TY - JOUR
T1 - Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK
T2 - a prospective observational study
AU - The PHOSP-COVID Collaborative Group
AU - Richardson, M.
AU - Saunders, R. M.
AU - Brown, J.
AU - Jones, M. G.
AU - Davies, M. J.
AU - Scott, J. T.
AU - Sheikh, A.
AU - Adeloye, D.
AU - Ahmad, S.
AU - Ahmed, R.
AU - Ali, M.
AU - Armstrong, N.
AU - Barker, R. E.
AU - Bell, D.
AU - Brown, A.
AU - Brown, J.
AU - Brown, M.
AU - Clarke, J.
AU - Cook, A.
AU - Davies, K.
AU - Dixon, M.
AU - Dobson, S. L.
AU - Finch, J.
AU - Fletcher, S.
AU - Henderson, M.
AU - Hewitt, M.
AU - Hughes, J.
AU - Hughes, R.
AU - Hutchinson, J.
AU - Johnson, C.
AU - Johnson, S.
AU - Jones, D.
AU - Jones, G.
AU - Jones, H.
AU - Jones, I.
AU - Jones, S.
AU - Li, X.
AU - Lim, L.
AU - Lloyd, A.
AU - Lynch, C.
AU - MacDonald, S.
AU - Mohamed, N.
AU - O'Brien, C.
AU - Parkes, M.
AU - Patel, S.
AU - Price, A.
AU - Richards, A.
AU - Robinson, E.
AU - Robinson, L.
AU - Ross, A.
AU - Sanderson, A.
AU - Scott, K.
AU - Selby, N.
AU - Shah, K.
AU - Shaw, A.
AU - Simpson, J.
AU - Smith, S.
AU - Smith, J.
AU - Smith, L.
AU - Taylor, A.
AU - Taylor, J.
AU - Thomas, C.
AU - Thomas, A. K.
AU - Thompson, T.
AU - Watson, J.
AU - Whittaker, S.
AU - Wilson, A.
AU - Wood, C.
AU - Woods, J.
AU - Wright, C.
AU - Young, B.
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2022/4/23
Y1 - 2022/4/23
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85135217228&partnerID=8YFLogxK
U2 - 10.1016/S2213-2600(22)00127-8
DO - 10.1016/S2213-2600(22)00127-8
M3 - Article
C2 - 35472304
AN - SCOPUS:85135217228
SN - 2213-2600
VL - 10
SP - 761
EP - 775
JO - The Lancet Respiratory Medicine
JF - The Lancet Respiratory Medicine
IS - 8
ER -