Projects Delivered

Procalcitonin is a marker of bacterial infection which can be measured in the blood. It is a relatively new test which is already used in some hospitals, mostly to help doctors understand what is causing severe infections.

We used this test during the COVID-19 pandemic because some data suggested it shows how unwell someone might become in the early stages of COVID-19. It could also be useful to identify patients who have bacterial infections on top of the COVID-19 disease or give doctors a measure of whether the disease is becoming more severe.

We want to find out whether this test was accurate, and whether it added important information beyond some of the more commonplace tests we do in the hospital. Understanding this will help us decide whether we should carry on doing the test in the future.

There is mounting evidence that socioeconomic deprivation increases the risk of death in people suffering from COVID-19 disease, independent of race or associated chronic health conditions.

The Scottish Government collects data on socioeconomic deprivation on a yearly basis using a tool called the Scottish Index of Multiple Deprivation, which breaks down the degree of deprivation in each area of the country according to income, employment, educational, health and housing indicators.

This study will investigate what deprivation indicators contribute to higher death rates among patients admitted to hospital with confirmed COVID-19 disease.

Project output

In October 2023, a journal article was published to share the results of this research: access the journal article

In conclusion, the research team found that overall deprivation status (as defined by the Scottish Index of Multiple Deprivation) was not reliably associated with deaths due to COVID-19. However, they found that the risk of death was doubled for those living in areas with higher levels of income-related deprivation and/or higher numbers of hospitalisations due to alcohol consumption. 

Therefore, for future allocation of resources, there may be greater benefit in looking at specific measures of deprivation - such as income, education level, crime rates, access to amenities - rather than solely the overall deprivation level, particularly in areas where overall affluence may mask pockets of deprivation.

People who survive COVID-19-related severe (critical) illness have complex care needs, requiring support from health and social care professionals in hospital and community settings. Long COVID is increasingly recognised as a public health issue. There is a pressing need for solutions that make better use of data from health records to support care for patients and families during recovery.

The project aims to identify the information that health and care professionals need to provide care for people recovering from COVID. It will also use data to better match up the care needs of people with available treatment options. In addition, the project aims to find ways of presenting this information to health and care professionals that means that they can quickly and efficiently understand what care patients and families need.

The project team will work closely with patients, families and the public to ensure that the work we do is relevant and focused to their needs.

On admission to hospital individuals with suspected COVID-19 will currently have swabs taken to check for the presence of COVID-19 viral RNA by a PCR test.  However, many individuals with presumed COVID-19 never have a positive PCR swab result which may be due to them having ceased shedding the virus by the time they are admitted to hospital. In these individuals, antibody tests may provide additional useful information to confirm their diagnosis.

For the currently available antibody tests it may be necessary to compare paired samples of blood to look for evidence of recent infection as a single blood sample may only be able to determine whether or not there has been evidence of past exposure.

Within NHS Lothian we have collected information about patients admitted with COVID-19. This project would use this information to describe the patterns seen in these patients. This could help researchers and Doctors work out those people who are at higher risk of becoming seriously unwell. Additionally by recognising those at higher risk, we may be able to suggest policy change to protect these groups.

Uncertainty remains as to the diagnostic performance of the combined nasal and throat swab, particularly in patients presenting late following the onset of symptoms when the viral load may be lower.

This study will define the performance of the combined nasal and throat swab in consecutive persons admitted to hospital with symptoms of COVID-19. It will also determine whether this differs in certain groups of patients, and help us to understand the value of repeated testing in those where the first test is negative.
 

You can view the publication based on this project on the BMC Infectious Diseases website: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-05976-1

Procalciton in is a marker of bacterial infection which can be measured in the blood. Data has shown it is able to be used as a prognostic marker in COVID-19 patients and can also potentially be used to identify secondary bacterial infection or disease becoming more severe.

This project aims to gather data from NHS Lothian patients to assess how this test is being used by clinicians in NHS Lothian and what the data means for patients. This will ultimately help understand the true meaning of a procalciton in test result and how it can be best used to aid patient care.

COVID-19 can cause multiple medical problems, for example pneumonia, kidney failure, confusion, blood clots etc. that involve different specialists, in the same patient. In the past each specialist would make their own arrangement to see or review the patient after discharge and perform blood tests, x-rays etc.

Multiple visits to different departments are not an ideal way of caring for patients, especially during the COVID-19 pandemic. For this reason we are designing a new way of reviewing patients after discharge that involves the specialists talking to each other, making a plan for each patient and if the patient needs tests or an appointment, these will done in one hospital visit.

We hope this will improve the patient experience and avoid unnecessary risks.