Clinical characteristics and outcomes of adult patients admitted with COVID-19 in East London: a retrospective cohort analysis
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Abstract
Descriptions of clinical characteristics of patients hospitalised withCOVID-19, their clinical course and short-term inpatient and outpatient outcomes in deprived urban populations in the UK are still relatively sparse. We describe the epidemiology, clinical course, experience of non-invasive ventilation and intensive care, mortality and short-term sequelae of patients admitted to two large District General Hospitals across a large East London National Health Service Trust during the first wave of the pandemic.
Methods
A retrospective analysis was carried out on a cohort of 1946 patients with a clinical or laboratory diagnosis of COVID-19, including descriptive statistics and survival analysis. A more detailed analysis was undertaken of a subset of patients admitted across three respiratory units in the trust.
Results
Increasing age, male sex and Asian ethnicity were associated with worse outcomes. Increasing severity of chest X-ray abnormalities trended with mortality. Radiological changes persisted in over 50% of cases at early follow-up (6 weeks). Ongoing symptoms including hair loss, memory impairment, breathlessness, cough and fatigue were reported in 70% of survivors, with 39% of patients unable to return to work due to ongoing symptoms.
Conclusions
Understanding the acute clinical features, course of illness and outcomes of COVID-19 will be crucial in understanding the effect of differences in risk, as well as the effectiveness of new interventions and vaccination between the successive waves of the pandemic.
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SciScore for 10.1101/2020.10.08.20193623: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: In line with the NHS Health Research Authority guidance, Research Ethics Committee approval was not required, and the Caldicott Guardian was consulted for approval for the use of anonymised patient data. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:4.2 Limitations: We present …
SciScore for 10.1101/2020.10.08.20193623: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: In line with the NHS Health Research Authority guidance, Research Ethics Committee approval was not required, and the Caldicott Guardian was consulted for approval for the use of anonymised patient data. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:4.2 Limitations: We present overall data, identified through clinical coding, for all patients diagnosed with suspected or confirmed COVID-19 infection. There is potential for incorrect coding of diagnoses in the case of suspected cases, resulting in both missed cases, and inclusion of individuals who did not in fact have COVID-19 in the overall cohort. For the nested RU analyses, individual patient records were reviewed by members of the respiratory team and such misclassification is less likely. Retrospective data collection using routine health records often results in incomplete data. This is evident in our study, including 19% of patients in the RU cohort who did not have a documented treatment escalation strategy; while many patients had not had biochemical parameters of interest assessed, such that these could not be included in analyses. We report the experience of the subset of patients admitted to the RUs, as due to the limitations of data collection approaches, this was the group for which more detailed data was available. This cohort represents most unwell COVID-19 patients in our hospitals, outside of critical care. However, patients admitted directly to CCU from the Emergency Department or wards who were not stepped down to the RU were not captured. Extrapolating from the rate from overall admission data (8.5%), this represents a small but significant proportion of patients. 4.3 Interpretation: These analyses add to the body of research into our understanding of...
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.
- No funding statement was detected.
- No protocol registration statement was detected.
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