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Observational Study
. 2020 May 22:369:m1985.
doi: 10.1136/bmj.m1985.

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

Annemarie B Docherty  1   2 , Ewen M Harrison  1 , Christopher A Green  3 , Hayley E Hardwick  4   5 , Riinu Pius  1 , Lisa Norman  1 , Karl A Holden  6 , Jonathan M Read  7 , Frank Dondelinger  7 , Gail Carson  8 , Laura Merson  8   9 , James Lee  8 , Daniel Plotkin  8 , Louise Sigfrid  8 , Sophie Halpin  10 , Clare Jackson  10 , Carrol Gamble  10 , Peter W Horby  11 , Jonathan S Nguyen-Van-Tam  12 , Antonia Ho  13 , Clark D Russell  14 , Jake Dunning  15   16 , Peter Jm Openshaw  17 , J Kenneth Baillie  2   18 , Malcolm G Semple  19   20 ; ISARIC4C investigators
Affiliations
Observational Study

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

Annemarie B Docherty et al. BMJ. .

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.

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Conflict of interest statement

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.

Figures

Fig 1
Fig 1
Patients with coronavirus disease 2019 (covid-19) stratified by age and sex (top panel), and date of hospital admission with covid-19 by sex (lower panel). Outcomes are discharge from hospital, ongoing care, and death at time of report (19 April 2020, n=20 133)
Fig 2
Fig 2
Presenting symptoms and comorbidities in patients in hospital with coronavirus disease 2019 (covid-19). Top left panel: symptoms by frequency of presentation (see table E1 for values); lower left panel: scaled Euler diagram of overlap of commonest symptoms; top right panel: comorbidities by frequency (see table 1 for values); lower right panel: scaled Euler diagram of overlap of commonest comorbidities
Fig 3
Fig 3
Level of care stratified by age: admitted to intensive care unit (ICU) or high dependency unit (HDU), high flow oxygen, non-invasive ventilation, and invasive ventilation
Fig 4
Fig 4
Status of patients at time of reporting stratified by level of care. Top panel: all patients in hospital with coronavirus disease 2019 (covid-19); middle panel: all patients admitted to intensive care unit (ICU) or high dependency unit (HDU); lower panel: patients receiving invasive mechanical ventilation
Fig 5
Fig 5
Multivariable Cox proportional hazards model (age, sex, and major comorbidities), where hazard is death. Patients who were discharged were kept in the risk set (n=15 194; No of events=3911)
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