Clinical characteristics and Outcomes of 500 patients with COVID Pneumonia – Results from a Single center (Southend University Hospital)

  1. Gouri Koduri
  2. Sriya Gokaraju
  3. Maria Darda
  4. Vinod Warrier
  5. Irina Duta
  6. Fiona Hayes
  7. Iman El Sayed
  8. Yasser Ahmed

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Abstract

Objectives

To characterise the clinical features of hospitalised COVID-19 patients in a single centre during the first epidemic wave and explore potential predictive variables associated with outcomes such as mortality and the need for mechanical ventilation, using baseline clinical parameters.

Methodology

We conducted a retrospective review of electronic records for demographic, clinical and laboratory data, imaging and outcomes for 500 hospitalised patients between February 20 th and May 7 th 2020 from Southend University Hospital, Essex, UK. Multivariate logistic regression models were used to identify risk factors relevant to outcome.

Results

The mean age of the cohort admitted to hospital with Covid-19, was 69.4 and 290 (58%) were over 70. The majority were Caucasians, 437 (87%) with ≤2 comorbidities 280(56%). Most common were hypertension 186(37%), Cardiovascular disease 178(36%) and Diabetes 128 (26%), represented in a larger proportion on the mortality group. Mean CFS was 4 with Non - Survivors had significantly higher CFS 5 vs 3 in survivors, p<0.001. In addition, Mean CRP was significantly higher 150 vs 90, p<0.001 in Non-Survivors. We observed the baseline predictors for mortality were age, CFS and CRP.

Conclusions

In this single centre study, older and frailer patients with more comorbidities and a higher baseline CRP and creatinine were risk factors for worse outcomes. Integrated frailty and age-based risk stratification are essential, in addition to monitoring SFR (Sp02/Fi02) and inflammatory markers throughout the disease course to allow for early intervention to improve patient outcomes.

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  1. ScreenIT

    SciScore for 10.1101/2020.08.13.20163030: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: The findings of this study are derived from hospitalised cases which might have introduced a bias in disease severity and fatality. The data collection is limited to what is documented in the electronic patient database whether there may be errors both with patient and clinician recall. Our single centre findings may not be generalizable. Routine tests such as LDH, Ferritin, D-Dimer and Troponin could not be carried out on all patients. Where do we go from here?: In this large retrospective study, we found that older age, comorbidities, frailty and elevated CRP at admission were significant risk factors for poor outcomes in patients with COVID-19. Now, more than ever, a holistic approach to patients with comorbidities is required, and rapid solutions to support this must be identified and implemented with urgency. Elderly patients are particularly susceptible to adverse clinical outcomes in COVID -19 infection and assessment and treatment is challenging. Long-stay residential care homes and hospitals need to urgently design adequate health care plans for elderly patients. Our results strengthen the NICE guidance on the Clinical Frailty Scale, to assist decision-making regarding hospitalization. We suggest integrating the frailty assessment in all COVID-19 patients at hospital admission, which can help clinicians in their decision-making processes. However, shared decision-making is always warranted with respect to personal wishes and preferences of the patient. G...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.08.13.20163030v1 on medRxiv