Evidence map›Paper›PMID 34274064›Full record

ArticleLancet (London, England)2021

Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study.

Thomas M Drake, Aya M Riad, Cameron J Fairfield, Conor Egan, Stephen R Knight, Riinu Pius, Hayley E Hardwick, Lisa Norman, Catherine A Shaw, Kenneth A McLean and 25 more

Erratum issuedAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Lancet (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 104 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
104citing papers in PubMed, 11 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

104 citing papers in PubMed, 11 syntheses or guidelines pooled it.

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44 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

35 authors.

Thomas M DrakeCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
Aya M RiadCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
Cameron J FairfieldCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
Conor EganCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
Stephen R KnightCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
Riinu PiusCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
Hayley E HardwickHealth 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.
Lisa NormanCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
Catherine A ShawCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
Kenneth A McLeanCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
A A Roger ThompsonDepartment of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
Antonia HoMedical Research Council-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK.
Olivia V SwannDepartment of Child Life and Health, University of Edinburgh, Edinburgh, UK; Paediatric Infectious Diseases, Royal Hospital for Sick Children, Edinburgh, UK.
Michael SullivanInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Felipe SoaresDepartment of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
Karl A HoldenHealth 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; Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK.
Laura MersonCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Daniel PlotkinCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Louise SigfridCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Thushan I de SilvaDepartment of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
Michelle GirvanLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
Clare JacksonLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
Clark D RussellRoslin Institute, University of Edinburgh, Edinburgh, UK; Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
Jake DunningHealth 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; Emerging Infections and Zoonoses Unit, National Infection Service, Public Health England, London, UK.
Tom SolomonHealth 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; Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Zoological Science, University of Liverpool, Liverpool, UK; Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.
Gail CarsonCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Piero OlliaroCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Jonathan S Nguyen-Van-TamDivision of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; United Kingdom Department of Health and Social Care, London, UK.
Lance TurtleHealth 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.
Annemarie B DochertyCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
Peter Jm OpenshawNational Heart and Lung Institute, Imperial College London, London, UK.
J Kenneth BaillieLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
Ewen M HarrisonCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK. Electronic address: ewen.harrison@ed.ac.uk.
Malcolm G SempleHealth 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; Paediatric Infectious Diseases, Royal Hospital for Sick Children, Edinburgh, UK.
ISARIC4C investigators

Funding

British Heart Foundation FS/18/13/33281Medical Research Council G0701652Medical Research Council MC_PC_15001Medical Research Council MC_PC_19025Medical Research Council MC_PC_19026Medical Research Council MC_PC_19059Medical Research Council MC_UU_12014/10Medical Research Council MC_UU_12014/12Medical Research Council MC_UU_12014/8Medical Research Council MC_UU_12014/9Medical Research Council MR/S032304/1Medical Research Council MR/V001671/1Wellcome Trust 109965/Z/15/ZWellcome Trust 205228/Z/16/ZWellcome Trust 215091/Z/18/Z
6 · The paper itself

Abstract

backgroundCOVID-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.

methodsWe 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.

findingsBetween 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.

interpretationComplications 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.

fundingNational Institute for Health Research and the UK Medical Research Council.

Indexed as

ComorbidityHospitalizationHospital MortalityAgedAge FactorsCardiovascular DiseasesClinical ProtocolsCOVID-19FemaleHospitalsHumansMaleNervous System DiseasesProspective StudiesRespiratory Tract DiseasesSARS-CoV-2

Identifiers

PMID34274064
PMCPMC8285118

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.