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Hospital Mortality and Resource Implications of Hospitalisation with COVID-19 in London, UK: A Prospective Cohort
Savvas Vlachos1, Adrian Wong1, Victoria Metaxa1
1Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS, London, UK.
Insights
This study found that increasing age, male sex, chronic kidney disease, high C-reactive protein, and dyspnea were linked to higher COVID-19 hospital mortality. The pandemic significantly strained critical care services, necessitating major reorganizations.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic severely impacted the UK's National Health Service, with London reporting over 35,000 cases by July 2020.
- Limited hospital-level data on patient characteristics, outcomes, and service strain hindered effective clinical decision-making and resource planning.
Purpose of the Study:
- To identify factors associated with hospital mortality in COVID-19 patients.
- To describe the strain on hospital and intensive care unit (ICU) services during the pandemic.
Main Methods:
- A prospective cohort study was conducted at a London tertiary academic center.
- Included adult patients with laboratory-confirmed COVID-19, followed for 30 days or until discharge.
- Semiparametric and parametric survival analyses identified factors linked to hospital mortality.
Main Results:
- The study analyzed 429 patients; 26% experienced hospital mortality and 34% ICU mortality.
- Independent predictors of hospital mortality included older age, male sex, chronic kidney disease, elevated C-reactive protein, and dyspnea.
- COVID-19 caused significant ICU and hospital strain, requiring ICU bed expansion from 69 to 129 and extensive service reorganization.
Conclusions:
- COVID-19 presents a high mortality burden for both ward and ICU patients.
- The pandemic necessitated substantial critical care service reconfiguration, highlighting implications for future planning and resource allocation.
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.
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