A new UK study of more than 2,000 patients after hospitalisation with COVID-19 presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2022, Lisbon 23-26), and published in The Lancet Respiratory Medicine shows that, one year after having COVID-19, only around one in four patients feel fully well again. The study is led by Professor Christopher Brightling, Dr Rachael Evans, and Professor Louise Wain, National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, UK and colleagues.
The authors found that being female versus being male (32% less likely), having obesity (half as likely) and having had mechanical ventilation in hospital (58% less likely) were all associated with a lower probability of feeling fully recovered at one year. The most common ongoing long-COVID symptoms were fatigue, muscle pain, physically slowing down, poor sleep, and breathlessness.
This research used data from the post-hospitalisation COVID-19 (PHOSP-COVID) study which assessed adults (aged 18 years and over) who had been hospitalised with COVID-19 across the UK and subsequently discharged. Patients from 39 UK National Health Service (NHS) hospitals* were included, who agreed to five-month and 1-year follow-up assessments in addition to their clinical care. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge. The researchers also took samples of participants’ blood at the five month visit to analyse it for the presence of various inflammatory proteins.
A total of 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (33%) participants completed both the 5-month and 1-year visits at the time of analysis (and the study is ongoing). These 807 patients had a mean age of 59 years, 279 (36%) were women and 28% received invasive mechanical ventilation. The proportion of patients reporting full recovery was similar between 5 months (501 [26%] of 1965) and 1 year (232 [29%] of 804).
In an earlier publication from this study* the authors had identified four groups or ‘clusters’ of symptom severity at five months, which were confirmed by this new study at one year. Of the 2320 participants, 1636 had sufficient data to allocate them to a cluster: 319 (20%) had very severe physical and mental health impairment, 493 (30%) had severe physical and mental health impairment, 179 (11%) moderate physical health impairment with cognitive impairment, and 645 (39%) mild mental and physical health impairment. Having obesity, reduced exercise capacity, a greater number of symptoms, and increased levels of the inflammatory biomarker C-reactive protein were associated with the more severe clusters. In both the very severe and the moderate with cognitive impairment clusters, levels of the inflammatory biomarker interleukin-6 (IL-6) were higher when compared with the mild cluster.
She adds: “We found female sex and obesity were major risk factors for not recovering at 1 year… In our clusters, female sex and obesity were also associated with more severe ongoing health impairments including reduced exercise performance and health-related quality of life at 1 year, potentially highlighting a group that might need higher intensity interventions such as supervised rehabilitation.”
On lack of existing treatments for long COVID, Professor Wain says: “No specific therapeutics exist for long COVID and our data highlight that effective interventions are urgently required. Our findings of persistent systemic inflammation, particularly in those in the very severe and moderate with cognitive impairment clusters, suggest that these groups might respond to anti-inflammatory strategies. The concordance of the severity of physical and mental health impairment in long COVID highlights the need not only for close integration between physical and mental health care for patients with long COVID, including assessment and interventions, but also for knowledge transfer between health-care professionals to improve patient care. The finding also suggests the need for complex interventions that target both physical and mental health impairments to alleviate symptoms. However, specific therapeutic approaches to manage post-traumatic stress disorder might also be needed.”
Professor Brightling concludes: “Our study highlights an urgent need for health-care services to support this large and rapidly increasing patient population in whom a substantial burden of symptoms exist, including reduced exercise capacity and substantially decreased health-related quality of life 1 year after hospital discharge. Without effective treatments, long COVID could become a highly prevalent new long-term condition. Our study also provides a rationale for investigating treatments for long COVID with a precision-medicine approach to target treatments to the individual patient’s profile to restore their health-related quality of life.”
For interviews with the authors at the Institute for Lung Health and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, UK, please e-mail E) phosp@leicester.ac.uk
Alternative contact: Tony Kirby in the ECCMID Press Centre. T) +44 7834 385827 E) tony@tonykirby.com
Notes to editors:
The Lancet Respiratory Medicine : Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: prospective observational study – to be presented at a special Lancet journals COVID-19 session in Hall A of the European Congress on Clinical Microbiology & Infectious Diseases (ECCMID 2022) on Sunday April 24 at 16.15-18.15 Lisbon/UK time (WEST time zone).
Click here to view press release in Spanish
Click here to view press release in Portuguese
List of participating hospitals for this part of study:
Site
NHS Trust
Addenbrookes Hospital
Cambridge University Hospitals
Aintree Hospital
University Hospitals of Liverpool NHS Foundation Trust
Belfast City Hospital
Belfast Health & Social Care Trust
Castle Hill Hospital
Hull University Teaching Hospitals NHS Trust
Glasgow Queen Elizabeth Hospital
NHS Greater Glasgow and Clyde
Glasgow Royal Infirmary
Glenfield Hospital
University Hospitals of Leicester NHS Trust
Guys & St Thomas' Hospital
Guy's and St Thomas' NHS Foundation Trust
Hammersmith Hospital
Imperial College Healthcare NHS Trust
Harefield Hospital
Royal Brompton & Harefield NHS Foundation Trust
Kings College Hospital
King's College Hospital NHS Foundation Trust
University Hospital Wishaw
NHS Lanarkshire
Manchester Royal Infirmary
Manchester University NHS Foundation Trust
Ninewells Hospital & Medical School
NHS Tayside
North Middlesex Hospital
North Middlesex University Hospital NHS Trust
Nottingham City Hospital
Nottingham University Hospitals NHS Trust
Oxford Churchill Hospital
Oxford University Hospitals NHS Foundation Trust
Prince Philip Hospital
Hywel Dda University Health Board
Queen Elizabeth Hospital
University Hospitals of Birmingham NHS Trust
Royal Infirmary of Edinburgh
NHS Lothian
Raigmore Hospital
NHS Highlands
Royal Brompton Hospital
Royal Free Hospital
The Royal Free London NHS Foundation Trust
Royal Gwent Hospital
Aneurin Bevan University Health Board
Royal Hallamshire Hospital
Sheffield Teaching Hospitals NHS Foundation Trust
Royal London Barts Hospital
Barts Health NHS Trust
Royal Papworth Hospital
Royal Papworth Hospital NHS Foundation Trust
Royal Victoria Infirmary
The Newcastle Upon Tyne Hospitals NHS Foundation Trust
Salford Royal Infirmary
Salford Royal NHS Foundation Trust
Southampton General Hospital
University Hospitals Southampton NHS Foundation Trust
Southmead Hospital
North Bristol NHS Trust
St Georges Hospital
St George’s University Hospitals NHS Foundation Trust
St James University Hospital
Leeds Teaching Hospitals NHS Trust
St Mary's Hospital
Tameside General Hospital
Tameside and Glossop Integrated Care NHS Foundation
The Whittington Hospital
Whittington Health NHS Trust
University College Hospital
University College London Hospitals NHS Foundation Trust
Wythenshawe Hospital
The Lancet Respiratory Medicine
Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: prospective observational study
23-Apr-2022
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