Hospital Mortality and Resource Implications of Hospitalisation with COVID-19 in London, UK: A Prospective Cohort Study

  1. Savvas Vlachos
  2. Adrian Wong
  3. Victoria Metaxa
  4. Sergio Canestrini
  5. Carmen Lopez Soto
  6. Jimstan Periselneris
  7. Kai Lee
  8. Tanya Patrick
  9. Christopher Stovin
  10. Katrina Abernethy
  11. Budoor Albudoor
  12. Rishi Banerjee
  13. Fatimah Juma
  14. Sara Al-Hashimi
  15. William Bernal
  16. Ritesh Maharaj

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Abstract

Background. Coronavirus disease 2019 (COVID-19) had a significant impact on the National Health Service in the United Kingdom (UK), with over 35 000 cases reported in London by July 30, 2020. Detailed hospital-level information on patient characteristics, outcomes, and capacity strain is currently scarce but would guide clinical decision-making and inform prioritisation and planning. Methods. We aimed to determine factors associated with hospital mortality and describe hospital and ICU strain by conducting a prospective cohort study at a tertiary academic centre in London, UK. We included adult patients admitted to the hospital with laboratory-confirmed COVID-19 and followed them up until hospital discharge or 30 days. Baseline factors that are associated with hospital mortality were identified via semiparametric and parametric survival analyses. Results. Our study included 429 patients: 18% of them were admitted to the ICU, 52% met criteria for ICU outreach team activation, and 61% had treatment limitations placed during their admission. Hospital mortality was 26% and ICU mortality was 34%. Hospital mortality was independently associated with increasing age, male sex, history of chronic kidney disease, increasing baseline C-reactive protein level, and dyspnoea at presentation. COVID-19 resulted in substantial ICU and hospital strain, with up to 9 daily ICU admissions and 41 daily hospital admissions, to a peak census of 80 infected patients admitted in the ICU and 250 in the hospital. Management of such a surge required extensive reorganisation of critical care services with expansion of ICU capacity from 69 to 129 beds, redeployment of staff from other hospital areas, and coordinated hospital-level effort. Conclusions. COVID-19 is associated with a high burden of mortality for patients treated on the ward and the ICU and required substantial reconfiguration of critical care services. This has significant implications for planning and resource utilisation.

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  1. Version published to 10.1155/2021/8832660
  2. ScreenIT

    SciScore for 10.1101/2020.07.16.20155069: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: , 2020) review board approvals waived the need for ethics committee review and the need for informed patient consent.
    Consent: , 2020) review board approvals waived the need for ethics committee review and the need for informed patient consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Analyses were performed using Stata/MP version 15.1 (StataCorp).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    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:
    Most patients had treatment limitations placed upon admission. In addition to being clinically frail, serious comorbidities such as active malignancy and stroke were more common in these patients. Within the framework of generic national guidance regarding treatment escalation and ICU admission [27], we believe that the COVID-19 pandemic promoted more proactive communication about goals of care between physicians and their patients. In fact, the Palliative Care service in our institution faced a dramatic increase in ward referrals over the study period [28], but comparative data from other UK settings are lacking. The resource implications of delivering a comprehensive palliative care response during a pandemic are unknown, but likely to be substantial [29-31]. Patients treated in the ICU had high morbidity and mortality. Few of them had trials of CPAP or NIV and almost all required invasive mechanical ventilation, which differs from the experience in the UK [7] and other countries [10]. Pulmonary involvement was significant, with longer periods of mechanical ventilation and more frequent recourse to rescue oxygenation therapies than previously described [9]. Extrapulmonary organ involvement was also common and led to higher utilisation of pharmacological circulatory support and RRT than that reported across the UK [8] and in recent COVID-19 cohorts from Italy (27.8%) [32], the USA (31%) [9], and China (25%) [33]. The high proportion of patients needing organ support in the I...

    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.

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  3. Version published to 10.1101/2020.07.16.20155069v1 on medRxiv