Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK.
BMJ. 2020 May 22;369:m1985. doi: 10.1136/bmj.m1985.
To 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.
Prospective observational cohort study with rapid data gathering and near real time analysis.
208 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.
20 133 hospital inpatients with covid-19.
Admission to critical care (high dependency unit or intensive care unit) and mortality in hospital.
The 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% (8199/20 133) 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.
ISARIC 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.
ISRCTN66726260.
描述英国在首次新冠疫情浪潮中，在国际严重急性呼吸和新发感染联合会（ISARIC）世界卫生组织（WHO）临床特征描述协议 UK（CCP-UK）研究中，入组的因 2019 年冠状病毒病（covid-19）住院的患者的临床特征，并探讨与住院死亡率相关的危险因素。
前瞻性观察队列研究，快速数据收集和近乎实时分析。
英格兰、威尔士和苏格兰的 208 家急性护理医院，时间为 2020 年 2 月 6 日至 4 月 19 日。由 ISARIC 和 WHO 制定的病例报告表用于收集临床数据。最短随访时间为两周（截至 2020 年 5 月 3 日），以便大多数患者完成住院治疗。
20133 名因 covid-19 住院或在医院确诊的住院患者。
入住重症监护病房（高度依赖病房或 ICU）和住院死亡率。
因 covid-19 住院或在医院确诊 covid-19 的患者的中位年龄为 73 岁（四分位间距 58-82 岁，范围 0-104 岁）。男性患者多于女性（男性 60%，n=12068；女性 40%，n=8065）。住院前症状的中位持续时间为 4 天（四分位间距 1-8 天）。最常见的合并症是慢性心脏疾病（31%，5469/17702）、无并发症糖尿病（21%，3650/17599）、非哮喘性慢性肺部疾病（18%，3128/17634）和慢性肾脏疾病（16%，2830/17506）；23%（4161/18525）无重大合并症报告。总体而言，8199/20133（41%）的患者存活出院，5165/20133（26%）死亡，6769/20133（34%）继续在报告日接受治疗。17%（3001/18183）需要入住高度依赖或 ICU；其中，28%（826/3001）存活出院，32%（958/3001）死亡，41%（1217/3001）继续在报告日接受治疗。接受机械通气的患者中，17%（276/1658）存活出院，37%（618/1658）死亡，46%（764/1658）仍在住院。年龄增长、男性、合并症包括慢性心脏疾病、非哮喘性慢性肺部疾病、慢性肾脏疾病、肝脏疾病和肥胖与住院死亡率较高相关。
ISARIC WHO CCP-UK 是一项针对因 covid-19 住院患者的大型前瞻性队列研究。在本报告发布时，该研究仍在继续入组。在研究参与者中，死亡率较高，独立危险因素包括年龄增长、男性、以及肥胖等慢性合并症。本研究表明了大流行准备的重要性，以及需要随时准备启动研究以应对疫情爆发。
ISRCTN66726260。
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