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      Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial study (COVID in Older PEople).

      research-article
      Author(s): , PhD 1 , ∗∗ , , MBChB MRCP MD 2 , ∗∗ , , MBChB 3 , , MBChB 4 , , MBChB 5 , , MD PhD 6 , , MBChB FRCP MD 7 , , BM MRCP 8 , , MSc 9 , , LMS, DGM, MSc, FRCP 10 , , MBChB, FRCS MD 11 , , PhD 12 , , MBChB 13 , , MBBS 14 , , BSc, MBChB PhD FRCS 15 , , MBBS MD FRCP 16 , , MB BS PhD 17 , ∗ , , BMedSci BMBS FRCS MD 18 , $ , , MB BS MD 19 , $ , COPE Study Collaborators
      Publication date (Electronic):
      Journal: The Journal of Hospital Infection
      Publisher: Published by Elsevier Ltd on behalf of The Healthcare Infection Society.
      Keywords: COVID-19, Nosocomial infection, community acquired infection

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          Abstract

          Introduction

          Hospital admissions for non-COVID-19 pathology have significantly reduced. It is believed that this may be due to public anxiety about acquiring COVID-19 infection in hospital and the subsequent risk of mortality. There is an urgent need for clarity regarding patients who acquire COVID-19 in hospital (nosocomial COVID-19 infection [NC]), their risk of mortality, compared to those with community acquired COVID-19 (CAC) infection.

          Methods

          The COPE-Nosocomial Study was an observational cohort study. The primary outcome was the time to all-cause mortality (estimated with an adjusted hazards ratio [aHR]), and secondary outcomes were Day-7 mortality and the time-to-discharge. A mixed-effects multivariable Cox’s proportional hazards model was used, adjusted for demographics and comorbidities.

          Results

          Our study included 1564 patients from 10 hospital sites throughout the UK, and one in Italy, and collected outcomes on patients admitted up to 28 th April, 2020. 12.5% of COVID-19 infections were acquired in hospital. 425 (27.2%) patients with COVID died. The median survival time in NC patients was 14 days, which compared to 10 days in CAC patients. In the primary analysis, NC infection was associated with reduced mortality (aHR=0.71, 95%CI 0.51-0.99). Secondary outcomes found no difference in Day-7 mortality (aOR=0.79, 95%CI 0.47-1.31), but NC patients required longer time in hospital during convalescence (aHR=0.49, 95%CI 0.37-0.66).

          Conclusion

          The minority of COVID-19 cases were the result of NC transmission. Whilst no COVID-19 infection comes without risk, patients with NC had a reduced risk of mortality compared to CAC infection, however, caution should be taken when interpreting this finding.

          In the United Kingdom, authority to conduct the study was granted by the Health Research Authority (20/HRA/1898), and in Italy by the Ethics Committee of Policlinico Hospital Modena (Reference 369/2020/OSS/AOUMO). Cardiff University was the study sponsor.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of Coronavirus Disease 2019 in China

            Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)
            Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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              Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

              Fei Zhou, Ting Yu, Ronghui Du … (2020)
              Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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                Author and article information

                Contributors
                B. Carter: Role: Senior Lecturer
                J.T. Collins
                F. Barlow-Pay
                F. Rickard
                E. Bruce
                A. Verduri
                T.J. Quinn: Role: Clinical Senior Lecturer
                E. Mitchell: Role: Specialist Registrar
                A. Price
                A. Vilches-Moraga: Role: Consultant Geriatrician, Honorary Senior Lecturer
                M.J. Stechman: Role: Consultant Surgeon
                R. Short: Role: Research Associate
                A. Einarsson: Role: Consultant Physician
                P. Braude: Role: Consultant Geriatrician
                S. Moug: Role: Professor and Consultant Colorectal Surgeon
                P.K. Myint
                J. Hewitt: Role: Clinical Senior Lecturer
                L. Pearce: Role: Consultant Surgeon
                K. McCarthy
                Journal
                Journal ID (nlm-ta): J Hosp Infect
                Journal ID (iso-abbrev): J. Hosp. Infect
                Title: The Journal of Hospital Infection
                Publisher: Published by Elsevier Ltd on behalf of The Healthcare Infection Society.
                ISSN (Print): 0195-6701
                ISSN (Electronic): 1532-2939
                Publication date PMC-release: 21 July 2020
                Publication date (Electronic): 21 July 2020
                Affiliations
                [1 ]Biostatistics. Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF. United Kingdom
                [2 ]Specialist Registrar in Geriatric Medicine. Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board
                [3 ]Specialty Registrar in Anaesthesia. Royal Alexandra Hospital, Paisley
                [4 ]Specialist Registrar Geriatric Medicine, North Bristol NHS Trust
                [5 ]Academic Foundation Trainee, Institute of Applied Health Sciences, University of Aberdeen
                [6 ]Consultant Respiratory Physician. Hospital of Modena Policlinico (Italy)
                [7 ]Institute of Cardiovascular and Medical Sciences, University of Glasgow
                [8 ]Geriatric Medicine, North Bristol NHS Trust
                [9 ]Advanced Clinical Practitioner. Salford Royal NHS Trust
                [10 ]Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, University of Manchester, UK
                [11 ]Department of Surgery, University Hospital of Wales, Cardiff
                [12 ]Forensic & Neurodevelopmental Sciences
                [13 ]Woodend Hospital, Aberdeen
                [14 ]North Bristol NHS Trust, UK
                [15 ]Department of Surgery, Royal Alexandra Hospital, Paisley PA2 9PN, UK
                [16 ]Old Age Medicine, Institute of Applied Health Sciences, University of Aberdeen
                [17 ]Cardiff University and Honorary Consultant Physician, Aneurin Bevan University Health Board
                [18 ]Department of Colorectal Surgery, Salford Royal NHS Foundation Trust, Manchester
                [19 ]Department of Surgery, North Bristol NHS Trust, Southmead Rd, Bristol BS10 5NB, UK
                Author notes
                [∗ ]Corresponding author. Division of Population Medicine, Cardiff University. hewittj2@ 123456cardiff.ac.uk HewittJ2@ 123456cardiff.ac.uk
                [∗]

                COPE Study Collaborators:

                [∗∗]

                These authors contributed equally as first author.

                [$]

                These authors contributed equally as senior author.

                Article
                Publisher ID: S0195-6701(20)30344-3
                DOI: 10.1016/j.jhin.2020.07.013
                PMC ID: 7372282
                PubMed ID: 32702463
                SO-VID: 31427a0a-3aa3-46fc-a706-27fd45866543
                Copyright © © 2020 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 10 June 2020
                Date accepted : 13 July 2020
                Categories
                Subject: Article

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: covid-19,nosocomial infection,community acquired infection
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: covid-19, nosocomial infection, community acquired infection

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