COVID-19: a retrospective cohort study with focus on the over-80s and hospital-onset disease

Abstract

Objectives: To describe the presenting features and outcomes of patients with COVID-19 in a UK hospital, with a focus on those patients over 80 years and patients with hospital onset infection. Design: Retrospective cohort study with data extracted from the electronic records of patients with PCR-confirmed COVID-19 admitted to our institution. Setting: Suburban general hospital serving the most populous London borough. Participants: The first 450 inpatients admitted to our hospital with swab-confirmed COVID-19 infection. Primary outcome: The primary outcome measure was death during the index hospital admission. Results: The median (IQR) age was 72 (56, 83), with 150 (33%) over 80 years old and 60% male. Presenting clinical and biochemical features were consistent with those reported elsewhere. The ethnic breakdown of patients admitted was similar to that of our underlying local population with no excess of BAME deaths. Inpatient mortality was high at 38%. Patients over 80 presented earlier in their disease course and were significantly less likely to present with the typical features of cough, breathlessness and fever. Cardiac co-morbidity and markers of cardiac dysfunction were more common, but not those of bacterial infection. Mortality was significantly higher in this group (60% vs 28%, p <0.001). 31 (7%) of patients were classified as having hospital-onset COVID-19 infection. The peak of hospital-onset infections occurred at the same time as the overall peak of admitted infections. Despite being older and more frail, the outcomes for this cohort were no worse. Conclusions: Inpatient mortality was high, especially among the over-80s, who were more likely to present atypically. The ethnic composition of our caseload was similar to the underlying population. While a significant number of patients presented with COVID-19 while already in hospital, their outcomes were no worse.

Atypical presentations of COVID‐19 in care home residents presenting to secondary care: A UK single centre study

“…Our findings are also consistent with previously reported associations between high mortality and older age 15,20‐22 . While we did not find associations between mortality and dyspnoea, 23 cardiovascular disease 24 or male gender 25 reported elsewhere, our population represents severe disease admitted to secondary care with a high overall mortality of 65%.…”

“…Data were collected retrospectively from the electronic patient record. Further information is available here 15 …”

“…There are more than 100 care homes in the borough 14 . Barnet Hospital is a general suburban hospital with 440 beds and was affected by a high volume of COVID‐19 cases early in the course of the UK pandemic 15 . Using admission data from this period, we set out to (a) characterize the presenting symptoms in older adults admitted with COVID‐19, (b) determine whether care home residents exhibited different presentations to the general older population, and (c) examine the mortality associations with typical and atypical presentations.…”

Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people

“…These findings add to emerging reports quantifying the relationship between frailty and mortality in COVID-19. In another London hospitalised cohort, crude deaths in COVID-19 were higher in patients who were frailer (median Clinical Frailty Scale score of 5 versus 4, p = 0.01) [13]. Other UK case series have shown that patients who died without ventilatory support had a median Clinical Frailty Scale score of 7 [14].…”

Outcomes for Patients With COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis

“…16,28,30,38,39 After accounting for potential overlapping patient cohorts in these smaller studies, we identified 20 unique cohorts encompassing 13,137 patients with available kidney disease-related information. 4,[12][13][14][15][19][20][21][22][23][24]26,30,32,33,[35][36][37][38][39] Of these 20 cohorts included in the statistical analysis, 13 were from China, 1 was from Korea, 3 were from the United States, and 3 were from Europe. The quality of peer-reviewed studies and preprint studies were similar (Supplementary Table S1).…”