Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol

Abstract

medRxiv preprint 5 Structured abstractObjective -To characterize the clinical features of patients with severe COVID-19 in the UK.Design -Prospective observational cohort study with rapid data gathering and near realtime analysis, using a pre-approved questionnaire adopted by the WHO. Setting -166 UK hospitals between 6 th February and 18 th April 2020. Participants-16,749 people with COVID-19.Interventions -No interventions were performed, but with consent samples were taken for research purposes. Many participants were co-enrolled in other interventional studies and clinical trials. Results -The median age was 72 years [IQR 57, 82; range 0, 104], the median duration of symptoms before admission was 4 days [IQR 1,8] and the median duration of hospital stay was 7 days [IQR 4,12]. The commonest comorbidities were chronic cardiac disease (29%), uncomplicated diabetes (19%), non-asthmatic chronic pulmonary disease (19%) and asthma (14%); 47% had no documented reported comorbidity. Increased age and comorbidities including obesity were associated with a higher probability of mortality. Distinct clusters of symptoms were found: 1. respiratory (cough, sputum, sore throat, runny nose, ear pain, wheeze, and chest pain); 2. systemic (myalgia, joint pain and fatigue); 3. enteric (abdominal pain, vomiting and diarrhoea). Overall, 49% of patients were discharged alive, 33% have died and 17% continued to receive care at date of reporting. 17% required admission to High Dependency or Intensive Care Units; of these, 31% were discharged alive, 45% died and 24% continued to receive care at the reporting date. Of those receiving mechanical ventilation, 20% were discharged alive, 53% died and 27% remained in hospital.Conclusions -We present the largest detailed description of COVID-19 in Europe, demonstrating the importance of pandemic preparedness and the need to maintain readiness to launch research studies in response to outbreaks.

Glycemic control of type 2 diabetic patients with coronavirus disease during hospitalization: a proposal for early insulin therapy

“…Older age and pre-existing medical conditions, specifically diabetes mellitus, hypertension, ischemic heart disease, and chronic lung disease, are associated with a more severe course of COVID-19 (5a). Diabetes mellitus is one of the most prevalent comorbidities among patients hospitalized due to COVID-19 (7). Data obtained from 21 hospitals in Wuhan, China, showed that 25% of the reported COVID-19 fatalities had a history of diabetes mellitus (33).…”

Why Aren't People Living with HIV at Higher Risk for Developing Severe Coronavirus Disease 2019 (COVID-19)?

“…1 Organ dysfunction, particularly progressive respiratory failure and acute kidney injury, is associated with the highest rates of mortality. 3,4 These manifestations have been linked to a systemic microvascular thrombosis and generalized coagulopathy, associated with a marked inflammatory response and persistent complement activation. 5 Severe disease usually occurs in the setting of certain comorbidities: obesity, diabetes mellitus, hypertension, advanced age, and male gender at any age.…”

“…5 Severe disease usually occurs in the setting of certain comorbidities: obesity, diabetes mellitus, hypertension, advanced age, and male gender at any age. 3,4 Given those risk factors, and the spread of SARS-CoV-2 by close contact, COVID-19 was expected to affect a disproportionate number of people in lower socioeconomic classes. First, these individuals may be less able to socially distance because of housing situation, or occupation, or both.…”

“…3 Among 16,749 patients with COVID-19 hospitalized in the United Kingdom, 1% involved PLWH, but HIV did not adversely impact survival. 4 A study of 5700 patients hospitalized with COVID-19 in the New York City area, an epicenter not only of CoV-2 infection but of HIV as well, found that only 0.8% involved HIV. 8 Finally, in a smaller series from Barcelona, of the 62 of 543 consecutive patients with COVID-19 requiring hospital admission, 5 were PLWH: 3 males, 2 transgender, 4 of them on effective antiretroviral therapy (ART).…”

“…3 Malignancy was a risk factor for mortality in the U.K. series, but it was of very modest impact, with a relative risk of 1.19-fold. 4 Given that multiple proinflammatory cytokines and innate immune factors appear to play a dominant role in promoting severe COVID-19, 5,13 it is conceivable that the immune suppression characteristic of cancer chemotherapy, and the persistent immune dysregulation that accompanies HIV infection despite effective ART, 14 may suppress CoV-2 pathology as well. This hypothesis is supported by a mouse model of SARS-CoV-1 infection.…”