajan, T
Nelson, M
Wilson, S
Otahal, I
Pais, M
Panchatsharam, S
Paraiso, H
Patel, B
Klenerman, P
Best, N
Pattison, N
Cullinan, P
Pepperell, J
Gunning, P
Peters, M
Phull, M
Pintus, S
Pooni, J
Post, F
Price, D
Prout, R
Bothma, P
Rae, N
Law, A
Winchester, S
Finch, L
Reschreiter, H
Reynolds, T
Richardson, N
Roberts, M
Roberts, D
Rose, A
Rousseau, G
Brealey, D
Ryan, B
Wiselka, M
Saluja, T
Shah, A
Fisher, LWS
Lim, WS
Shanmuga, P
Sharma, A
Shawcross, A
Sizer, J
Shankar-Hari, M
Brittain-Long, R
McEwen, R
Smith, R
Snelson, C
Spittle, N
Staines, N
Foster, T
Stambach, T
Mentzer, AJ
Stewart, R
Subudhi, P
Szakmany, T
Filipe, AD
Bulteel, N
Tatham, K
Thomas, J
Thompson, C
Thompson, R
Tridente, A
Garcia-Dorival, I
Tupper-Carey, D
Twagira, M
Merson, L
Wolverson, A
Ustianowski, A
Burden, T
Vallotton, N
Wooton, DG
Noursadeghi, M
Workman, A
Yates, B
Young, P
Moore, SC
Palmarini, M
Hartley, C
Meda, M
Paxton, WA
Clarke, EA
Pollakis, G
Price, N
Rambaut, A
Robertson, DL
Russell, CD
Sancho-Shimizu, V
Scott, JT
Silva, TD
Mills, G
Sigfrid, L
Jensen, RL
Caruth, V
Solomon, T
Sriskandan, S
Stuart, D
Summers, C
Tedder, RS
Thomson, EC
Thompson, AAR
Minton, J
Thwaites, RS
Turtle, LCW
Zambon, M
Chadwick, D
Jones, CB
Hardwick, H
Donohue, C
Lyons, R
Griffiths, F
Oosthuyzen, W
Ijaz, S
Norman, L
Pius, R
Fairfield, CJ
Knight, SR
Chambler, D
Mclean, KA
Jones, TR
Murphy, D
Shaw, CA
Dalton, J
Mirfenderesky, M
Girvan, M
Saviciute, E
Roberts, S
Harrison, J
Marsh, L
Chee, N
Connor, M
Halpin, S
Openshaw, PJM
Jackson, C
Mohandas, K
Gamble, C
Item Type: Journal Article
Abstract: Background Studies of patients admitted to hospital with COVID-19 have found varying mortality outcomes associated with underlying respiratory conditions and inhaled corticosteroid use. Using data from a national, multicentre, prospective cohort, we aimed to characterise people with COVID-19 admitted to hospital with underlying respiratory disease, assess the level of care received, measure in-hospital mortality, and examine the effect of inhaled corticosteroid use. Methods We analysed data from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study. All patients admitted to hospital with COVID-19 across England, Scotland, and Wales between Jan 17 and Aug 3, 2020, were eligible for inclusion in this analysis. Patients with asthma, chronic pulmonary disease, or both, were identified and stratified by age (<16 years, 16–49 years, and ≥50 years). In-hospital mortality was measured by use of multilevel Cox proportional hazards, adjusting for demographics, comorbidities, and medications (inhaled corticosteroids, short-acting β-agonists [SABAs], and long-acting β-agonists [LABAs]). Patients with asthma who were taking an inhaled corticosteroid plus LABA plus another maintenance asthma medication were considered to have severe asthma. Findings 75 463 patients from 258 participating health-care facilities were included in this analysis: 860 patients younger than 16 years (74 [8·6%] with asthma), 8950 patients aged 16–49 years (1867 [20·9%] with asthma), and 65 653 patients aged 50 years and older (5918 [9·0%] with asthma, 10 266 [15·6%] with chronic pulmonary disease, and 2071 [3·2%] with both asthma and chronic pulmonary disease). Patients with asthma were significantly more likely than those without asthma to receive critical care (patients aged 16–49 years: adjusted odds ratio [OR] 1·20 [95% CI 1·05–1·37]; p=0·0080; patients aged ≥50 years: adjusted OR 1·17 [1·08–1·27]; p<0·0001), and patients aged 50 years and older with chronic pulmonary disease (with or without asthma) were significantly less likely than those without a respiratory condition to receive critical care (adjusted OR 0·66 [0·60–0·72] for those without asthma and 0·74 [0·62–0·87] for those with asthma; p<0·0001 for both). In patients aged 16–49 years, only those with severe asthma had a significant increase in mortality compared to those with no asthma (adjusted hazard ratio [HR] 1·17 [95% CI 0·73–1·86] for those on no asthma therapy, 0·99 [0·61–1·58] for those on SABAs only, 0·94 [0·62–1·43] for those on inhaled