Abstract
SummaryBackgroundCOVID-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.MethodsWe 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.FindingsBetween 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.InterpretationComplications 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.FundingNational Institute for Health Research and the UK Medical Research Council.
Highlights
Many people across the world have been hospitalised with COVID-19 following SARS-CoV-2 infection
Information around inhospital complication rates are important for decision making about treatment, long-term planning, possible
Study design and participants The ISARIC WHO Char acterisation Protocol UK (CCP-UK) protocol was developed by an international consensus in 2012–14 and reactivated in response to the COVID-19 pandemic on Jan 17, 2020.12 Our study is an actively recruiting prospective cohort study across 302 health-care facilities in the UK
Summary
Many people across the world have been hospitalised with COVID-19 following SARS-CoV-2 infection. Evi dence has established that these patients have high mortality rates (26%), and up to 17% of patients admitted to hospital will require ventilatory support and critical care.[1] Several case reports, cross-sectional studies, and case-control studies have described the presence of non-respiratory complications in those with COVID-19 and suggest that these are likely to be associated with poor outcomes.[2,3,4]. Understanding the possible complications of COVID-19 is important for patient management and provision in health-care systems. Information around inhospital complication rates are important for decision making about treatment, long-term planning, possible. The corrected version first appeared at thelancet.com on July 29, 2021
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