Thomas M Drake , MBChB a , * , Aya M Riad , BMedSci a , * , Cameron J Fairfield , MBChB a , Conor Egan , MSc a , Stephen R Knight , MBChB a , Riinu Pius , PhD a , Hayley E Hardwick e , Lisa Norman , PhD a , Catherine A Shaw , PhD a , Kenneth A McLean , MBChB a , A A Roger Thompson , PhD h , Antonia Ho , PhD i , Olivia V Swann , PhD b , k , Michael Sullivan , MBChB j , Felipe Soares , MPhil h , Karl A Holden , MBChB e , l , Laura Merson , BSc m , Daniel Plotkin , BA m , Louise Sigfrid , PhD m , Thushan I de Silva , PhD h , Michelle Girvan , BSc f , Clare Jackson f , Clark D Russell , MBChB c , d , Jake Dunning , PhD e , n , Tom Solomon , Prof, PhD e , g , o , Gail Carson , MBChB m , Piero Olliaro , Prof, PhD m , Jonathan S Nguyen-Van-Tam , Prof, DM p , q , Lance Turtle , PhD e , Annemarie B Docherty , PhD a , Peter JM Openshaw , Prof, PhD r , J Kenneth Baillie , PhD f , Ewen M Harrison , Prof, PhD a , † , * , Malcolm G Semple , PhD e , k , † , ISARIC4C investigators
17 July 2021
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.