corticosteroids only, 1·02 [0·67–1·54] for those on inhaled corticosteroids plus LABAs, and 1·96 [1·25–3·08] for those with severe asthma). Among patients aged 50 years and older, those with chronic pulmonary disease had a significantly increased mortality risk, regardless of inhaled corticosteroid use, compared to patients without an underlying respiratory condition (adjusted HR 1·16 [95% CI 1·12–1·22] for those not on inhaled corticosteroids, and 1·10 [1·04–1·16] for those on inhaled corticosteroids; p<0·0001). Patients aged 50 years and older with severe asthma also had an increased mortality risk compared to those not on asthma therapy (adjusted HR 1·24 [95% CI 1·04–1·49]). In patients aged 50 years and older, inhaled corticosteroid use within 2 weeks of hospital admission was associated with decreased mortality in those with asthma, compared to those without an underlying respiratory condition (adjusted HR 0·86 [95% CI 0·80−0·92]). Interpretation Underlying respiratory conditions are common in patients admitted to hospital with COVID-19. Regardless of the severity of symptoms at admission and comorbidities, patients with asthma were more likely, and those with chronic pulmonary disease less likely, to receive critical care than patients without an underlying respiratory condition. In patients aged 16 years and older, severe asthma was associated with increased mortality compared to non-severe asthma. In patients aged 50 years and older, inhaled corticosteroid use in those with asthma was associated with lower mortality than in patients without an underlying respiratory condition; patients with chronic pulmonary disease had significantly increased mortality compared to those with no underlying respiratory condition, regardless of inhaled corticosteroid use. Our results suggest that the use of inhaled corticosteroids, within 2 weeks of admission, improves survival for patients aged 50 years and older with asthma, but not for those with chronic pulmonary disease.
Issue Date: 1-Jul-2021
Date of Acceptance: 5-Jan-2021
URI: http://hdl.handle.net/10044/1/85397
DOI: 10.1016/S2213-2600(21)00013-8
ISSN: 2213-2600
Publisher: Elsevier
Start Page: 699
End Page: 711
Journal / Book Title: The Lancet Respiratory Medicine
Volume: 9
Issue: 7
Replaces: 10044/1/86567
http://hdl.handle.net/10044/1/86567
Copyright Statement: © Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
© 2021 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: National Institute for Health Research
UKRI MRC COVID-19 Rapid Response Call
UK Research and Innovation
UK Research and Innovation
National Institute for Health Research
National Institute for Health Research
GlaxoSmithKline Biologicals
Medical Research Council (MRC)
Funder's Grant Number: NIHR201385
MC_PC19025
9815274 MC_PC_19025
1257927
HPRU-2012-10064
RP-2016-07-012
PO 3001965656
MR/T031565/1
Keywords: Science & Technology
Life Sciences & Biomedicine
Critical Care Medicine
Respiratory System
General & Internal Medicine
INHALED CORTICOSTEROIDS
ASTHMA
PREVALENCE
Adolescent
Adult
Asthma
COVID-19
Clinical Protocols
Cohort Studies
Female
Hospital Mortality
Hospitalization
Humans
Male
Middle Aged
Prospective Studies
Pulmonary Disease, Chronic Obstructive
Risk Assessment
United Kingdom
World Health Organization
Young Adult
ISARIC investigators
Humans
Asthma
Pulmonary Disease, Chronic Obstructive
Clinical Protocols
Hospitalization
Hospital Mortality
Risk Assessment
Cohort Studies
Prospective Studies
Adolescent
Adult
Middle Aged
World Health Organization
Female
Male
Young Adult
United Kingdom
COVID-19
1103 Clinical Sciences
1117 Public Health and Health Services
1199 Other Medical and Health Sciences
Notes: doi: 10.1016/S2213-2600(21)00013-8
Publication Status: Published
Online Publication Date: 2021-03-04
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Department of Surgery and Cancer
Department of Infectious Diseases
National Heart and Lung Institute
Faculty of Medicine
Imperial College London COVID-19



This item is licensed under a Creative Commons License Creative Commons