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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

Our take —

In this large, prospective cohort study that began during the early stages of the COVID-19 outbreak, the clinical presentation and outcomes of 20,133 patients hospitalized in the UK with COVID-19 were described. Possibly due to the high median age (80 years), the mortality rate in the study was higher than previous reports of ICU patients in Italy and the US, but common symptoms, comorbidities, and factors associated with mortality were similar.

Study design

Prospective Cohort

Study population and setting

This prospective cohort study includes 20,133 patients with COVID-19 who were admitted to 203 acute care hospitals in England, Scotland, and Wales between February 6 and April 19, 2020 with follow-up through May 3, 2020. The study population accounts for 34% of all COVID-19 hospital admissions for the included countries.

Summary of Main Findings

Participants had a median age of 73, 60% were male, 1.5% were <18 years old, and 100 were pregnant. Most patients reported respiratory symptoms (cough, fever, and shortness of breath), though some patients also experienced clusters of musculoskeletal and enteric symptoms; only 4.5% of patients were asymptomatic. The majority of patients had at least one comorbidity (77.5%), and the most common comorbidities were cardiac disease (31%), diabetes with/without complications (28%), chronic pulmonary disease (18%), and chronic kidney disease (16%). Over half of patients (55%) received high flow oxygen during hospitalization, and 17% required admission to high dependency or intensive care units. Forty one percent of patients were discharged alive, 26% died, and 34% were still hospitalized at the time of analysis. Factors independently associated with mortality in multivariable Cox proportional hazards analysis included: increasing age, male sex, chronic cardiac disease, chronic pulmonary disease, diabetes, obesity, chronic neurological disorder, dementia, malignancy, and moderate/severe liver disease. The median time from onset of symptoms to hospital presentation was 4 days (interquartile range 1-8).

Study Strengths

This was a very large multi-site study, encompassing more than a third of all hospitalized COVID-19 patients in the study region. Data collection began during the early phase of the outbreak. Future studies plan to link to administrative healthcare databases to assess potential selection bias.

Limitations

Missing data, which seemed to be a pervasive problem, was not imputed. A large portion of patients were still hospitalized at the time of analysis, so the mortality rate is the minimum total mortality that will be observed. Because enrollment began in the early phases of the outbreak, COVID-19 screening and testing criteria changed throughout the study period, potentially resulting in the study population including sicker patients. Findings may not be generalizable to individuals with more moderate or mild disease progression.

Value added

This very large and rapidly conducted study describes the clinical characteristics and outcomes of 20,133 patients at 203 hospitals in the UK (England, Scotland, and Wales).

This review was posted on: 17 June 2020