Features of 20133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study
Features of 20133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study
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DOI：
10.1136/bmj.m1985
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发表时间：
2020-05-22
影响因子：
105.7
通讯作者：
Semple, Malcolm G.
中科院分区：
文献类型：
--
作者：
Docherty, Annemarie B.;Harrison, Ewen M.;Semple, Malcolm G.
Objectiveto表征了英国第一次爆发阶段的增长阶段，在英国冠状病毒疾病2019（Covid-19）的患者的临床特征表征，这些患者已入学，这些爆发阶段已入选国际严重的急性呼吸和新兴感染联盟（ISARIC）世界卫生组织（WHO）临床特征协议英国（CCP-UK）研究，并探索与医院死亡率相关的危险因素。Designprospective观察性研究研究，随着快速数据收集和接近实时分析。SETTINGTINGTING208急诊医院，以及2020年2月6日至4月19日之间的苏格兰。由Isaric开发的案例报告表，并用于收集临床数据。最小的随访时间为两周（至2020年5月3日），大多数患者可以完成住院。医院。诊断为19 COVID-19的医院的患者中位年龄，或者在医院诊断为Covid-19的医院年龄为73岁（四分位间距58-82，范围为0-104）。男性被录取的男性多（男性60％，n = 12 068；女性40％，n = 8065）。入院前症状的中位持续时间为4天（四分位间范围1-8）。最常见的合并症是慢性心脏病（31％，5469/17 702），简单的糖尿病（21％，3650/17 599），非哮喘性慢性肺部疾病（18％，3128/17 634）和慢性肾脏疾病（慢性肾脏疾病（ 16％，2830/17 506）; 23％（4161/18 525）没有报告主要合并症。总体而言，有41％（8199/20133）的患者还活着出院，26％（5165/20 133）死亡，34％（6769/20 133）继续在报告日期接受护理。 17％（3001/18 183）要求入学高依赖或重症监护病房；其中，有28％（826/3001）被活着出院，32％（958/3001）死亡，41％（1217/3001）在报告日期继续接受护理。在接受机械通气的人中，有17％（276/1658）被活着出院，37％（618/1658）死亡，46％（764/1658）仍留在医院。年龄增长，男性性别和合并症，包括慢性心脏病，非心脏病性慢性肺部疾病，慢性肾脏疾病，肝病和肥胖与医院的死亡率较高有关。CCP-CCP-IK是对患者的大型前瞻性人群研究的conccp-ccp-uk。与19日的医院。该报告在本报告时继续注册。在研究参与者中，死亡率很高，独立的危险因素的年龄增加，男性性别和慢性合并症，包括肥胖。这项研究表明，大流行准备的重要性，以及需要保持对爆发的研究的准备就绪。
OBJECTIVETo characterise the clinical features of patients admitted to hospital with coronavirus disease 2019 (covid-19) in the United Kingdom during the growth phase of the first wave of this outbreak who were enrolled in the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO) Clinical Characterisation Protocol UK (CCP-UK) study, and to explore risk factors associated with mortality in hospital.DESIGNProspective observational cohort study with rapid data gathering and near real time analysis.SETTING208 acute care hospitals in England, Wales, and Scotland between 6 February and 19 April 2020. A case report form developed by ISARIC and WHO was used to collect clinical data. A minimal follow-up time of two weeks (to 3 May 2020) allowed most patients to complete their hospital admission.PARTICIPANTS20133 hospital inpatients with covid-19.MAIN OUTCOME MEASURESAdmission to critical care (high dependency unit or intensive care unit) and mortality in hospital.RESULTThe median age of patients admitted to hospital with covid-19, or with a diagnosis of covid-19 made in hospital, was 73 years (interquartile range 58-82, range 0-104). More men were admitted than women (men 60%, n=12 068; women 40%, n=8065). The median duration of symptoms before admission was 4 days (interquartile range 1-8). The commonest comorbidities were chronic cardiac disease (31%, 5469/17 702), uncomplicated diabetes (21%, 3650/17 599), non-asthmatic chronic pulmonary disease (18%, 3128/17 634), and chronic kidney disease (16%, 2830/17 506); 23% (4161/18 525) had no reported major comorbidity. Overall, 41% (8199/20133) of patients were discharged alive, 26% (5165/20 133) died, and 34% (6769/20 133) continued to receive care at the reporting date. 17% (3001/18 183) required admission to high dependency or intensive care units; of these, 28% (826/3001) were discharged alive, 32% (958/3001) died, and 41% (1217/3001) continued to receive care at the reporting date. Of those receiving mechanical ventilation, 17% (276/1658) were discharged alive, 37% (618/1658) died, and 46% (764/1658) remained in hospital. Increasing age, male sex, and comorbidities including chronic cardiac disease, non-asthmatic chronic pulmonary disease, chronic kidney disease, liver disease and obesity were associated with higher mortality in hospital.CONCLUSIONSISARIC WHO CCP-UK is a large prospective cohort study of patients in hospital with covid-19. The study continues to enrol at the time of this report. In study participants, mortality was high, independent risk factors were increasing age, male sex, and chronic comorbidity, including obesity. This study has shown the importance of pandemic preparedness and the need to maintain readiness to launch research studies in response to outbreaks.