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

Drake, Thomas M; Riad, Aya M; Fairfield, Cameron J; Egan, Conor; Knight, Stephen R; Pius, Riinu; Hardwick, Hayley E; Norman, Lisa; Shaw, Catherine A; McLean, Kenneth A; Thompson, A A Roger; Ho, Antonia; Swann, Olivia V; Sullivan, Michael; Soares, Felipe; Holden, Karl A; Merson, Laura; Plotkin, Daniel; Sigfrid, Louise; de Silva, Thushan I; Girvan, Michelle; Jackson, Clare; Russell, Clark D; Jake Dunning, Jake; Tom Solomon, Tom; Carson, Gail; Olliaro, Piero; S Nguyen-Van-Tam, Jonathan; Turtle, Lance; B Docherty, Annemarie; JM Openshaw, Peter; Baillie, J Kenneth; M Harrison, Ewen; Semple, Malcolm G; ISARIC4C investigators, on behalf of the

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

Citation

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., … ISARIC4C investigators, O. B. O. T. (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), 223-237. https://doi.org/10.1016/S0140-6736%2821%2900799-6

• Journal Article Type: Article
• Acceptance Date: Jul 9, 2021
• Online Publication Date: Jul 17, 2021
• Publication Date: Jul 17, 2021
• Deposit Date: Jul 20, 2021
• Publicly Available Date: Jul 20, 2021
• Journal: Lancet
• Print ISSN: 0140-6736
• Electronic ISSN: 1474-547X
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 398
• Issue: 10296
• Pages: 223-237
• Series ISSN: 0140-6736
• DOI: https://doi.org/10.1016/S0140-6736%2821%2900799-6
• Public URL: https://nottingham-repository.worktribe.com/output/5808841
• Publisher URL: thelancet.com/journals/lancet/article/PIIS0140-6736(21)00799-6/fulltext
• Related Public URLs: sciencedirect.com/science/article/pii/S0140673621007996