tetano
Editor, Senior Moderator
Clin Med (Lond)
. 2020 Jul 24;clinmed.2020-0303.
doi: 10.7861/clinmed.2020-0303. Online ahead of print.
Characteristics and outcomes of patients with COVID-19 at a district general hospital in Surrey, UK
Harry Knights[SUP] 1 [/SUP], Nikhil Mayor[SUP] 1 [/SUP], Kristina Millar[SUP] 1 [/SUP], Matthew Cox[SUP] 1 [/SUP], Evgeniya Bunova[SUP] 1 [/SUP], Morgan Hughes[SUP] 1 [/SUP], Jack Baker[SUP] 1 [/SUP], Sanju Mathew[SUP] 1 [/SUP], David Russell-Jones[SUP] 2 [/SUP], Aleksandra Kotwica[SUP] 1 [/SUP]
Affiliations
Abstract
Background: This retrospective cohort study aims to define the clinical findings and outcomes of every patient admitted to a district general hospital in Surrey with COVID-19 in March 2020, providing a snapshot of the first wave of infection in the UK. This study is the first detailed insight into the impact of frailty markers on patient outcomes and provides the infection rate among healthcare workers.
Methods: Data were obtained from medical records. Outcome measures were level of oxygen therapy, discharge and death. Patients were followed up until 21 April 2020.
Results: 108 patients were included. 34 (31%) died in hospital or were discharged for palliative care. 43% of patients aged over 65 died. The commonest comorbidities were hypertension (49; 45%) and diabetes (25; 23%). Patients who died were older (mean difference ?SEM, 13.76?3.12 years; p<0.0001) with a higher NEWS2 score (median 6, IQR 2.5-7.5 vs median 2, IQR 2-6) and worse renal function (median differences: urea 2.7 mmol/L, p<0.01; creatinine 4 μmol/L, p<0.05; eGFR 14 mL/min, p<0.05) on admission compared with survivors. Frailty markers were identified as risk factors for death. Clinical Frailty Scale (CFS) was higher in patients over 65 who died than in survivors (median 5, IQR 4-6 vs 3.5, IQR 2-5; p<0.01). Troponin and creatine kinase levels were higher in patients who died than in those who recovered (p<0.0001). Lymphopenia was common (median 0.8, IQR 0.6-1.2; p<0.005). Every patient with heart failure died (8). 26 (24%) were treated with continuous positive airway pressure (CPAP; median 3 days, IQR 2-7.3) and 9 (8%) were intubated (median 14 days, IQR 7-21). All patients who died after discharge (4; 6%) were care home residents. 276 of 699 hospital staff tested were positive for COVID-19.
Conclusions: This study identifies older patients with frailty as being particularly vulnerable and reinforces government policy to protect this group at all costs.
Keywords: COVID-19; Clinical Frailty Scale; Coronavirus; SARS-CoV-2; frailty.
. 2020 Jul 24;clinmed.2020-0303.
doi: 10.7861/clinmed.2020-0303. Online ahead of print.
Characteristics and outcomes of patients with COVID-19 at a district general hospital in Surrey, UK
Harry Knights[SUP] 1 [/SUP], Nikhil Mayor[SUP] 1 [/SUP], Kristina Millar[SUP] 1 [/SUP], Matthew Cox[SUP] 1 [/SUP], Evgeniya Bunova[SUP] 1 [/SUP], Morgan Hughes[SUP] 1 [/SUP], Jack Baker[SUP] 1 [/SUP], Sanju Mathew[SUP] 1 [/SUP], David Russell-Jones[SUP] 2 [/SUP], Aleksandra Kotwica[SUP] 1 [/SUP]
Affiliations
- PMID: 32709637
- DOI: 10.7861/clinmed.2020-0303
Abstract
Background: This retrospective cohort study aims to define the clinical findings and outcomes of every patient admitted to a district general hospital in Surrey with COVID-19 in March 2020, providing a snapshot of the first wave of infection in the UK. This study is the first detailed insight into the impact of frailty markers on patient outcomes and provides the infection rate among healthcare workers.
Methods: Data were obtained from medical records. Outcome measures were level of oxygen therapy, discharge and death. Patients were followed up until 21 April 2020.
Results: 108 patients were included. 34 (31%) died in hospital or were discharged for palliative care. 43% of patients aged over 65 died. The commonest comorbidities were hypertension (49; 45%) and diabetes (25; 23%). Patients who died were older (mean difference ?SEM, 13.76?3.12 years; p<0.0001) with a higher NEWS2 score (median 6, IQR 2.5-7.5 vs median 2, IQR 2-6) and worse renal function (median differences: urea 2.7 mmol/L, p<0.01; creatinine 4 μmol/L, p<0.05; eGFR 14 mL/min, p<0.05) on admission compared with survivors. Frailty markers were identified as risk factors for death. Clinical Frailty Scale (CFS) was higher in patients over 65 who died than in survivors (median 5, IQR 4-6 vs 3.5, IQR 2-5; p<0.01). Troponin and creatine kinase levels were higher in patients who died than in those who recovered (p<0.0001). Lymphopenia was common (median 0.8, IQR 0.6-1.2; p<0.005). Every patient with heart failure died (8). 26 (24%) were treated with continuous positive airway pressure (CPAP; median 3 days, IQR 2-7.3) and 9 (8%) were intubated (median 14 days, IQR 7-21). All patients who died after discharge (4; 6%) were care home residents. 276 of 699 hospital staff tested were positive for COVID-19.
Conclusions: This study identifies older patients with frailty as being particularly vulnerable and reinforces government policy to protect this group at all costs.
Keywords: COVID-19; Clinical Frailty Scale; Coronavirus; SARS-CoV-2; frailty.