Clinical characteristics, risk factors and outcomes in patients with severe COVID-19 registered in the ISARIC WHO Clinical Characterisation Protocol: a prospective, multinational, multicentre, observational study

Reyes, L. F. et al. (2022) Clinical characteristics, risk factors and outcomes in patients with severe COVID-19 registered in the ISARIC WHO Clinical Characterisation Protocol: a prospective, multinational, multicentre, observational study. ERJ Open Research, 8(1), 00552-2021. (doi: 10.1183/23120541.00552-2021) (PMID:35169585) (PMCID:PMC8669808)

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Abstract

Due to the large number of patients with severe COVID-19, many were treated outside of the traditional walls of the ICU, and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside of the ICU is unknown. This was a multinational, multicentre, prospective cohort study embedded in the ISARIC WHO COVID-19 platform. Severe COVID-19 patients were identified as those admitted to an ICU and/or those treated with one of the following treatments: invasive or non-invasive mechanical ventilation, high-flow nasal cannula, inotropes, and vasopressors. A logistic Generalised Additive Model was used to compare clinical outcomes among patients admitted and not to the ICU. A total of 40 440 patients from 43 countries and six continents were included in this analysis. Severe COVID-19 patients were frequently male (62.9%), older adults (median [IQR], 67 years [55, 78]), and with at least one comorbidity (63.2%). The overall median (IQR) length of hospital stay was 10 days (5–19) and was longer in patients admitted to an ICU than in those that were cared for outside of ICU (12 [6–23] versus 8 [4–15] days, p<0.0001). The 28-day fatality ratio was lower in ICU-admitted patients (30.7% [5797/18831] versus 39.0% [7532/19295], p<0.0001). Patients admitted to an ICU had a significantly lower probability of death than those who were not (adjusted OR:0.70, 95%CI: 0.65-0.75, p<0.0001). Patients with severe COVID-19 admitted to an ICU had significantly lower 28-day fatality ratio than those cared for outside of an ICU.

Item Type:Articles
Additional Information:This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z] and the Bill & Melinda Gates Foundation [OPP1209135]; CIHR Coronavirus Rapid Research Funding Opportunity OV2170359; Grants from Rapid European COVID-19 Emergency Response research (RECOVER) [H2020 project 101003589] and European Clinical Research Alliance on Infectious Diseases (ECRAID) [965313]; The Imperial NIHR Biomedical Research Centre; The Cambridge NIHR Biomedical Research Centre; and Endorsed by the Irish Critical Care- Clinical Trials Group, co-ordinated in Ireland by the Irish Critical Care- Clinical Trials Network at University College Dublin and funded by the Health Research Board of Ireland [CTN-2014-12]. Data and Material provision was supported by grants from: the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (MRC; grant MC_PC_19059), and by the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), (award 200907), Wellcome Trust [Turtle, Lance-fellowship 205228/Z/16/Z], NIHR HPRU in Respiratory Infections at Imperial College London with PHE (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award IS-BRC-1215-20013), and NIHR Clinical Research Network providing infrastructure support. This work was possible due to the dedication and hard work of the Norwegian SARSCoV-2 study team, and supported by grants from Research Council of Norway grant no 312780, and a philanthropic donation from Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Scott, Dr Janet and Ho, Dr Antonia
Creator Roles:
Ho, A. Y. W.Conceptualization, Writing – review and editing, Investigation, Supervision, Resources, Project administration, Funding acquisition
Authors: Reyes, L. F., Murthy, S., Garcia-Gallo, E., Irvine, M., Merson, L., Martin-Loeches, I., Rello, J., Taccone, F. S., Fowler, R. A., Docherty, A. B., Kartsonaki, C., Aragao, I., Barrett, P. W., Beane, A., Burrell, A., Cheng, M. P., Christian, M. D., Cidade, J. P., Citarella, B. W., Donnelly, C. A., Fernandes, S., French, C., Haniffa, R., Harrison, E. M., Ho, A. Y. W., Joseph, M., Khan, I., Kho, M. E., Kildal, A. B., Kutsogiannis, D., Lamontagne, F., Lee, T. C., Bassi, G. L., Lopez Revilla, J. W., Marquis, C., Millar, J., Neto, R., Nichol, A., Parke, R., Pereira, R., Poli, S., Povoa, P., Ramanathan, K., Rewa, O., Riera, J., Shrapnel, S., Joao Silva, M., Udy, A., Uyeki, T., Webb, S. A., Wils, E.-J., Rojek, A., Olliaro, P. L., and ISARIC Clinical Characterization Group, .
College/School: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:ERJ Open Research
Publisher:European Respiratory Society
ISSN:2312-0541
ISSN (Online):2312-0541
Published Online:10 December 2021
Copyright Holders:Copyright ©The authors 2021
First Published:First published in ERJ Open Research 8(1): 00552-2021
Publisher Policy:Reproduced under a Creative Commons Licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
310665ISARIC - Coronavirus Clinical Characterisation ConsortiumAntonia HoMedical Research Council (MRC)MC_PC_19059 - 9815274III - Centre for Virus Research