COVID-19: a retrospective cohort study with focus on the over-80s and hospital-onset disease

  1. Simon E. Brill
  2. Hannah C. Jarvis
  3. Ezgi Ozcan
  4. Thomas L. P. Burns
  5. Rabia A. Warraich
  6. Lisa J. Amani
  7. Amina Jaffer
  8. Stephanie Paget
  9. Anand Sivaramakrishnan
  10. Dean D. Creer

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Abstract

Background

Data from the UK COVID-19 outbreak are emerging, and there are ongoing concerns about a disproportionate effect on ethnic minorities. There is very limited information on COVID-19 in the over-80s, and the rates of hospital-onset infections are unknown.

Methods

This was a retrospective cohort study from electronic case records of the first 450 patients admitted to our hospital with PCR-confirmed COVID-19, 77% of the total inpatient caseload to date. Demographic, clinical and biochemical data were extracted. The primary endpoint was death during the index hospital admission. The characteristics of all patients, those over 80 years of age and those with hospital-onset COVID-19 were examined.

Results

The median (IQR) age was 72 (56, 83), with 150 (33%) over 80 years old and 60% male. Presenting clinical and biochemical features were consistent with those reported elsewhere. The ethnic breakdown of patients admitted was similar to that of our underlying local population. Inpatient mortality was high at 38%.

Patients over 80 presented earlier in their disease course and were significantly less likely to present with the typical features of cough, breathlessness and fever. Cardiac co-morbidity and markers of cardiac dysfunction were more common, but not those of bacterial infection. Mortality was significantly higher in this group (60% vs 28%, p  < 0.001). Thirty-one (7%) patients acquired COVID-19 having continuously been in hospital for a median of 20 (14, 36) days. The peak of hospital-onset infections occurred at the same time as the overall peak of admitted infections. Despite being older and more frail than those with community-onset infection, their outcomes were no worse.

Conclusions

Inpatient mortality was high, especially among the over-80s, who are more likely to present atypically. The ethnic composition of our caseload was similar to the underlying population. While a significant number of patients acquired COVID-19 while already in hospital, their outcomes were no worse.

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  1. Version published to 10.1186/s12916-020-01665-z
  2. ScreenIT

    SciScore for 10.1101/2020.05.11.20097790: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The data presented here were collected during routine clinical practice and formal Research Ethics Committee review was not required.
    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:
    Despite these strengths, there are several limitations to this study. We did not collect data on some presenting features that are important, notably atypical symptoms at presentation and more detail on pre-existing comorbidities and medications. Furthermore, this was an observational study and therefore data collection was not standardised. Owing to this, and the fact that we only introduced a clinical care bundle specifying laboratory tests two to three weeks into the outbreak, there is a proportion of missing data in some of the biochemical variables. This will have affected our ability to detect more subtle signals, although does not diminish the significance of those we have reported. We also did not have follow-up data on those patients discharged and were therefore unable to assess subsequent deaths or readmissions. Whilst many of the findings from our study correlate with other UK reports11, notably a high inpatient mortality and an increasing risk of death with increasing age and cardiac comorbidity, striking differences were observed compared to non UK studies. This reflects the severity of disease in those hospitalised with COVID-19 in the UK as well as the underlying age of our population which was older with an associated increased frailty. The UK experience therefore differs dramatically from the initial reports from China16, with a reported in-hospital mortality of 1·4%. It is also higher than the 21% reported in the USA by Richardson and colleagues9, although ...

    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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  3. Version published to 10.1101/2020.05.11.20097790v1 on medRxiv