Incidence of community acquired lower respiratory tract disease in Bristol, UK during the COVID-19 pandemic: A prospective cohort study

Hyams, Catherine; Challen, Robert; Southern, Jo; King, Jade; Morley, Anna; Szasz-Benczur, Zsuzsa; González, María García; Kinney, Jane; Campling, James; Gray, Sharon; Oliver, Jennifer; Hubler, Robin; Valluri, Srinivas Rao; Vyse, Andrew; Ellsbury, Gillian; Maskell, Nick A; Gessner, Bradford D.; Danon, León; Finn, Adam; Langdon, Amelia; Turner, Anabella; Mattocks, Anya; Osborne, Bethany; Grimes, Charli; Mitchell, Claire; Adegbite, David; Bridgeman, Emma; Scott, Emma C.; Perkins, Fiona; Bayley, Francesca; Ruffino, Gabriella; Valentine, Gabriella; Tilzey, Grace; Wright, Johanna Kellett; Brzezinska, Julia; Cloake, Julie; Milutinovic, Katarina; Helliker, Kate; Maughan, Katie; Fox, Kazminder; Minou, Konstantina; Ward, Lana; Fleming, Leah; Smart, Lily; Wright, Louise; Grimwood, Lucy; Bellavia, Maddalena; Clout, Madeleine; Vasquez, Marianne; Jeenes-Flanagan, Milo; Chang, Natalie; Grace, Niall; Manning, Nicola; Griffiths, Oliver; Croxford, Pip; Sequenza, Peter; Lazarus, Rajeka; Walters, Rhian; Marlow, Robin; Heath, Robyn; Antico, Rupert; Arachchge, Sandi Nammuni; Suppiah, Seevakumar; Mona, Taslima; Riaz, Tawassal; Mackay, Vicki; Maseko, Zandile; Taylor, Zoe; Friedrich, Zsolt

doi:10.1016/j.lanepe.2022.100473

Cited by 17 publications

(18 citation statements)

References 24 publications

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“…10,11 It is likely that public health efforts to reduce the spread of SARS-CoV-2, such as lockdowns, may also have influenced the spread of other communicable diseases contributing to the risk of sepsis. 12,13 However, only one study has evaluated the impact of the pandemic on sepsis incidence rate and case fatality risk, using a few selected sepsis codes. 14 No previous study has focused exclusively on sepsis incidence rate using all sepsis codes, 2 and compared sepsis incidence rate and case fatality during the two first years of the COVID-19 pandemic with long-term historic trends.…”

Section: Introductionmentioning

confidence: 99%

Long-term temporal trends in incidence rate and case fatality of sepsis and COVID-19-related sepsis: nationwide registry study

Skei

Nilsen

Knoop

et al. 2022

Preprint

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Importance: Sepsis is one of the leading causes of morbidity and mortality. The majority of sepsis cases is attributed to bacterial infections, but virus infections can also induce sepsis. Conflicting results in incidence rates and case fatality trends of sepsis is reported, and how the COVID-19 pandemic influenced these trends are unknown. Objective: To estimate temporal trends in incidence rate and case fatality during a 14-year period from 2008 through 2021, and to assess possible shifts in these trends during the COVID-19 pandemic. Design: A nationwide longitudinal registry study using ICD-10 discharge codes to identify sepsis. Setting: All Norwegian hospitals from 2008 through 2021. Participants: All sepsis cases included 317.705 patients and of these, 222.832 had a first sepsis episode. Main outcomes and measures: Annual age-standardized incidence rates with 95% confidence intervals (CI). Poisson regression was used to estimate changes in incidence rates across time, and logistic regression was used to estimate odds ratios for in-hospital death. Results: Among 12.619.803 adult hospitalizations, 317.705 (2.5%) patients met the sepsis criteria and 222.832 (70.0%) had a first sepsis episode. In the period 2009-2019, the annual incidence rate for a first sepsis episode was stable (incidence rate ratio per year, 0.999; 95% CI, 0.994-1.004), whereas for all sepsis the incidence rate increased by 15.5% during the period (annual incidence rate ratio, 1.013; 95% CI 1.007-1.019). During the COVID-19 pandemic, the incidence rate ratio for a first sepsis was 0.877 (95% CI, 0.829-0.927) in 2020 and 0.929 (95% CI, 0.870-0.992) in 2021, and for all sepsis it was 0.870 (95% CI, 0.810-0.935) in 2020 and 0.908 (95% CI, 0.840-0.980) in 2021, compared to the previous 11-year period. In-hospital deaths declined in the period 2009-2019 (odds ratio per year, 0.954 [95% CI,0.950-0.958]), whereas deaths increased during the COVID-19 pandemic in 2020 (odds ratios, 1.061 [95% CI 1.001-1.124] and in 2021 odds ratio (1.164 [95% CI, 1.098-1.233]). Conclusion and relevance: We found a stable incidence rate of a first sepsis episode during the years 2009-2019. However, the increasing burden of all sepsis admissions indicates that sepsis awareness with updated guidelines and education must continue.

