Evans, Rachael A, Leavy, Olivia C, Richardson, Matthew, Elneima, Omer, McAuley, Hamish JC, Shikotra, Aarti, Singapuri, Amisha, Sereno, Marco, Saunders, Ruth M, Harris, Victoria C et al (show 57 more authors)
(2022)
Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study.
LANCET RESPIRATORY MEDICINE, 10 (8).
pp. 761-775.
Abstract
<h4>Background</h4>No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.<h4>Methods</h4>The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.<h4>Findings</h4>2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.<h4>Interpretation</h4>The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.<h4>Funding</h4>UK Research and Innovation and National Institute for Health Research.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | PHOSP-COVID Collaborative Group, Humans, Obesity, Inflammation, Hospitalization, Retrospective Studies, Longitudinal Studies, Prospective Studies, Quality of Life, Adolescent, Adult, Middle Aged, Female, Male, United Kingdom, COVID-19, SARS-CoV-2, Post-Acute COVID-19 Syndrome |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 25 Apr 2022 07:31 |
| Last Modified: | 18 Jan 2023 21:04 |
| DOI: | 10.1016/S2213-2600(22)00127-8 |
| Open Access URL: | https://doi.org/10.1016/S2213-2600(22)00127-8 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3153771 |
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