Analysis of the short and long-term in-hospital complications following diagnosis of COVID-19

1. Older age, male sex, and pre-existing comorbidities were independent risk factors for developing complications following COVID-19 infection.

2. The most common complications included renal, complex respiratory, systemic, and cardiovascular.

Evidence Rating Level: 2 (Good) 

Study Rundown: Patients hospitalized with COVID-19 are likely to develop in-hospital complications which may worsen their prognosis. It is crucial to characterize these complications in an effort to optimize patient care and provide better management. This prospective cohort study aimed to identify the short-term complications of symptomatic COVID-19 patients with underlying severe acute respiratory infection using the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) Protocol. The primary outcome of this study was the incidence of in-hospital complications, defined by a clinical diagnosis independent of or co-existing with COVID-19. According to study results, individuals older than 60 years of age were most likely to have an in-hospital complication, with the most common ones being renal, respiratory, systemic, and cardiovascular in nature. Incidence of complications during the hospital stay was associated with a decreased ability to self-care following hospital discharge. This study was strengthened by a large sample size of UK patients with symptomatic COVID-19 and an array of organ-specific complications.

Click to read the study in The Lancet

Relevant Reading: Clinical Characteristics of Coronavirus Disease 2019 in China

In-depth [prospective cohort]: Between Jan 17 and Aug 4, 2020, 80 388 patients were enrolled from 302 clinical sites in the UK. Included patients were adults  ≥19 years old with suspected or laboratory confirmed COVID-19. Those with duplicate patient records and no in-hospital complication were excluded. Overall, 36 367 patients (49.7%) had ≥1 in-hospital complication and were included in the final analysis. Among enrolled patients, mean age was 71.1 years (standard deviation [SD] 18.7) with the majority (56.0%) being male and 81.0% having one or more comorbidity.

The primary outcome of in-hospital complications was greater among individuals older than 60 years of age (54.5% in males vs. 48.2% in females) than those less than 60 (48.8% in males vs. 36.6% in females). The three most common organ-specific complications were renal (24.3%), complex respiratory (18.4%), and systemic (16.3%), although cardiovascular complications (12.3%) were not far behind. With regard to specific complications, acute kidney injury, acute respiratory distress syndrome (ARDS), hepatic injury, and anemia topped the list. Risk factors for in-hospital complications included older age, race (Black patients more affected than White patients), pre-existing comorbidity, male sex, and high BMI. For instance, obese patients were 1.6 and 1.3 times more likely to have respiratory and renal complications, respectively, than non-obese patients. Post-discharge complications were most common among patients admitted to critical care (82.4%) and those who received invasive mechanical ventilation (91.7%). Overall, findings from this study suggest that although in-hospital complications following COVID-19 are frequent, timely identification and management may improve long-term prognosis.

Image: PD

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