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Section: Introductionmentioning

confidence: 99%

Long-term temporal trends in incidence rate and case fatality of sepsis and COVID-19-related sepsis: nationwide registry study

Skei

Nilsen

Knoop

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…Positive pressure support was more frequently required in SARS-CoV-2 AECOPD compared with non-SARS-CoV-2 infective AECOPD and NI-COPD (18.5% and 11.7% vs. 7.5%, respectively). Despite similar age, CCI and frailty scores, patients admitted with SARS-CoV-2 AECOPD had longer hospitalisation stays (median 7 [3][4][5][6][7][8][9][10][11][12][13][14][15] days vs. 5 [2][3][4][5][6][7][8][9][10] and 4 [2][3][4][5][6][7][8][9]) and increased 30-day mortality (16.9% vs. 11.1% and 5.9%) than those with non-SARS-CoV-2 infective AECOPD or NI-COPD, respectively (Table 1, Figure 1, Supplementary Data 4).…”

Section: Resultsmentioning

confidence: 99%

Impact of SARS-CoV-2 infective exacerbation of chronic obstructive pulmonary disease on clinical outcomes in a prospective cohort study of hospitalised adults

et al. 2023

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Objectives To determine whether acute exacerbations of chronic obstructive pulmonary disease (AECOPD) triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have worse outcomes than AECOPD caused by other infectious agents or non-infective AECOPD (NI-COPD). Design A two-hospital prospective cohort study of adults hospitalised with acute respiratory disease. We compared outcomes with AECOPD and a positive test for SARS-CoV-2 (n = 816), AECOPD triggered by other infections (n = 3038) and NI-COPD (n = 994). We used multivariable modelling to adjust for potential confounders and assessed variation by seasons associated with different SARS-CoV-2 variants. Setting Bristol UK, August 2020–May 2022. Participants Adults (≥18 y) hospitalised with AECOPD. Main outcome measures We determined the risk of positive pressure support, longer hospital admission and mortality following hospitalisation with AECOPD due to non-SARS-CoV-2 infection compared with SARS-CoV-2 AECOPD and NI-COPD. Results Patients with SARS-CoV-2 AECOPD, in comparison to non-SARS-CoV-2 infective AECOPD or NI-COPD, more frequently required positive pressure support (18.5% and 7.5% vs. 11.7%, respectively), longer hospital stays (median [interquartile range, IQR]: 7 [3–15] and 5 [2–10] vs. 4 [2–9] days, respectively) and had higher 30-day mortality (16.9% and 11.1% vs. 5.9%, respectively) (all p < 0.001). In adjusted analyses, SARS-CoV-2 AECOPD was associated with a 55% (95% confidence interval [95% CI]: 24–93), 26% (95% CI: 15–37) and 35% (95% CI: 10–65) increase in the risk of positive pressure support, hospitalisation length and 30-day mortality, respectively, relative to non-SARS-CoV-2 infective AECOPD. The difference in risk remained similar during periods of wild-type, Alpha and Delta SARS-CoV-2 strain dominance, but diminished during Omicron dominance. Conclusions SARS-CoV-2-related AECOPD had worse patient outcomes compared with non-SARS-CoV-2 AECOPD or NI-AECOPD, although the difference in risks was less pronounced during Omicron dominance.

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“…AvonCAP is a prospective observational cohort study undertaking comprehensive surveillance of adults admitted to two acute care hospitals encompassing all admissions in Bristol, UK (ISRCTN:17354061), with full details previously published. 26 We analysed submission data from adults (≥18 years) hospitalised from 1 August 2020 to 31 July 2022 and screened patients for signs and symptoms of community-acquired respiratory disease. Hospital-acquired infection was excluded as an aetiology if infection was diagnosed after 48 h. In this analysis, we included only patients with SARS-CoV-2-negative respiratory infection and with a known blood group.…”

Section: Methodsmentioning

confidence: 99%

Association of ABO and Rhesus blood groups with severe outcomes from non‐SARS‐CoV‐2 respiratory infection: A prospective observational cohort study in Bristol, UK 2020–2022

Hathaway,

Qian,

King

et al. 2023

Br J Haematol

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SummaryDespite significant global morbidity associated with respiratory infection, there is a paucity of data examining the association between severity of non‐SARS‐CoV‐2 respiratory infection and blood group. We analysed a prospective cohort of adults hospitalised in Bristol, UK, from 1 August 2020 to 31 July 2022, including patients with acute respiratory infection (pneumonia [n = 1934] and non‐pneumonic lower respiratory tract infection [NP‐LRTI] [n = 1184]), a negative SARS‐CoV‐2 test and known blood group status. The likelihood of cardiovascular complication, survival and hospital admission length was assessed using regression models with group O and RhD‐negative status as reference groups. Group A and RhD‐positive were over‐represented in both pneumonia and NP‐LRTI compared to a first‐time donor population (p < 0.05 in all); contrastingly, group O was under‐represented. ABO group did not influence cardiovascular complication risk; however, RhD‐positive patients with pneumonia had a reduced odds ratio (OR) for cardiovascular complications (OR = 0.77 [95% CI = 0.59–0.98]). Compared to group O, group A individuals with NP‐LRTI were more likely to be discharged within 60 days (hazard ratio [HR] = 1.17 [95% CI = 1.03–1.33]), while group B with pneumonia was less likely (HR = 0.8 [95% CI = 0.66–0.96]). This analysis provides some evidence that blood group status may influence clinical outcome following respiratory infection, with group A having increased risk of hospitalisation and RhD‐positive patients having reduced cardiovascular complications.

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Incidence of community acquired lower respiratory tract disease in Bristol, UK during the COVID-19 pandemic: A prospective cohort study

Cited by 17 publications

References 24 publications

Long-term temporal trends in incidence rate and case fatality of sepsis and COVID-19-related sepsis: nationwide registry study

Long-term temporal trends in incidence rate and case fatality of sepsis and COVID-19-related sepsis: nationwide registry study

Impact of SARS-CoV-2 infective exacerbation of chronic obstructive pulmonary disease on clinical outcomes in a prospective cohort study of hospitalised adults

Association of ABO and Rhesus blood groups with severe outcomes from non‐SARS‐CoV‐2 respiratory infection: A prospective observational cohort study in Bristol, UK 2020–2022

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