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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. |
URI: | https://bura.brunel.ac.uk/handle/2438/25532 |
DOI: | https://doi.org/10.1016/S2213-2600(22)00127-8 |
ISSN: | 2213-2600 |
Appears in Collections: | Dept of Health Sciences Research Papers |
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