英国团队分析了20133名covid-19住院患者的临床特征

英国利物浦大学Malcolm G Semple团队分析了20133名英国covid-19住院患者的临床特征。2020年5月22日，《英国医学杂志》发表了这一成果。

为了分析英国在疫情第一波爆发的增长阶段，covid-19住院患者的临床特征，并探讨与医院死亡相关的危险因素，研究组进行了一项快速数据收集和近实时分析的前瞻性观察性队列研究。

2020年2月6日至4月19日，研究组在英格兰、威尔士和苏格兰设立了208家急诊医院，共招募了20133名covid-19住院患者，中位年龄为73岁。男性占60%，多于女性（40%）。入院前症状的中位持续时间为4天。最常见的合并症是慢性心脏病（31%）、单纯性糖尿病（21%）、非哮喘性慢性肺病（18%）和慢性肾脏病（16%），23%的患者未报告严重合并症。

截止到报告日期，41%的患者活着出院，26%死亡，34%继续接受治疗。17%的患者需进入高度依赖或重症监护病房，其中28%活着出院，32%死亡，41%继续接受治疗。接受机械通气的患者中，有17%活着出院，37%死亡，46%仍在住院。年龄增长、男性以及包括慢性心脏病、非哮喘性慢性肺病、慢性肾脏病、肝病和肥胖症等合并症均与更高的院内死亡率有关。

总之，covid-19住院患者死亡率很高，其独立危险因素是年龄、男性和包括肥胖在内的慢性合并症。

附：英文原文

Title: Features of 20133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study

Author: Annemarie B Docherty, Ewen M Harrison, Christopher A Green, Hayley E Hardwick, Riinu Pius, Lisa Norman, Karl A Holden, Jonathan M Read, Frank Dondelinger, Gail Carson, Laura Merson, James Lee, Daniel Plotkin, Louise Sigfrid, Sophie Halpin, Clare Jackson, Carrol Gamble, Peter W Horby, Jonathan S Nguyen-Van-Tam, Antonia Ho, Clark D Russell, Jake Dunning, Peter JM Openshaw, J Kenneth Baillie, Malcolm G Semple

Issue&Volume: 2020/05/22

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 20133 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=12068; 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%, 5469/17702), uncomplicated diabetes (21%, 3650/17599), non-asthmatic chronic pulmonary disease (18%, 3128/17634), and chronic kidney disease (16%, 2830/17506); 23% (4161/18525) had no reported major comorbidity. Overall, 41% (8199/20133) of patients were discharged alive, 26% (5165/20133) died, and 34% (6769/20133) continued to receive care at the reporting date. 17% (3001/18183) 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.

DOI: 10.1136/bmj.m1985

Source: https://www.bmj.com/content/369/bmj.m1985 

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