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

ISARIC4C Investigators

Research output: Contribution to journalArticlepeer-review

47 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)223-237
Number of pages15
JournalThe Lancet
Volume398
Issue number10296
DOIs
Publication statusPublished - 17 Jul 2021

Bibliographical note

Funding 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). The views expressed are those of the authors and not necessarily those of the DHSC, Department for International Development, NIHR, MRC, Wellcome Trust, or Public Health England. This work uses data provided by patients and collected by the National Health Service (NHS) as part of their care and support. We are extremely grateful to the 2648 front-line NHS clinical and research staff and volunteer medical students, who collected this data in challenging circumstances, and the generosity of the participants and their families for their individual contributions in these difficult times. We also acknowledge the support of Jeremy J Farrar and Nahoko Shindo.

Funding Information:
ABD reports grants from the Department of Health and Social Care (DHSC), during the conduct of the study; and grants from Wellcome Trust, outside the submitted work. PJMO reports institutional fees from consultancies from Janssen, Oxford Immunotech, Nestle, Pfizer, and the European Respiratory Society; grants from the MRC, MRC Global Challenge Research Fund, EU, NIHR Biomedical Research Centre, MRC, GlaxoSmithKline, Wellcome Trust, and NIHR Health Protection Research Unit (HPRU) in Respiratory Infection; and is NIHR senior investigator outside the submitted work. PJMO's role as president of the British Society for Immunology was unpaid but travel and accommodation at some meetings was provided by the Society.JKB reports grants from MRC UK. MGS reports grants from DHSC, NIHR UK, MRC UK, HPRU in Emerging and Zoonotic Infections, and University of Liverpool, during the conduct of the study; and is chair of the Infectious Diseases Science Advisory Board and minority shareholder of Integrum Scientific, Greensboro NC, outside the submitted work. All other authors declare no competing interests.

Funding 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). The views expressed are those of the authors and not necessarily those of the DHSC, Department for International Development, NIHR, MRC, Wellcome Trust, or Public Health England. This work uses data provided by patients and collected by the National Health Service (NHS) as part of their care and support. We are extremely grateful to the 2648 front-line NHS clinical and research staff and volunteer medical students, who collected this data in challenging circumstances, and the generosity of the participants and their families for their individual contributions in these difficult times. We also acknowledge the support of Jeremy J Farrar and Nahoko Shindo.

Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Fingerprint

Dive into the research topics of 'Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study'. Together they form a unique fingerprint.

Cite this