Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Issue 8 (August 2022)

• Record Type: Journal Article
• Authors: Evans, R A; Leavy, O C; Richardson, M; Elneima, O; McAuley, H J C; Shikotra, A; Singapuri, A; Sereno, M; Saunders, R M; Harris, V C; Houchen-Wolloff, L; Aul, R; Beirne, P; Bolton, C E; Brown, J S; Choudhury, G; Diar-Bakerly, N; Easom, N; Echevarria, C; Fuld, J; Hart, N; Hurst, J; Jones, M G; Parekh, D; Pfeffer, P; Rahman, N M; Rowland-Jones, S L; Shah, A M; Wootton, D G; Chalder, T; Davies, M J; De Soyza, A; Geddes, J R; Greenhalf, W; Greening, N J; Heaney, L G; Heller, S; Howard, L S; Jacob, J; Jenkins, R G; Lord, J M; Man, W D-C; McCann, G P; Neubauer, S; Openshaw, P J M; Porter, J C; Rowland, M J; Scott, J T; Semple, M G; Singh, S J; Thomas, D C; Toshner, M; Lewis, K E; Thwaites, R S; Briggs, A; Docherty, A B; Kerr, S; Lone, N I; Quint, J; Sheikh, A; Thorpe, M; Zheng, B; Chalmers, J D; Ho, L P; Horsley, A; Marks, M; Poinasamy, K; Raman, B; Harrison, E M; Wain, L V; Brightling, C E; Abel, K; Adamali, H; Adeloye, D; Adeyemi, O; Adrego, R; Aguilar Jimenez, L A; 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, R J; Allerton, L; Allsop, L; Almeida, P; Altmann, D; Alvarez Corral, M; Amoils, S; Anderson, D; Antoniades, C; Arbane, G; Arias, A; Armour, C; Armstrong, L; Armstrong, N; Arnold, D; Arnold, H; Ashish, A; Ashworth, A; Ashworth, M; Aslani, S; Assefa-Kebede, H; Atkin, C; Atkin, P; Aung, H; Austin, L; Avram, C; Ayoub, A; Babores, M; Baggott, R; Bagshaw, J; Baguley, D; Bailey, L; Baillie, J K; Bain, S; Bakali, M; Bakau, M; Baldry, E; Baldwin, D; Ballard, C; Banerjee, A; Bang, B; Barker, R E; Barman, L; Barratt, S; Barrett, F; Basire, D; Basu, N; Bates, M; Bates, A; Batterham, R; Baxendale, H; Bayes, H; Beadsworth, M; Beckett, P; Beggs, M; Begum, M; Bell, D; Bell, R; Bennett, K; Beranova, E; Bermperi, A; Berridge, A; Berry, C; Betts, S; Bevan, E; Bhui, K; Bingham, M; Birchall, K; Bishop, L; Bisnauthsing, K; Blaikely, J; Bloss, A; Bolger, A; Bonnington, J; Botkai, A; Bourne, C; Bourne, M; 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• Is Part Of: Lancet. Volume 10:Issue 8(2022)
• Page Start: 761
• Page End: 775
• Publication Date: 2022-08
• Subjects: Respiratory organs -- Diseases -- Periodicals; 616.2005
• DOI: 10.1016/S2213-2600(22)00127-8
• Languages: English
• ISSNs: 2213-2600

Abstract

Summary: 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.