dziakj1
commented
4 years ago Summary
Suggested questions to answer about each paper:
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What did they analyze? Prospective study of 20133 inpatients with COVID-19 in 208 hospitals in the UK, each followed for a minimum of 2 weeks. This paper (accepted 15 May 2020 and put online almost immediately) is a report from a large-scale ongoing study. Not all of the patients were hospitalized specifically for COVID-19 but all tested positive for it. "The current case definition of cough and fever, if strictly applied, would miss 7% of our inpatients. A smaller proportion, 4% of patients, presented with enteric symptoms only."
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What methods did they use? Descriptive statistics, and significance tests such as the chi-squared test. A multivariate Cox proportional hazards survival model was also fit. Multiple imputation was not performed.
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Does this paper study COVID-19, SARS-CoV-2, or a related disease and/or virus? It is specifically about COVID-19.
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What is the main finding (or a few main takeaways)? From their plain language summary: "This rapid prospective investigation of patients with covid-19 admitted to hospital in England, Wales, and Scotland showed that obesity, chronic kidney disease, and liver disease were also associated with increased hospital mortality. "Obesity is a major additional risk factor that was not highlighted in data from China." "Severe covid-19 leads to a prolonged hospital stay and a high mortality rate; over a quarter of inpatients in this study had died at the time of reporting, and nearly a third remained in hospital" after at least two weeks follow-up. Clusters of symptoms were observed, including respiratory, musculoskeletal, enteric and mucocutaneous. "Enhanced severity in male patients was seen across all ages."
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What does this paper tell us about the background and/or diagnostics/therapeutics for COVID-19 / SARS-CoV-2? It adds to some previous findings about risk factors for severity and mortality in a Western population.
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Do you have any concerns about methodology or the interpretation of these results beyond this analysis?
Although the researchers and journal are reputable, I do notice that the paper was published very quickly (the study began on 17 January 2020, patients were enrolled between 6 February and 19 April 2020, final data was extracted on 3 May 2020, and paper was accepted for publication on 15 May 2020). This is probably justified by the situation, but bears noting.
The authors do mention some limitations which were inherent to the nature of a large-scale observational study of a poorly understood public health emergency -- lots of missing data and probable selection bias. "We suggest it is possible that the sickest patients were enrolled in our study, and this could partly explain our high mortality rates in hospital." Furthermore, "Some of the sickest patients in the study had the longest lengths of hospital stay and we do not have outcome data for all of these patients yet" so the mortality rate can't be exactly specified.
Any comments or notes?
If I understand correctly, the study was done by a preexisting consortium which was in place for surveillance of outbreaks. They promise more publications later.
Title: Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study
General Information
Please paste a link to the paper or a citation here:
Link: http://dx.doi.org/10.1136/bmj.m1985
What is the paper's Manubot-style citation?
Citation: @doi:10.1136/bmj.m1985
Is this paper primarily relevant to Background or Pathogenesis?
Please list some keywords (3-10) that help identify the relevance of this paper to COVID-19
Please note the publication / review status
Which areas of expertise are particularly relevant to the paper?