Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
Lancet. 2021 Jul 17;398(10296):223-237. doi: 10.1016/S0140-6736(21)00799-6.
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.
COVID-19 是一种多系统疾病，幸存的患者可能会出现院内并发症。这些并发症很可能对患者、医疗保健利用、医疗保健系统准备和持续的 COVID-19 大流行期间的社会产生重要的短期和长期后果。我们的目的是使用国际严重急性呼吸和新兴感染协会 COVID-19 临床特征协议 UK，描述 COVID-19 并发症的程度和影响，特别是在那些幸存的患者中。
我们在英国的 302 个医疗保健设施中进行了一项前瞻性、多中心队列研究。纳入了年龄在 19 岁或以上、确诊或高度疑似导致 COVID-19 的 SARS-CoV-2 感染的成年患者。本研究的主要结局是院内并发症的发生率，定义为单独或与任何 COVID-19 疾病标志一起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局与院内并发症、年龄和预先存在的合并症之间的关联。
在 2020 年 1 月 17 日至 8 月 4 日期间，纳入了 80388 名患者。在因 COVID-19 住院治疗的患者中，49.7%（36367/73197）至少有一种并发症。我们队列的平均年龄为 71.1 岁（SD 18.7），56.0%（41025/73197）为男性，81.0%（59289/73197）至少有一种合并症。男性和年龄大于 60 岁的患者最有可能出现并发症（年龄≥60 岁：男性 54.5%[16579/30416]，女性 48.2%[11707/24288]；年龄<60 岁：男性 48.8%[5179/10609]，女性 36.6%[2814/7689]）。肾脏（24.3%，17752/73197）、复杂呼吸（18.4%，13486/73197）和全身（16.3%，11895/73197）并发症最为常见。心血管（12.3%，8973/73197）、神经（4.3%，3115/73197）和胃肠或肝脏（0.8%，7901/73197）并发症也有报道。
COVID-19 住院患者的并发症和更差的功能结局很高，即使是年轻、以前健康的个体也是如此。急性并发症与出院时自我护理能力下降有关，神经并发症与最差的功能结局有关。COVID-19 并发症很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旨在为 COVID-19 后患者提供护理的服务。
英国国民健康保险制度和英国医学研究理事会。
