Covid research

The University of Glasgow is one of six universities to have contributed to the largest cohort study to date on the detailed characterisation of hospital COVID-19 patients in the world.

The new study -- published today in The BMJ and led by the University of Liverpool, University of Edinburgh and Imperial College London --  revealed age, male sex, obesity, and underlying illness have emerged as risk factors for severe COVID-19 or death in the UK.

The risk of death increases in the over 50s, as does being male, obese, or having underlying heart, lung, liver and kidney disease.

As the largest prospective observational study reported worldwide so far, it provides a comprehensive picture of the characteristics of patients hospitalised in the UK with COVID-19 and their outcomes. 

Because the study is ongoing, it has now recruited over 43,000 patients. The University’s Dr Antonia Ho, Clinical Senior Lecturer/Consultant in Infectious Diseases at the UofG-MRC Centre for Virus Research (CVR), coordinated Scottish patient recruitment on behalf of the study, recruiting around a third of all consented patients in the UK. The CVR is the receiving biorespository for Scotland.

The findings will help health professionals learn more about how the illness progresses and enable us to compare the UK with other countries, say the researchers. 

Studies in China have reported risk factors associated with severe COVID-19, but studies describing the features and outcomes of patients with severe COVID-19 who have been admitted to hospital in Europe are lacking.

To address this knowledge gap, a team of UK researchers analysed data from 20,133 patients with COVID-19 admitted to 208 acute care hospitals in England, Wales, and Scotland between 6 February and 19 April 2020.

This represents around a third of all patients admitted to hospital with COVID-19 in the UK. The average age of patients in the study was 73 years, and more men (12,068; 60%) were admitted to hospital than women (8,065; 40%).

Besides increasing age, and underlying heart, lung, liver and kidney disease – factors already known to cause poor outcomes – the researchers found that obesity and gender were key factors associated with the need for higher levels of care and higher risk of death in hospital.

At the time of publication, just over a quarter (26%) of all COVID-19 patients in hospital had died, 54% were discharged alive, and a third (34%) remained in hospital. Outcomes were poorer for those requiring mechanical ventilation: 37% had died, 17% had been discharged alive, and 46% remained in hospital.

The pattern of disease we describe broadly reflects the pattern reported globally, say the researchers. However, obesity is a major additional risk factor that was not highlighted in data from China. They suspect that reduced lung function or inflammation associated with obesity may play a role.

This is an observational study, so cannot establish cause, and the researchers point to some limitations that may have affected their results. Nevertheless, they say this is the largest study of its kind outside of China and clearly shows that severe covid-19 leads to a prolonged hospital stay and a high mortality rate. 

Dr Antonia Ho said: “The detailed characterisation of such a large number of patients admitted to hospital with COVID-19 takes us a step closer to the better understanding of this new disease.

"It is a huge collaborative effort, and enormous thanks must also go to the patients and carers who participated in the study.”

Prof Malcolm Semple, a study lead, added: “Our study identifies sectors of the population that are at greatest risk of a poor outcome, and shows the importance of forward planning and investment in preparedness studies.”

These results have already been shared with the UK Government and World Health Organisation, and are being compared with data from other countries around the world.

At the outset of the COVID-19 pandemic, it was natural to focus first on the people with severe disease who might need potentially scarce resources in hospital and intensive care, write US researchers in a linked editorial.

Cohort studies of such patients are important, they say, and this study is a testament to good planning and preparation before, and implementation of data collection during a pandemic.

They add that if we are going to be managing COVID-19 for the next several years, “we need to understand and optimize care before, during, and beyond the hospital.”

The study, ‘Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study’ is published in The BMJ. The study is funded by the National Institute for Health Research (NIHR), Medical Research Council, Wellcome Trust, Department for International Development, Bill and Melinda Gates Foundation, Liverpool Experimental Cancer Medicine Centre, NIHR Health Protection Unit in Emerging and Zoonotic Infections at University of Liverpool with Public Health England.

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Enquiries: ali.howard@glasgow.ac.uk or elizabeth.mcmeekin@glasgow.ac.uk / 0141 330 6557 or 0141 330 4831

First published: 22 May 2020