BACKGROUND AND PURPOSE:

• Docherty et al. (BMJ, 2020) studied the first wave of hospitalized COVID-19 patients in the UK to determine the following
  • Clinical features of this group
  • Risk factors associated with in-hospital mortality

METHODS:

• Prospective observational cohort study (February 6 to April 19, 2020)
• UK maintains a “prepandemic suite of protocols, documents, and agreements in preparation for future outbreaks”
  • The International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study was part of the above suite of protocols
• Setting
  • 208 acute care hospitals in England, Wales, and Scotland
• Participants
  • Hospitalized COVID-19 patients
• Study design
  • Clinical data were collected using a case report form developed by ISARIC and WHO
  • Minimum follow-up: 2 weeks
• Primary outcomes
  • Admission to critical care (high dependency or ICU)
  • Mortality in hospital

RESULTS:

• Total of 20,133 patients
  • Median (IQR) age: 73 (58-82) years | 60% men
• Onset of symptoms
  • Median duration of symptoms before admission: 4 days (IQR 1-8 days)
• Most common comorbidities
  • Cardiac disease: 31%
  • Uncomplicated diabetes: 21%
  • Non-asthmatic chronic pulmonary disease: 18%
  • Chronic kidney disease: 16%
• No major comorbidities: 23%
• Endpoint outcomes
  • Discharged alive: 41%
  • Died: 26%
  • Still in hospital: 34%
• Outcomes for patients in critical care
  • Overall admission: 17%
  • Discharged alive: 28%
  • Died: 32%
  • Still in hospital: 41%
• Outcomes for patients receiving mechanical ventilation
  • Discharged alive: 17%
  • Died: 37%
  • Still in hospital: 46%
• Higher in-hospital mortality associated with
  • Increasing age
  • Male sex
  • Comorbidities (e.g. chronic cardiac disease, non-asthmatic chronic pulmonary disease, chronic kidney disease, liver disease and obesity)

CONCLUSION:

• The COVID-19 outcomes consistent with other large cohorts
• Outcomes worse for
  • Pre-existing characteristics: Men (across all age groups) | Older patients | Patients with comorbidities
  • Clinical course: Patients admitted to critical care or requiring mechanical ventilation
• The authors state that additional COVID-19 studies from ISARIC will continue to be published over time and in addition they make the point that

Studies such as this cannot be developed, approved, and opened from the start of a pandemic in time to inform case management and public health policy

Our study has shown the importance of forward planning and investment in preparedness studies 

Learn More – Primary Sources:

Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study

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MMWR Reports on Initial US COVID-19 Experience: Demographics, Mortality and Outcomes