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. 2021 Feb 4;9(1):6.
doi: 10.3390/medsci9010006.

COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis

Kenneth F Baker  1   2 , Aidan T Hanrath  1 , Ina Schim van der Loeff  1 , Su Ann Tee  3 , Richard Capstick  3 , Gabriella Marchitelli  3 , Ang Li  3 , Andrew Barr  3 , Alsafi Eid  3 , Sajeel Ahmed  3 , Dalvir Bajwa  3 , Omer Mohammed  3 , Neil Alderson  3 , Clare Lendrem  4 , Dennis W Lendrem  2 , Covid-Control Group, Covid-Clinical Group, Lucia Pareja-Cebrian  3 , Andrew Welch  3 , Joanne Field  3 , Brendan A I Payne  1   3 , Yusri Taha  3 , David A Price  3 , Christopher Gibbins  3 , Matthias L Schmid  3 , Ewan Hunter  3 , Christopher J A Duncan  1   3
Affiliations

COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis

Kenneth F Baker et al. Med Sci (Basel). .

Abstract

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, p < 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.

Keywords: SARS-CoV-2; intubation; mortality; treatment escalation; ventilation.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
(A): Cumulative daily incidence of admissions, discharges and deaths up to censor point of 16 April 2020. (B): Daily prevalence of inpatients with COVID-19 by oxygen and ventilation requirements up to censor point of 16 April 2020.
Figure 2
Figure 2
Schematic summarising treatment groups and patient outcomes. Note one patient in ICU group remained hospitalised at time of analysis. ICU: intensive care unit; NIPS: non-invasive pressure support.
Figure 3
Figure 3
(A): Admissions by age and sex of cohort of 316 patients. (B): Percentage of deaths among 315 patients with a confirmed clinical outcome, stratified by age and sex.
See this image and copyright information in PMC

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