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

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.

Metadata

Item Type:	Article
Authors/Creators:	Drake, TM Riad, AM Fairfield, CJ Egan, C Knight, SR Pius, R Hardwick, HE Norman, L Shaw, CA McLean, KA Thompson, AAR Ho, A Swann, OV Sullivan, M Soares, F Holden, KA Merson, L Plotkin, D Sigfrid, L de Silva, TI Girvan, M Jackson, C Russell, CD Dunning, J Solomon, T Carson, G Olliaro, P Nguyen-Van-Tam, JS Turtle, L Docherty, AB Openshaw, PJM Baillie, JK Harrison, EM Semple, MG Baillie, JK Semple, MG Openshaw, PJM Carson, G Alex, B Bach, B Barclay, WS Bogaert, D Chand, M Cooke, GS Docherty, AB Dunning, J da Silva Filipe, A Fletcher, T Green, CA Harrison, EM Hiscox, JA Ho, AYW Horby, PW Ijaz, S Khoo, S Klenerman, P Law, A Lim, WS Mentzer, AJ Merson, L Meynert, AM Noursadeghi, M Moore, SC Palmarini, M Paxton, WA Pollakis, G Price, N Rambaut, A Robertson, DL Russell, CD Sancho-Shimizu, V Scott, JT de Silva, T Sigfrid, L Solomon, T Sriskandan, S Stuart, D Summers, C Tedder, RS Thomson, EC Thompson, AAR https://orcid.org/0000-0002-0717-4551 Thwaites, RS Turtle, LCW Gupta, RK Palmieri, C Swann, OV 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, TM Fairfield, CJ Knight, SR Mclean, KA Murphy, D Shaw, CA 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, SE Keating, S Ahmed, KA Armstrong, JA Ashworth, M Asiimwe, IG Bakshi, S Barlow, SL Booth, L Brennan, B Bullock, K Catterall, BWA Clark, JJ Clarke, EA Cole, S Cooper, L Cox, H Davis, C Dincarslan, O Dunn, C Dyer, P Elliott, A Evans, A Finch, L Fisher, LWS Foster, T Garcia-Dorival, I Greenhalf, W Gunning, P Hartley, C Jensen, RL Jones, CB Jones, TR Khandaker, S King, K Kiy, RT Koukorava, C Lake, A Lant, S Latawiec, D Lavelle-Langham, L Lefteri, D Lett, L Livoti, LA Mancini, M McDonald, S McEvoy, L McLauchlan, J Metelmann, S Miah, NS Middleton, J Mitchell, J Moore, SC Murphy, EG Penrice-Randal, R Pilgrim, J Prince, T Reynolds, W Ridley, PM Sales, D Shaw, VE Shears, RK Small, B Subramaniam, KS Szemiel, A Taggart, A Tanianis-Hughes, J Thomas, J Trochu, E van Tonder, L Wilcock, E Zhang, JE 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, EL 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, DB 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, MK 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, DG Workman, A Yates, B Young, P
Copyright, Publisher and Additional Information:	© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. (https://creativecommons.org/licenses/by/4.0/)
Dates:	Published: 17 July 2021 Published (online): 17 July 2021
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Sheffield Teaching Hospitals
Funding Information:	Funder Grant number BRITISH HEART FOUNDATION FS/18/13/33281
Depositing User:	Symplectic Sheffield
Date Deposited:	21 Jul 2021 09:58
Last Modified:	21 Jul 2021 09:58
Status:	Published
Publisher:	Elsevier BV
Refereed:	Yes
Identification Number:	10.1016/s0140-6736(21)00799-6
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:176374

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

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