tetano
Editor, Senior Moderator
Crit Care Res Pract
. 2021 Jan 27;2021:8832660.
doi: 10.1155/2021/8832660. eCollection 2021.
Hospital Mortality and Resource Implications of Hospitalisation with COVID-19 in London, UK: A Prospective Cohort Study
Savvas Vlachos[SUP] 1 [/SUP], Adrian Wong[SUP] 1 [/SUP], Victoria Metaxa[SUP] 1 [/SUP], Sergio Canestrini[SUP] 1 2 [/SUP], Carmen Lopez Soto[SUP] 1 [/SUP], Jimstan Periselneris[SUP] 3 [/SUP], Kai Lee[SUP] 3 [/SUP], Tanya Patrick[SUP] 3 [/SUP], Christopher Stovin[SUP] 3 [/SUP], Katrina Abernethy[SUP] 3 [/SUP], Budoor Albudoor[SUP] 1 [/SUP], Rishi Banerjee[SUP] 1 [/SUP], Fatimah Juma[SUP] 1 [/SUP], Sara Al-Hashimi[SUP] 1 [/SUP], William Bernal[SUP] 1 [/SUP], Ritesh Maharaj[SUP] 1 4 5 [/SUP]
Affiliations
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.
. 2021 Jan 27;2021:8832660.
doi: 10.1155/2021/8832660. eCollection 2021.
Hospital Mortality and Resource Implications of Hospitalisation with COVID-19 in London, UK: A Prospective Cohort Study
Savvas Vlachos[SUP] 1 [/SUP], Adrian Wong[SUP] 1 [/SUP], Victoria Metaxa[SUP] 1 [/SUP], Sergio Canestrini[SUP] 1 2 [/SUP], Carmen Lopez Soto[SUP] 1 [/SUP], Jimstan Periselneris[SUP] 3 [/SUP], Kai Lee[SUP] 3 [/SUP], Tanya Patrick[SUP] 3 [/SUP], Christopher Stovin[SUP] 3 [/SUP], Katrina Abernethy[SUP] 3 [/SUP], Budoor Albudoor[SUP] 1 [/SUP], Rishi Banerjee[SUP] 1 [/SUP], Fatimah Juma[SUP] 1 [/SUP], Sara Al-Hashimi[SUP] 1 [/SUP], William Bernal[SUP] 1 [/SUP], Ritesh Maharaj[SUP] 1 4 5 [/SUP]
Affiliations
- PMID: 33564474
- PMCID: PMC7864763
- DOI: 10.1155/2021/8832660
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.