Clinical characteristics, inflammation of long COVID and association with... recovery, 2022, PHOSP-COVID Collaborative

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00127-8/fulltext

The PHOSP-COVID Collaborative Group

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

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.

 

My impression (i.e I haven't been counting !) is that there's a fairly consistent picture around the 'long covid' post hospitalisation cohorts that sets them apart from any common picture of the ME/CFS patient population - notably gender and age; from above: "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".

Non hospitalised post acute COVID19 cohorts seem to comprise far more diverse populations with some reflecting the expected pattern of ME/CFS - high % female and mean age 30>40. Cohort selection looks like it has a large effect on the results of LC studies.

 

Interesting difference and possible clue, if it holds up.

 

I thought this quote was intriguing

“...Available therapies for some adults with long COVID include rehabilitation,35 but the optimal exercise prescription is contentious because of concerns of post-exertional symptom exacerbation. ...”



Especially given that a member of the writing group for this paper is Trudie Chalder [seems to have been mostly involved in data analysis and interpretation]

 

That's just the cohort of people they followed up with to see if they had recovered or not, which presumably skewed male because men are more likely to be hospitalized. They found "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])", so if I'm doing the math right, they found 20% of men did not recover and 45% of women did not recover at one year, definitely in the range of reported sex ratios for ME. Huge confidence interval on this number though, as the study was relatively small, so take it with a grain of salt.