On 22 May, the UK investigators of the International Severe Acute Respiratory and emeRging Infections Consortium (ISARIC) published the first results of their prospective cohort study of patients in hospital with COVID-19.
COVID-19, the viral disease caused by the novel SARS-CoV-2 coronavirus, was declared a pandemic by the World Health Organisation (WHO) in early March. As of 23 May, there have been 5,105,881 confirmed COVID-19 cases worldwide, including 333,446 deaths. The ISARIC clinical characterisation protocol (CCP) was created in coordination with the WHO in the wake of the 2012 MERS epidemic, providing a standardised clinical protocol that enables data and biological samples to be rapidly collected in a globally-harmonised manner. The UK ISARIC CCP was activated on 17 January 2020, enabling UK patients admitted to hospital with COVID-19 to be enrolled. In their BMJ article, the investigators of the ISARIC CCP-UK study characterise the clinical features of hospital patients with COVID-19 up to 19 April 2020. They also describe patient outcomes and risk factors associated with COVID-19 mortality in the hospital setting.
Between January and 19 April 2020, a total of 20,133 hospital patients with COVID-19 were enrolled into the ISARIC CCP-UK study. The median age of patients was 73 years, with a range of 0 to 104 years. More men than women were admitted to hospital (59.9% vs 40.1%) and the most common COVID-19 symptoms were cough, fever and shortness of breath. The most frequently-occurring comorbidities upon admission were chronic cardiac disease (30.9%), diabetes (20.7%), chronic pulmonary disease (17.7%) and chronic kidney disease (16.2%). 13.6% of COVID-19 patients in the ISARIC CCP-UK study had a dementia diagnosis.
Overall, 41% of patients were discharged alive, 26% died and 34% continue to receive hospital care. The median age of people who died in hospital from COVID-19 was 80 years, and only 11% of these individuals had no documented comorbidity. Using a multivariate Cox proportional hazards model, the ISARIC CCP-UK investigators identified risk factors associated with COVID-19 mortality in their hospital population, although the investigators noted that their infographic based on this information should not be used for predictive tools in clinical practice, or to inform individual treatment decisions. Age on admission was by far the strongest predictor of mortality in hospital, after adjusting for other factors. Female sex was associated with a ~20% reduction in COVID-19 mortality, while several major cardiac, pulmonary, kidney and metabolic comorbidities were associated with increased risk of mortality. Of these, chronic kidney disease was associated with a 28% increased risk of COVID-19 mortality, while obesity and dementia were associated with a ~33% and 40% increased risk, respectively.
The original BMJ article can be found here:
https://www.bmj.com/content/bmj/369/bmj.m1985.full.pdf
The ISARIC4C infographic on COVID-19 outcomes can be found here:
Further information on ISARIC can be found here:
