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Title: Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study
Authors: Evans, RA
Leavy, OC
Richardson, M
Elneima, O
McAuley, HJC
Shikotra, A
Singapuri, A
Sereno, M
Saunders, RM
Harris, VC
Houchen-Wolloff, L
Aul, R
Beirne, P
Bolton, CE
Brown, JS
Choudhury, G
Diar-Bakerly, N
Easom, N
Echevarria, C
Fuld, J
Hart, N
Hurst, J
Jones, MG
Parekh, D
Pfeffer, P
Rahman, NM
Rowland-Jones, SL
Shah, AM
Wootton, DG
Chalder, T
Davies, MJ
De Soyza, A
Geddes, JR
Greenhalf, W
Greening, NJ
Heaney, LG
Heller, S
Howard, LS
Jacob, J
Jenkins, RG
Lord, JM
Man, WDC
McCann, GP
Neubauer, S
Openshaw, PJM
Porter, JC
Rowland, MJ
Scott, JT
Semple, MG
Singh, SJ
Thomas, DC
Toshner, M
Lewis, KE
Thwaites, RS
Briggs, A
Docherty, AB
Kerr, S
Lone, NI
Quint, J
Sheikh, A
Thorpe, M
Zheng, B
Chalmers, JD
Ho, LP
Horsley, A
Marks, M
Poinasamy, K
Raman, B
Harrison, EM
Wain, LV
Brightling, CE
Abel, K
Adamali, H
Adeloye, D
Adeyemi, O
Adrego, R
Aguilar Jimenez, LA
Ahmad, S
Ahmad Haider, N
Ahmed, R
Ahwireng, N
Ainsworth, M
Al-Sheklly, B
Alamoudi, A
Ali, M
Aljaroof, M
All, AM
Allan, L
Allen, RJ
Allerton, L
Allsop, L
Almeida, P
Altmann, D
Alvarez Corral, M
Amoils, S
Anderson, D
Antoniades, C
Arbane, G
Arias, A
Armour, C
Issue Date: 1-Aug-2022
Publisher: Elsevier
Citation: Evans, R.A. et al. (2022) ‘Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study’ in The Lancet Respiratory Medicine, 10 (8), pp. 761 - 775. doi: 10.1016/s2213-2600(22)00127-8.
Abstract: Copyright © 2022 The Author(s). Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: UK Research and Innovation and National Institute for Health Research.
ISSN: 2213-2600
Appears in Collections:Dept of Health Sciences Research Papers

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