Higher clinical acuity and 7-day hospital mortality in non-COVID-19 acute medical admissions: prospective observational study

Lyall, Marcus J; Lone, Nazir

Abstract Objectives: To understand the effect of COVID-19 lockdown measures on severity of illness and mortality in non-COVID-19 acute medical admissions. Design: A prospective observational study Setting: 3 large acute medical receiving units in NHS Lothian, Scotland. Participants: Non-covid-19 acute admissions (n = 1756) were examined over the first 31 days after the implementation of the COVID-19 lockdown policy in the United Kingdom on 23rd March 2019. Patients admitted over a matched interval in the previous 5 years were used as a comparator cohort (n = 14961). Main outcome measures: Patient demography, biochemical markers of clinical acuity and 7-day hospital inpatient mortality. Results: Non-covid-19 acute medical admissions reduced by a mean 43.8% (95% CI 27.3, 59.4) across all 3 sites in comparison to the mean of the preceding 5 years P < 0.001. The reduction in admissions predominated in the over 75 age category and a greater proportion arrived by emergency ambulance transport. Non-covid-19 admissions during lockdown had a greater incidence of severe renal injury, hyperlactataemia and over twice the risk of hospital death within 7 days 5.01% vs 2.49% which persisted after adjustment for confounders (OR 2.17, 95% CI 1.70,2.73, P < 0.0001) Conclusions: These data support current fears that patients are delaying seeking medical attention for acute illness which is associated with worsening clinical parameters and a higher risk of death following admission.