Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study

Drake, T. M. et al. (2021) Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study. Lancet, 398(10296), pp. 223-237. (doi: 10.1016/S0140-6736(21)00799-6) (PMID:34274064) (PMCID:PMC8285118)

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.

• Item Type: Articles
• Additional Information: This work is supported by grants from: the NIHR (award CO-CIN-01), MRC (grant MC_PC_19059), NIHR Imperial Biomedical Research Centre (grant P45058), HPRU in Respiratory Infections at Imperial College London, and NIHR HPRU in Emerging and Zoonotic Infections at the University of Liverpool, in partnership with Public Health England (NIHR award 200907), Wellcome Trust, Department for International Development (215091/Z/18/Z), Bill & Melinda Gates Foundation (OPP1209135), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (IS-BRC-1215–20013), EU Platform for European Preparedness Against (Re-) Emerging Epidemics (PREPARE; FP7 project 602525). NIHR Clinical Research Network provided the infrastructure support for this research. LT is a Wellcome Trust clinical career development fellow, supported by grant number 205228/Z/16/Z. This research was funded in part by the Wellcome Trust. PJMO is supported by an NIHR Senior Investigator Award (award 201385).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Robertson, Professor David and Sullivan, Dr Michael and Da Silva Filipe, Dr Ana and Ho, Dr Antonia and Scott, Dr Janet and Palmarini, Professor Massimo and Thomson, Professor Emma and McDonald, Dr Sarah and Davis, Dr Chris
• Authors: 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., de Silva, T. I., Girvan, M., Jackson, C., Russell, C. D., Dunning, J., Solomon, T., Carson, G., Olliaro, P., Nguyen-Van-Tam, J. S., Turtle, L., Docherty, A. B., Openshaw, P. J., Baillie, J. K., Harrison, E. M., Semple, M. G., Baillie, J. K., Semple, M. G., Openshaw, P. J., Carson, G., Alex, B., Bach, B., Barclay, W. S., Bogaert, D., Chand, M., Cooke, G. S., Docherty, A. B., Dunning, J., da Silva Filipe, A., Fletcher, T., Green, C. A., Harrison, E. M., Hiscox, J. A., Ho, A. Y., Horby, P. W., Ijaz, S., Khoo, S., Klenerman, P., Law, A., Lim, W. S., Mentzer, A. J., Merson, L., Meynert, A. M., Noursadeghi, M., Moore, S. C., Palmarini, M., Paxton, W. A., Pollakis, G., Price, N., Rambaut, A., Robertson, D. L., Russell, C. D., Sancho-Shimizu, V., Scott, J. T., de Silva, T., Sigfrid, L., Solomon, T., Sriskandan, S., Stuart, D., Summers, C., Tedder, R. S., Thomson, E. C., Thompson, A. R., Thwaites, R. S., Turtle, L. C., Gupta, R. K., Palmieri, C., Swann, O. V., Zambon, M., Dumas, M.-E., Griffin, J., Takats, Z., Chechi, K., Andrikopoulos, P., Osagie, A., Olanipekun, M., Liggi, S., Lewis, M., dos Santos Correia, G., Sands, C., Takis, P., Maslen, L., Hardwick, H., Donohue, C., Griffiths, F., Oosthuyzen, W., Norman, L., Pius, R., Drake, T. M., Fairfield, C. J., Knight, S. R., Mclean, K. A., Murphy, D., Shaw, C. A., Dalton, J., Girvan, M., Saviciute, E., Roberts, S., Harrison, J., Marsh, L., Connor, M., Halpin, S., Jackson, C., Gamble, C., Plotkin, D., Lee, J., Leeming, G., Law, A., Wham, M., Clohisey, S., Hendry, R., Scott-Brown, J., Greenhalf, W., Shaw, V., McDonald, S. E., Keating, S., Ahmed, K. A., Armstrong, J. A., Ashworth, M., Asiimwe, I. G., Bakshi, S., Barlow, S. L., Booth, L., Brennan, B., Bullock, K., Catterall, B. W., Clark, J. J., Clarke, E. A., Cole, S., Cooper, L., Cox, H., Davis, C., Dincarslan, O., Dunn, C., Dyer, P., Elliott, A., Evans, A., Finch, L., Fisher, L. W., Foster, T., Garcia-Dorival, I., Greenhalf, W., Gunning, P., Hartley, C., Jensen, R. L., Jones, C. B., Jones, T. R., Khandaker, S., King, K., Kiy, R. T., Koukorava, C., Lake, A., Lant, S., Latawiec, D., Lavelle-Langham, L., Lefteri, D., Lett, L., Livoti, L. A., Mancini, M., McDonald, S., McEvoy, L., McLauchlan, J., Metelmann, S., Miah, N. S., Middleton, J., Mitchell, J., Moore, S. C., Murphy, E. G., Penrice-Randal, R., Pilgrim, J., Prince, T., Reynolds, W., Ridley, P. M., Sales, D., Shaw, V. E., Shears, R. K., Small, B., Subramaniam, K. S., Szemiel, A., Taggart, A., Tanianis-Hughes, J., Thomas, J., Trochu, E., van Tonder, L., Wilcock, E., Zhang, J. E., Flaherty, L., Maziere, N., Cass, E., Doce Carracedo, A., Carlucci, N., Holmes, A., Massey, H., Murphy, L., Wrobel, N., McCafferty, S., Morrice, K., MacLean, A., Adeniji, K., Agranoff, D., Agwuh, K., Ail, D., Aldera, E. L., Alegria, A., Angus, B., Ashish, A., Atkinson, D., Bari, S., Barlow, G., Barnass, S., Barrett, N., Bassford, C., Basude, S., Baxter, D., Beadsworth, M., Bernatoniene, J., Berridge, J., Best, N., Bothma, P., Chadwick, D., Brittain-Long, R., Bulteel, N., Burden, T., Burtenshaw, A., Caruth, V., Chadwick, D., Chambler, D., Chee, N., Child, J., Chukkambotla, S., Clark, T., Collini, P., Cosgrove, C., Cupitt, J., Cutino-Moguel, M.-T., Dark, P., Dawson, C., Dervisevic, S., Donnison, P., Douthwaite, S., Drummond, A., DuRand, I., Dushianthan, A., Dyer, T., Evans, C., Eziefula, C., Fegan, C., Finn, A., Fullerton, D., Garg, S., Garg, S., Garg, A., Gkrania-Klotsas, E., Godden, J., Goldsmith, A., Graham, C., Hardy, E., Hartshorn, S., Harvey, D., Havalda, P., Hawcutt, D. B., Hobrok, M., Hodgson, L., Hormis, A., Jacobs, M., Jain, S., Jennings, P., Kaliappan, A., Kasipandian, V., Kegg, S., Kelsey, M., Kendall, J., Kerrison, C., Kerslake, I., Koch, O., Koduri, G., Koshy, G., Laha, S., Laird, S., Larkin, S., Leiner, T., Lillie, P., Limb, J., Linnett, V., Little, J., Lyttle, M., MacMahon, M., MacNaughton, E., Mankregod, R., Masson, H., Matovu, E., McCullough, K., McEwen, R., Meda, M., Mills, G., Minton, J., Mirfenderesky, M., Mohandas, K., Mok, Q., Moon, J., Moore, E., Morgan, P., Morris, C., Mortimore, K., Moses, S., Mpenge, M., Mulla, R., Murphy, M., Nagel, M., Nagarajan, T., Nelson, M., Norris, L., O'Shea, M. K., Otahal, I., Ostermann, M., Pais, M., Palmieri, C., Panchatsharam, S., Papakonstantinou, D., Paraiso, H., Patel, B., Pattison, N., Pepperell, J., Peters, M., Phull, M., Pintus, S., Singh Pooni, J., Post, F., Price, D., Prout, R., Rae, N., Reschreiter, H., Reynolds, T., Richardson, N., Roberts, M., Roberts, D., Rose, A., Rousseau, G., Ryan, B., Saluja, T., Shah, A., Shanmuga, P., Sharma, A., Shawcross, A., Sizer, J., Shankar-Hari, M., Smith, R., Snelson, C., Spittle, N., Staines, N., Stambach, T., Stewart, R., Subudhi, P., Szakmany, T., Tatham, K., Thomas, J., Thompson, C., Thompson, R., Tridente, A., Tupper-Carey, D., Twagira, M., Vallotton, N., Vancheeswaran, R., Vincent-Smith, L., Visuvanathan, S., Vuylsteke, A., Waddy, S., Wake, R., Walden, A., Welters, I., Whitehouse, T., Whittaker, P., Whittington, A., Papineni, P., Wijesinghe, M., Williams, M., Wilson, L., Sarah, S., Winchester, S., Wiselka, M., Wolverson, A., Wootton, D. G., Workman, A., Yates, B., and Young, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Infection & Immunity; College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Virus Research
• Journal Name: Lancet
• Publisher: Lancet Publishing Group
• ISSN: 0140-6736
• ISSN (Online): 1474-547X
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Lancet 398(10296): 223-237
• Publisher Policy: Reproduced under a Creative Commons License