Imperial College London
Alternate

Claire L. Shovlin PhD FRCP

Faculty of Medicine, National Heart & Lung Institute

Professor of Practice (Clinical and Molecular Medicine)
 
 
 
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Contact

 

c.shovlin Website

 
 
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Location

 

534Block L Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@unpublished{Vizcaychipi:2020:10.1101/2020.05.08.20088393,
author = {Vizcaychipi, M and Shovlin, C and Hayes, M and Singh, S and Christie, L and Sisson, A and Davies, R and Lockie, C and Howard, A and Brown, A and McCarthy, A and Popescu, M and Gupta, A and Armstrong, J and Said, H and Peters, T and Keays, R and ChelWest, COVID-19 Consortium},
doi = {10.1101/2020.05.08.20088393},
publisher = {medRxiv},
title = {Early detection of severe COVID-19 disease patterns define near real-time personalised care, bioseverity in males, and decelerating mortality rates.},
url = {http://dx.doi.org/10.1101/2020.05.08.20088393},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - UNPB
AB  - BACKGROUND: COVID-19 is a global health emergency. Recent data indicate a 50% mortality rate across UK intensive care units.  METHODS: A single institution, two-centre retrospective analysis following implementation of a Decision Support tool and real-time data dashboard for early detection of patients requiring personalised enhanced care, focussing particularly on respiratory rate, diastolic blood pressure, oxygenation indices, C-reactive protein, D-dimer and ferritin. Protocols differing from conventional practice included high-dose prophylactic anticoagulation for all COVID-19 positive patients and antioxidant prescription. RESULTS: By 22nd April 2020, 923 patients tested COVID-19 positive. 569 patients (61.7%) were male. The majority presented with advanced disease: interquartile ranges were C-reactive protein 44.9-179mg/L, D-dimer 1070-3802ng/L, and ferritin 261-1208μg/L. Completed case fatality rates were 25.1% [95% CI 20.0, 30.0] in females, 40.5% [95% CI 35.9, 45.0] in males. 139 patients were admitted to intensive care where current death rates are 16.2% [95% CI 3.8, 28.7] in females, 38.2% [95% CI 28.6, 47.8] in males with no trends for differences based on ethnicity. A real-time traffic lights dashboard enabled rapid assessment of patients using critical parameters to accelerate adjustments to management protocols. In total 513 (55.6%) of patients were flagged as high risk for thromboembolic disease, exceeding the numbers flagged for respiratory deteriorations (N=391, 42.4%), or cytokine storm (N=68, 7.4%). There was minimal evidence that age was associated with disease severity, but males had higher levels of all dashboard indices, particularly C-reactive protein and ferritin (p<0.0001) which displayed no relationship with age.  CONCLUSIONS: Survival rates are encouraging. Protocols employed (traffic light-driven personalised care, protocolised early therapeutic anticoagulation based on D-dimer >1,000ng/L and/or CRP>200 mg/L, personalised ven
AU  - Vizcaychipi,M
AU  - Shovlin,C
AU  - Hayes,M
AU  - Singh,S
AU  - Christie,L
AU  - Sisson,A
AU  - Davies,R
AU  - Lockie,C
AU  - Howard,A
AU  - Brown,A
AU  - McCarthy,A
AU  - Popescu,M
AU  - Gupta,A
AU  - Armstrong,J
AU  - Said,H
AU  - Peters,T
AU  - Keays,R
AU  - ChelWest,COVID-19 Consortium
DO  - 10.1101/2020.05.08.20088393
PB  - medRxiv
PY  - 2020///
TI  - Early detection of severe COVID-19 disease patterns define near real-time personalised care, bioseverity in males, and decelerating mortality rates.
UR  - http://dx.doi.org/10.1101/2020.05.08.20088393
UR  - http://hdl.handle.net/10044/1/81980
ER  -
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