Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study.
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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DOI：
10.1016/s0140-6736(21)00799-6
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发表时间：
2021-07-17
期刊：
影响因子：
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通讯作者：
ISARIC4C investigators
中科院分区：
文献类型：
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作者：
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 PJ;Baillie JK;Harrison EM;Semple MG;ISARIC4C investigators
COVID-19是一种多系统疾病，存活下来的患者可能会出现院内并发症。在持续的COVID-19大流行中，这些并发症可能对患者、卫生保健利用、卫生保健系统准备和社会产生重要的短期和长期后果。我们的目的是利用国际严重急性呼吸道和新发感染联盟世卫组织英国临床特征协议，描述COVID-19并发症的程度和影响，特别是对幸存者的影响。我们在302家英国医疗机构中进行了一项前瞻性、多中心队列研究。年龄在19岁或以上、确诊或高度疑似SARS-CoV-2感染导致COVID-19的成年患者被纳入研究。本研究的主要结果是院内并发症的发生率，定义为单独发生或除任何COVID-19疾病特征外发生的器官特异性诊断。我们使用多水平逻辑回归和生存模型来探讨这些结果与院内并发症、年龄和既往合并症之间的关系。在2020年1月17日至8月4日期间，80388名患者纳入了这项研究。在因COVID-19住院治疗的患者中，49.7%（73197例中的36367例）至少有一种并发症。我们队列的平均年龄为71.1岁（标准差为18.7），其中56.0%（73,197例中41 025例）为男性，81.5%（73,197例中59 289例）至少有一种合并症。男性和年龄大于60岁者最容易发生并发症（年龄≥60岁男性占54.5%[30416例中有16579例]，女性占48.2%[24288例中有1707例]；年龄<60岁男性占48.8%[10609例中有5179例]，女性占36.6%[7689例中有2814例]）。肾脏并发症（24.3%，17752例）、复杂呼吸系统并发症（18.4%，13486例）和全身并发症（16.3%，11895例）最为常见。心血管并发症（12.3%，8973例）、神经系统并发症（4.3%，3115例）、胃肠道或肝脏并发症（0.8%，7901例）也有报道。入院的COVID-19患者的并发症和较差的功能结果很高，即使在以前健康的年轻人中也是如此。急性并发症与出院时自我护理能力下降有关，神经系统并发症与最差的功能结果有关。2019冠状病毒病并发症可能在未来几年对卫生和社会保健造成巨大压力。这些数据将有助于设计和提供针对COVID-19患者住院后护理的服务。国家健康研究所和英国医学研究理事会。
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. 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. 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. 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. National Institute for Health Research and the UK Medical Research Council.