Abstract
BackgroundThe global pandemic of coronavirus disease 2019 (COVID-19) has placed a huge strain on UK hospitals. Early studies suggest that patients can deteriorate quickly after admission to hospital. The aim of this study was to model changes in vital signs for patients hospitalised with COVID-19. MethodsThis was a retrospective observational study of adult patients with COVID-19 admitted to one acute hospital trust in the UK (CV) and a cohort of patients admitted to the same hospital between 2013-2017 with viral pneumonia (VI). The primary outcome was the start of continuous positive airway pressure/non-invasive positive pressure ventilation, ICU admission or death in hospital. We used non-linear mixed-effects models to compare changes in vital sign observations prior to the primary outcome. Using observations and FiO2 measured at discharge in the VI cohort as the model of normality, we also combined individual vital signs into a single novelty score. ResultsThere were 497 cases of COVID-19, of whom 373 had been discharged from hospital. 135 (36.2%) of patients experienced the primary outcome, of whom 99 died in hospital. In-hospital mortality was over 4-times higher in the CV than the VI cohort (26.5% vs 6%). For those patients who experienced the primary outcome, CV patients became increasingly hypoxaemic, with a median estimated FiO2 (0.75) higher than that of the VI cohort (estimated FiO2 of 0.35). Prior to the primary outcome, blood pressure remained within normal range, and there was only a small rise in heart rate. The novelty score showed that patients with COVID-19 deteriorated more rapidly that patients with viral pneumonia. ConclusionsPatients with COVID-19 who deteriorate in hospital experience rapidly-worsening respiratory failure, with low SpO2 and high FiO2, but only minor abnormalities in other vital signs. This has potential implications for the ability of early warning scores to identify deteriorating patients.
Highlights
The global pandemic of coronavirus disease 2019 (COVID-19) has placed a huge strain on UK hospitals
This study demonstrates that patients with COVID-19 deteriorate more rapidly than seen in other viral pneumonias, with progressively lower oxygen saturations, greater oxygen requirements and only minor abnormalities in other vital signs
UK Government strategy recognises that intensive care unit (ICU) capacity is a limited, yet ICUs are a critical resource in the treatment of COVID-19.2 Current evidence suggests that almost all patients admitted to the ICU will require respiratory support, of whom 60-90% will receive mechanical ventilation.[3,4]
Summary
The global pandemic of coronavirus disease 2019 (COVID-19) has placed a huge strain on UK hospitals. Conclusions: Patients with COVID-19 who deteriorate in hospital experience rapidly-worsening respiratory failure, with low SpO2 and high FiO2, but only minor abnormalities in other vital signs. This has potential implications for the ability of early warning scores to identify deteriorating patients. The global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has placed a huge strain on UK hospitals.[1] UK Government strategy recognises that intensive care unit (ICU) capacity is a limited, yet ICUs are a critical resource in the treatment of COVID-19.2 Current evidence suggests that almost all patients admitted to the ICU will require respiratory support, of whom 60-90% will receive mechanical ventilation.[3,4] Around one third of patients will require advanced cardiovascular or renal support.[4,5] data from the Intensive Care National Audit and Research Centre (ICNARC) estimates that mortality in patients admitted to ICU could exceed 50%.4. UK Government strategy recognises that intensive care unit (ICU) capacity is a limited, yet ICUs are a critical resource in the treatment of COVID-19.2 Current evidence suggests that almost all patients admitted to the ICU will require respiratory support, of whom 60-90% will receive mechanical ventilation.[3,4] Around one third of patients will require advanced cardiovascular or renal support.[4,5] data from the Intensive Care National Audit and Research Centre (ICNARC) estimates that mortality in patients admitted to ICU could exceed 50%.4 Several observational studies have described factors that could affect prognosis,3,6À11 most are either small (< 1000 cases) or limited to patients who were treated in the ICU
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