COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis
Recent large national and international cohorts describe the baseline characteristics and outcome of hospitalised patients with COVID-19, however there is limited granularity to these reports. We aimed to provide a detailed description of a UK COVID-19 cohort, focusing on management and outcome. We...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-02-01
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| Series: | Medical Sciences |
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| Online Access: | https://www.mdpi.com/2076-3271/9/1/6 |
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| author | Kenneth F. Baker Aidan T. Hanrath Ina Schim van der Loeff Su Ann Tee Richard Capstick Gabriella Marchitelli Ang Li Andrew Barr Alsafi Eid Sajeel Ahmed Dalvir Bajwa Omer Mohammed Neil Alderson Clare Lendrem Dennis W. Lendrem COVID-19 Control Group COVID-19 Clinical Group Lucia Pareja-Cebrian Andrew Welch Joanne Field Brendan A. I. Payne Yusri Taha David A. Price Christopher Gibbins Matthias L. Schmid Ewan Hunter Christopher J. A. Duncan |
| author_facet | Kenneth F. Baker Aidan T. Hanrath Ina Schim van der Loeff Su Ann Tee Richard Capstick Gabriella Marchitelli Ang Li Andrew Barr Alsafi Eid Sajeel Ahmed Dalvir Bajwa Omer Mohammed Neil Alderson Clare Lendrem Dennis W. Lendrem COVID-19 Control Group COVID-19 Clinical Group Lucia Pareja-Cebrian Andrew Welch Joanne Field Brendan A. I. Payne Yusri Taha David A. Price Christopher Gibbins Matthias L. Schmid Ewan Hunter Christopher J. A. Duncan |
| author_sort | Kenneth F. Baker |
| collection | DOAJ |
| description | Recent large national and international cohorts describe the baseline characteristics and outcome of hospitalised patients with COVID-19, however there is limited granularity to these reports. We aimed to provide a detailed description of a UK COVID-19 cohort, focusing on management and outcome. We performed a retrospective single-centre analysis of clinical management and 28-day outcomes of consecutive adult inpatients with SARS-CoV-2 PCR-confirmed COVID-19 from 31 January to 16 April 2020 inclusive. In total, 316 cases were identified. Most patients were elderly (median age 75) with multiple comorbidities. One quarter were admitted from residential or nursing care. Mortality was 84 out of 316 (26.6%). Most deaths occurred in patients in whom a ceiling of inpatient treatment had been determined and for whom end of life care and specialist palliative care input was provided where appropriate. No deaths occurred in patients aged under 56 years. Decisions to initiate respiratory support were individualised after consideration of patient wishes, premorbid frailty and comorbidities. In total, 59 (18%) patients were admitted to intensive care, of which 31 (10% overall cohort) required intubation. Multiple logistic regression identified associations between death and age, frailty, and disease severity, with age as the most significant factor (odds ratio 1.07 [95% CI 1.03–1.10] per year increase, <i>p</i> < 0.001). These findings provide important clinical context to outcome data. Mortality was associated with increasing age. Most deaths were anticipated and occurred in patients with advance decisions on ceilings of treatment. |
| first_indexed | 2024-03-09T05:43:18Z |
| format | Article |
| id | doaj.art-870b230cba944667b97b082405b7389c |
| institution | Directory Open Access Journal |
| issn | 2076-3271 |
| language | English |
| last_indexed | 2024-03-09T05:43:18Z |
| publishDate | 2021-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medical Sciences |
| spelling | doaj.art-870b230cba944667b97b082405b7389c2023-12-03T12:23:24ZengMDPI AGMedical Sciences2076-32712021-02-0191610.3390/medsci9010006COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective AnalysisKenneth F. Baker0Aidan T. Hanrath1Ina Schim van der Loeff2Su Ann Tee3Richard Capstick4Gabriella Marchitelli5Ang Li6Andrew Barr7Alsafi Eid8Sajeel Ahmed9Dalvir Bajwa10Omer Mohammed11Neil Alderson12Clare Lendrem13Dennis W. Lendrem14COVID-19 Control GroupCOVID-19 Clinical GroupLucia Pareja-Cebrian15Andrew Welch16Joanne Field17Brendan A. I. Payne18Yusri Taha19David A. Price20Christopher Gibbins21Matthias L. Schmid22Ewan Hunter23Christopher J. A. Duncan24Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UKTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UKTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKNIHR In Vitro Diagnostics Cooperative, Newcastle University, Newcastle upon Tyne NE2 4HH, UKNational Institute of Health Research (NIHR) Newcastle Biomedical Research Centre, Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 4HH, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKThe Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP, UKTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UKRecent large national and international cohorts describe the baseline characteristics and outcome of hospitalised patients with COVID-19, however there is limited granularity to these reports. We aimed to provide a detailed description of a UK COVID-19 cohort, focusing on management and outcome. We performed a retrospective single-centre analysis of clinical management and 28-day outcomes of consecutive adult inpatients with SARS-CoV-2 PCR-confirmed COVID-19 from 31 January to 16 April 2020 inclusive. In total, 316 cases were identified. Most patients were elderly (median age 75) with multiple comorbidities. One quarter were admitted from residential or nursing care. Mortality was 84 out of 316 (26.6%). Most deaths occurred in patients in whom a ceiling of inpatient treatment had been determined and for whom end of life care and specialist palliative care input was provided where appropriate. No deaths occurred in patients aged under 56 years. Decisions to initiate respiratory support were individualised after consideration of patient wishes, premorbid frailty and comorbidities. In total, 59 (18%) patients were admitted to intensive care, of which 31 (10% overall cohort) required intubation. Multiple logistic regression identified associations between death and age, frailty, and disease severity, with age as the most significant factor (odds ratio 1.07 [95% CI 1.03–1.10] per year increase, <i>p</i> < 0.001). These findings provide important clinical context to outcome data. Mortality was associated with increasing age. Most deaths were anticipated and occurred in patients with advance decisions on ceilings of treatment.https://www.mdpi.com/2076-3271/9/1/6treatment escalationventilationintubationSARS-CoV-2mortality |
| spellingShingle | Kenneth F. Baker Aidan T. Hanrath Ina Schim van der Loeff Su Ann Tee Richard Capstick Gabriella Marchitelli Ang Li Andrew Barr Alsafi Eid Sajeel Ahmed Dalvir Bajwa Omer Mohammed Neil Alderson Clare Lendrem Dennis W. Lendrem COVID-19 Control Group COVID-19 Clinical Group Lucia Pareja-Cebrian Andrew Welch Joanne Field Brendan A. I. Payne Yusri Taha David A. Price Christopher Gibbins Matthias L. Schmid Ewan Hunter Christopher J. A. Duncan COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis Medical Sciences treatment escalation ventilation intubation SARS-CoV-2 mortality |
| title | COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis |
| title_full | COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis |
| title_fullStr | COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis |
| title_full_unstemmed | COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis |
| title_short | COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis |
| title_sort | covid 19 management in a uk nhs foundation trust with a high consequence infectious diseases centre a retrospective analysis |
| topic | treatment escalation ventilation intubation SARS-CoV-2 mortality |
| url | https://www.mdpi.com/2076-3271/9/1/6 |
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