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Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1985 (Published 22 May 2020) Cite this as: BMJ 2020;369:m1985

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  1. Annemarie B Docherty, senior clinical lecturer and honorary consultant in critical care1 2,
  2. Ewen M Harrison, professor of surgery and data science1,
  3. Christopher A Green, senior clinical lecturer3,
  4. Hayley E Hardwick, project manager4 5,
  5. Riinu Pius, senior data manager1,
  6. Lisa Norman, research assistant1,
  7. Karl A Holden, NIHR academic clinical fellow in paediatrics6,
  8. Jonathan M Read, senior lecturer in biostatistics7,
  9. Frank Dondelinger, lecturer in biostatistics7,
  10. Gail Carson, head of ISARIC global support centre8,
  11. Laura Merson, head of data and associate director8 9,
  12. James Lee, senior trial manager8,
  13. Daniel Plotkin, clinical data manager8,
  14. Louise Sigfrid, clinical research fellow8,
  15. Sophie Halpin, supervising data manager10,
  16. Clare Jackson, senior data manager10,
  17. Carrol Gamble, professor of medical statistics10,
  18. Peter W Horby, professor of emerging infectious diseases11,
  19. Jonathan S Nguyen-Van-Tam, professor of health protection12,
  20. Antonia Ho, senior clinical lecturer in infectious diseases13,
  21. Clark D Russell, clinical lecturer in infectious diseases14,
  22. Jake Dunning, head of emerging infections and zoonoses15 16,
  23. Peter JM Openshaw, professor of experimental medicine17,
  24. J Kenneth Baillie, academic consultant in critical care medicine2 18,
  25. Malcolm G Semple, professor of outbreak medicine and child health and consultant physician in paediatric respiratory medicine19 20
  26. on behalf of the ISARIC4C investigators
  1. 1Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
  2. 2Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK
  3. 3Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
  4. 4National Institute of Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK
  5. 5Institute of Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
  6. 6Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
  7. 7Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, UK
  8. 8ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
  9. 9Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
  10. 10Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
  11. 11Centre for Tropical Medicine and International Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
  12. 12Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
  13. 13Medical Research Council University of Glasgow Centre for Virus Research, Glasgow, UK
  14. 14Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
  15. 15National Infection Service, Public Health England, London, UK
  16. 16Faculty of Medicine, Imperial College London, London, UK
  17. 17National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
  18. 18Roslin Institute, University of Edinburgh, Edinburgh, UK
  19. 19NIHR Health Protection Research Unit in Emerging and Zoonotic Infections and Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
  20. 20Respiratory Medicine, Alder Hey Children’s Hospital, Institute in The Park, University of Liverpool, Alder Hey Children’s Hospital, Liverpool L12 2AP, UK
  1. Correspondence to: M G Semple m.g.semple{at}liverpool.ac.uk (or @TweedieChap on Twitter)
  • Accepted 15 May 2020

Abstract

Objective 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.

Design Prospective observational cohort study with rapid data gathering and near real time analysis.

Setting 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.

Participants 20 133 hospital inpatients with covid-19.

Main outcome measures Admission to critical care (high dependency unit or intensive care unit) and mortality in hospital.

Results 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.

Conclusions 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.

Study registration ISRCTN66726260.

Footnotes

  • Contributors: Conceptualisation: JKB, JD, GC, LM, JSN-V-T, PJMO, MGS. Formal analysis: ABD, FD, CG, EMH, PWH, LN, PJMO, RP, JMR, MGS. Writing original draft: ABD, PJMO, MGS. Writing reviewing and editing: JKB, ABD, JD, CG, CAG, EMH, PWH, JSN-V-T, PJMO, MGS, LS. Project administration: SH, HEH, CG, AH, KAH, JL, LM, DP, CDR. Investigation: EMH, PWH, CG, CAG, AH, MGS. Supervision: JKB, HEH, EMH, CG, AH, PWH, PJMO, MGS. Data curation: LM, SH, CJ. Validation: KAH, SH, CJ. Funding acquisition: JKB, GC, PWH, PJMO, MGS. MGS is guarantor and corresponding author for this work, and attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding: This work is supported by grants from: the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (MRC; grant MC_PC_19059), the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine and the University of Oxford (NIHR award 200907), Wellcome Trust and Department for International Development (DID; 215091/Z/18/Z), and the Bill and Melinda Gates Foundation (OPP1209135), and Liverpool Experimental Cancer Medicine Centre for providing infrastructure support for this research (grant reference C18616/A25153). JSN-V-T is seconded to the Department of Health and Social Care, England (DHSC). The views expressed are those of the authors and not necessarily those of the DHSC, DID, NIHR, MRC, Wellcome Trust, or PHE.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the National Institute for Health Research (NIHR), the Medical Research Council (MRC), the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, and Public Health England (PHE), Wellcome Trust, Department for International Development (DID), the Bill and Melinda Gates Foundation, Liverpool Experimental Cancer Medicine Centre, and Department of Health and Social Care (DHSC) for the submitted work; ABD reports grants from DHSC during the conduct of the study; grants from Wellcome Trust outside the submitted work; CAG reports grants from DHSC NIHR UK during the conduct of the study; FD is due to start a position at F Hoffmann-La Roche on 4 May 2020; PWH reports grants from Wellcome Trust, DID, Bill and Melinda Gates Foundation, and NIHR during the conduct of the study; JSN-V-T reports grants from DHSC during the conduct of the study, and is seconded to DHSC; PJMO reports personal fees from consultancies and from the European Respiratory Society; grants from MRC, MRC Global Challenge Research Fund, EU, NIHR Biomedical Research Centre, MRC/GSK, Wellcome Trust, NIHR (HPRU in Respiratory Infection), and is an NIHR senior investigator outside the submitted work; his role as President of the British Society for Immunology was unpaid but travel and accommodation at some meetings was provided by the Society; JKB reports grants from MRC UK; MGS reports grants from DHSC NIHR UK, MRC UK, HPRU in Emerging and Zoonotic Infections, University of Liverpool during the conduct of the study; other from Integrum Scientific LLC, Greensboro, NC, US outside the submitted work; the remaining authors declare no competing interests; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Ethical approval was given by the South Central - Oxford C Research Ethics Committee in England (Ref 13/SC/0149), the Scotland A Research Ethics Committee (Ref 20/SS/0028), and the WHO Ethics Review Committee (RPC571 and RPC572, 25 April 2013).

  • Data sharing: We welcome applications for data and material access through our Independent Data and Material Access Committee (https://isaric4c.net).

  • The lead author (the manuscript's guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Dissemination to participants and related patient and public communities: ISARIC4C has a public facing website and twitter account @CCPUKstudy. We are engaging with print and internet press, television, radio, news, and documentary programme makers. We will explore distribution of findings with The Asthma UK and British Lung Foundation Partnership, and take advice from NIHR Involve and GenerationR Alliance Young People’s Advisory Groups.

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