Background

COVID-19 is a multisystem disease and patients who survive might have in-hospital complications. These complications are likely to have important short-term and long-term consequences for patients, health-care utilisation, health-care system preparedness, and society amidst the ongoing COVID-19 pandemic. Our aim was to characterise the extent and effect of COVID-19 complications, particularly in those who survive, using the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK.

Methods

We did a prospective, multicentre cohort study in 302 UK health-care facilities. Adult patients aged 19 years or older, with confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 were included in the study. The primary outcome of this study was the incidence of in-hospital complications, defined as organ-specific diagnoses occurring alone or in addition to any hallmarks of COVID-19 illness. We used multilevel logistic regression and survival models to explore associations between these outcomes and in-hospital complications, age, and pre-existing comorbidities.

Findings

Between Jan 17 and Aug 4, 2020, 80 388 patients were included in the study. Of the patients admitted to hospital for management of COVID-19, 49·7% (36 367 of 73 197) had at least one complication. The mean age of our cohort was 71·1 years (SD 18·7), with 56·0% (41 025 of 73 197) being male and 81·0% (59 289 of 73 197) having at least one comorbidity. Males and those aged older than 60 years were most likely to have a complication (aged ≥60 years: 54·5% [16 579 of 30 416] in males and 48·2% [11 707 of 24 288] in females; aged <60 years: 48·8% [5179 of 10 609] in males and 36·6% [2814 of 7689] in females). Renal (24·3%, 17 752 of 73 197), complex respiratory (18·4%, 13 486 of 73 197), and systemic (16·3%, 11 895 of 73 197) complications were the most frequent. Cardiovascular (12·3%, 8973 of 73 197), neurological (4·3%, 3115 of 73 197), and gastrointestinal or liver (0·8%, 7901 of 73 197) complications were also reported.

Interpretation

Complications and worse functional outcomes in patients admitted to hospital with COVID-19 are high, even in young, previously healthy individuals. Acute complications are associated with reduced ability to self-care at discharge, with neurological complications being associated with the worst functional outcomes. COVID-19 complications are likely to cause a substantial strain on health and social care in the coming years. These data will help in the design and provision of services aimed at the post-hospitalisation care of patients with COVID-19.

Funding

National Institute for Health Research and the UK Medical Research Council.

中文翻译：

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使用 ISARIC WHO 临床特征描述方案英国描述与 COVID-19 相关的院内并发症：一项前瞻性、多中心队列研究

背景

COVID-19 是一种多系统疾病，幸存的患者可能会出现院内并发症。在持续的 COVID-19 大流行中，这些并发症可能会对患者、医疗保健利用、医疗保健系统准备情况和社会产生重要的短期和长期后果。我们的目的是利用国际严重急性呼吸系统和新发感染联盟 WHO 临床特征协议（英国）来描述 COVID-19 并发症的程度和影响，特别是对幸存者的影响。

方法

我们在 302 个英国医疗机构中进行了一项前瞻性、多中心队列研究。该研究纳入了年龄 19 岁或以上、确诊或高度怀疑感染 SARS-CoV-2 并导致 COVID-19 的成年患者。这项研究的主要结果是院内并发症的发生率，院内并发症定义为单独发生或与 COVID-19 疾病的任何特征一起发生的器官特异性诊断。我们使用多水平逻辑回归和生存模型来探讨这些结果与院内并发症、年龄和既往存在的合并症之间的关联。

发现

2020年1月17日至8月4日期间，该研究纳入了80388名患者。在因 COVID-19 入院治疗的患者中，49·7%（73 197 例中的 36 367 例）至少有一种并发症。我们队列的平均年龄为 71·1 岁 (SD 18·7)，其中 56·0%（73 197 人中的 41 025 人）为男性，81·0%（73 197 人中的 59 289 人）至少患有一种合并症。男性和年龄超过 60 岁的人最有可能出现并发症（年龄≥60 岁：男性为 54·5% [30 416 人中的 16 579 人]，女性为 48·2% [24 288 人中的 11 707 人]；年龄<60 岁：男性为 48·8% [10 609 人中的 5179 人]，女性为 36·6% [7689 人中的 2814 人]。最常见的是肾脏并发症（24·3%，73 197 例中的 17 752 例）、复杂呼吸系统并发症（18·4%，73 197 例中的 13 486 例）和全身并发症（16·3%，73 197 例中的 11 895 例）。还报告了心血管（12·3%，73 197 人中的 8973 人）、神经系统（4·3%，73 197 人中的 3115 人）和胃肠道或肝脏（0·8%，73 197 人中的 7901 人）并发症。

解释

因 COVID-19 入院的患者的并发症和较差的功能结果很高，即使是以前健康的年轻个体。急性并发症与出院时自我护理能力下降有关，神经系统并发症与最差的功能结果有关。COVID-19 并发症可能会在未来几年对健康和社会护理造成巨大压力。这些数据将有助于设计和提供针对 COVID-19 患者出院后护理的服务。

资金

国家健康研究所和英国医学研究委员会。