Clinical Characteristics and Predictors of Outcomes of Hospitalized Patients With Coronavirus Disease 2019 in a Multiethnic London National Health Service Trust: A Retrospective Cohort Study

Perez‐Guzman, Pablo N; Daunt, Anna; Mukherjee, Sujit; Crook, Peter; Forlano, Roberta; Kont, Mara D.; Løchen, Alessandra; Vollmer, Michaela; Middleton, Paul; Judge, Rebekah; Harlow, Christopher; Soubières, Anet; Cooke, Graham; White, Peter J; Hallett, Timothy B.; Aylin, Paul; Ferguson, Neil; Hauck, Katharina; Thursz, Mark; Nayagam, Shevanthi

doi:10.1093/cid/ciaa1091

Cited by 95 publications

(122 citation statements)

References 14 publications

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“…There have been controversial reports of D614G being associated with higher fatality rates and/or severe illness in a few data sets [ 57 , 58 ], whereas more recent data suggests no correlations of D614G with clinical outcome [ 33 ], the latter supported by our findings. Our analysis pointed at significant associations between lethal outcome and arterial hypertension, kidney failure, and ICU admission, which mirrors clinical studies on associated factors or predictors of disease severity/progression [ 59 , 60 ].…”

Section: Discussionsupporting

confidence: 74%

SARS-CoV-2 genomic characterization and clinical manifestation of the COVID-19 outbreak in Uruguay

Elizondo¹,

Harkins

Mabvakure

et al. 2021

Emerging Microbes & Infections

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COVID-19 is a respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and declared by the World Health Organization a global public health emergency. Among the severe outbreaks across South America, Uruguay has become known for curtailing SARS-CoV-2 exceptionally well. To understand the SARS-CoV-2 introductions, local transmissions, and associations with genomic and clinical parameters in Uruguay, we sequenced the viral genomes of 44 outpatients and inpatients in a private healthcare system in its capital, Montevideo, from March to May 2020. We performed a phylogeographic analysis using sequences from our cohort and other studies that indicate a minimum of 23 independent introductions into Uruguay, resulting in five major transmission clusters. Our data suggest that most introductions resulting in chains of transmission originate from other South American countries, with the earliest seeding of the virus in late February 2020, weeks before the borders were closed to all non-citizens and a partial lockdown implemented. Genetic analyses suggest a dominance of S and G clades (G, GH, GR) that make up >90% of the viral strains in our study. In our cohort, lethal outcome of SARS-CoV-2 infection significantly correlated with arterial hypertension, kidney failure, and ICU admission (FDR < 0.01), but not with any mutation in a structural or non-structural protein, such as the spike D614G mutation. Our study contributes genetic, phylodynamic, and clinical correlation data about the exceptionally well-curbed SARS-CoV-2 outbreak in Uruguay, which furthers the understanding of disease patterns and regional aspects of the pandemic in Latin America.

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Section: Discussionsupporting

confidence: 74%

SARS-CoV-2 genomic characterization and clinical manifestation of the COVID-19 outbreak in Uruguay

Elizondo¹,

Harkins

Mabvakure

et al. 2021

Emerging Microbes & Infections

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“…There were also significant correlations between CRP and TSH ( R = –0.19, P < .001) and CRP and FT4 ( R = 0.15, P = .006). Serum albumin, which has previously been shown to be negatively associated with acute mortality from COVID-19 ( 10 ), was significantly lower in those diagnosed with COVID-19 (see Table 1 ) but no significant correlations of FT4 and TSH were seen with albumin ( Fig. 2 ).…”

Section: Resultsmentioning

confidence: 77%

Thyroid Function Before, During, and After COVID-19

Khoo

Tan

Clarke

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

182

159

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Context The effects of COVID-19 on the thyroid axis remain uncertain. Recent evidence has been conflicting, with both thyrotoxicosis and suppression of thyroid function reported. Objective We aimed to detail the acute effects of COVID-19 on thyroid function and determine if these effects persisted on recovery from COVID-19. Design A cohort observational study was conducted. Participants and Setting Adult patients admitted to Imperial College Healthcare National Health Service Trust, London, UK, with suspected COVID-19 between March 9 to April 22, 2020, were included, excluding those with preexisting thyroid disease and those missing either free thyroxine (FT4) or thyrotropin (TSH) measurements. Of 456 patients, 334 had COVID-19 and 122 did not. Main Outcome Measures TSH and FT4 measurements were recorded at admission, and where available, in 2019 and at COVID-19 follow-up. Results Most patients (86.6%) presenting with COVID-19 were euthyroid, with none presenting with overt thyrotoxicosis. Patients with COVID-19 had a lower admission TSH and FT4 compared to those without COVID-19. In the COVID-19 patients with matching baseline thyroid function tests from 2019 (n = 185 for TSH and 104 for FT4), TSH and FT4 both were reduced at admission compared to baseline. In a complete case analysis of COVID-19 patients with TSH measurements at follow-up, admission, and baseline (n = 55), TSH was seen to recover to baseline at follow-up. Conclusions Most patients with COVID-19 present with euthyroidism. We observed mild reductions in TSH and FT4 in keeping with a nonthyroidal illness syndrome. Furthermore, in survivors of COVID-19, thyroid function tests at follow-up returned to baseline.

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“…The swab-negative clinical COVID-19 group of patients was compared to a subgroup of a previously described swab-positive cohort who were similarly admitted via general medical admissions 12 . Chi-square, Fisher’s and rank sum tests were used, as appropriate, to compare the cohorts’ characteristics, and odds ratios (OR) calculated to assess differences in the outcomes of respiratory deterioration, defined as requiring greater than 60% oxygen, and death.…”

Section: Methodsmentioning

confidence: 99%

Characteristics and outcomes of clinically diagnosed RT-PCR swab negative COVID-19: a retrospective cohort study

Middleton

Perez‐Guzman

Cheng

et al. 2021

Sci Rep

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Patients with strong clinical features of COVID-19 with negative real time polymerase chain reaction (RT-PCR) SARS-CoV-2 testing are not currently included in official statistics. The scale, characteristics and clinical relevance of this group are not well described. We performed a retrospective cohort study in two large London hospitals to characterize the demographic, clinical, and hospitalization outcome characteristics of swab-negative clinical COVID-19 patients. We found 1 in 5 patients with a negative swab and clinical suspicion of COVID-19 received a clinical diagnosis of COVID-19 within clinical documentation, discharge summary or death certificate. We compared this group to a similar swab positive cohort and found similar demographic composition, symptomology and laboratory findings. Swab-negative clinical COVID-19 patients had better outcomes, with shorter length of hospital stay, reduced need for > 60% supplementary oxygen and reduced mortality. Patients with strong clinical features of COVID-19 that are swab-negative are a common clinical challenge. Health systems must recognize and plan for the management of swab-negative patients in their COVID-19 clinical management, infection control policies and epidemiological assessments.

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Clinical Characteristics and Predictors of Outcomes of Hospitalized Patients With Coronavirus Disease 2019 in a Multiethnic London National Health Service Trust: A Retrospective Cohort Study

Cited by 95 publications

References 14 publications

SARS-CoV-2 genomic characterization and clinical manifestation of the COVID-19 outbreak in Uruguay

SARS-CoV-2 genomic characterization and clinical manifestation of the COVID-19 outbreak in Uruguay

Thyroid Function Before, During, and After COVID-19

Characteristics and outcomes of clinically diagnosed RT-PCR swab negative COVID-19: a retrospective cohort study

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