RT Journal Article
SR Electronic
T1 Characteristics and outcomes of patients with COVID-19 at a district general hospital in Surrey, UK
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP clinmed.2020-0303
DO 10.7861/clinmed.2020-0303
A1 Harry Knights
A1 Nikhil Mayor
A1 Kristina Millar
A1 Matthew Cox
A1 Evgeniya Bunova
A1 Morgan Hughes
A1 Jack Baker
A1 Sanju Mathew
A1 David Russell-Jones
A1 Aleksandra Kotwica
YR 2020
UL http://www.rcpjournals.org/content/early/2020/07/24/clinmed.2020-0303.abstract
AB Background This retrospective cohort study aims to define the clinical findings and outcomes of every patient admitted to a district general hospital in Surrey with COVID-19 in March 2020, providing a snapshot of the first wave of infection in the UK. This study is the first detailed insight into the impact of frailty markers on patient outcomes and provides the infection rate among healthcare workers.Methods Data were obtained from medical records. Outcome measures were level of oxygen therapy, discharge and death. Patients were followed up until 21 April 2020.Results 108 patients were included. 34 (31%) died in hospital or were discharged for palliative care. 43% of patients aged over 65 died. The commonest comorbidities were hypertension (49; 45%) and diabetes (25; 23%). Patients who died were older (mean difference ±SEM, 13.76±3.12 years; p<0.0001) with a higher NEWS2 score (median 6, IQR 2.5–7.5 vs median 2, IQR 2–6) and worse renal function (median differences: urea 2.7 mmol/L, p<0.01; creatinine 4 μmol/L, p<0.05; eGFR 14 mL/min, p<0.05) on admission compared with survivors. Frailty markers were identified as risk factors for death. Clinical Frailty Scale (CFS) was higher in patients over 65 who died than in survivors (median 5, IQR 4–6 vs 3.5, IQR 2–5; p<0.01). Troponin and creatine kinase levels were higher in patients who died than in those who recovered (p<0.0001). Lymphopenia was common (median 0.8, IQR 0.6–1.2; p<0.005). Every patient with heart failure died (8). 26 (24%) were treated with continuous positive airway pressure (CPAP; median 3 days, IQR 2–7.3) and 9 (8%) were intubated (median 14 days, IQR 7–21). All patients who died after discharge (4; 6%) were care home residents. 276 of 699 hospital staff tested were positive for COVID-19.Conclusions This study identifies older patients with frailty as being particularly vulnerable and reinforces government policy to protect this group at all costs.