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.
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.
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.
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.
National Institute for Health Research and the UK Medical Research Council.
Several case reports, cross-sectional studies, and case-control studies have described the presence of non-respiratory complications in those with COVID-19 and suggest that these are likely to be associated with poor outcomes.
Understanding the possible complications of COVID-19 is important for patient management and provision in health-care systems. For patients, information around in-hospital complication rates are important for decision making about treatment, long-term planning, possible resumption of normal activity and, more recently, vaccination. For health-care systems, these data are vital to inform immediate preparedness measures (ie, allocation of resources, equipment, and staffing) and also for long-term planning of health-care delivery to a population that might have incurred additional morbidity due to COVID-19.
Evidence before this study
We did a systematic search of the MEDLINE and PubMed databases on Dec 5, 2020, using the search terms (“in-hospital” OR “hospital”) AND (“SARS-CoV-2” OR “COVID” OR “COVID-19”) AND “complications”. We limited dates of searches from Jan 1, 2020, to the date the search was conducted. No language restrictions applied. Data from other areas of health care, such as surgery, suggest that patients with COVID-19 are at greater risk of subsequent complications, but systematic characterisation of complications in these patients has not yet been undertaken in large multicentre studies of patients admitted to hospital. Most COVID-19 studies have focused on mortality and respiratory support outcomes. Characterising the burden of complications is important for health-care system preparedness for further waves of infection, determining future population…