Study Shows That Long COVID Is More Predominant Than Thought With Only 1 Out Of 4 Hospitalized COVID-19 Patients Feeling Fully Recovered After One Year!
: A new study by researchers from the PHOSP-COVID Collaborative Group which is a consortium of over 168 researchers focused on Long COVID research and which is led by the National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester-UK has found that Long COVID is more predominant than though with only 1 out of 4 hospitalized COVID-19 patients feeling fully recovered after one year!
To date, no effective pharmacological or non-pharmacological interventions exist for patients with long COVID.
The Long COVID
study team 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.
The Post-hospitalization 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. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.
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.
Detailed inflammatory protein profiling was analyzed from plasma at the 5-month visit.
The study involved 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, who 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 study findings found that 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.
The study team 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).
The study findings showed a su
bstantial 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.
The study findings showed that 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.
The study findings were published in the peer reviewed journal: The Lancet Respiratory Medicine. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00127-8/fulltext
The new UK study of more than 2,000 patients after hospitalization with COVID-19 was also presented at this year's European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2022, Lisbon 23-26) shows that, one year after having COVID-19, only around one in four patients feel fully well again.
The research was led by Professor Dr Christopher Brightling, Dr Rachael Evans, and Professor Dr Louise Wain, all from the National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester along with other medical scientists.
The study findings indicated 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.
Interestingly, the most common ongoing long-COVID symptoms were fatigue, muscle pain, physically slowing down, poor sleep, and breathlessness.
The study used data from the post-hospitalization COVID-19 (PHOSP-COVID) study which assessed adults (aged 18 years and over) who had been hospitalized with COVID-19 across the UK and subsequently discharged.
COVID-19 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 study team also took samples of participants' blood at the five month visit to analyze it for the presence of various inflammatory proteins.
Patient-perceived recovery at 1 year. (A) Compared with patient-perceived recovery at 5 months. (B) Risk factors for being less likely to recover. (C) Compared according to the four clusters. (D) Compared with health-related quality of life (assessed by the EQ-5D-5L utility index). WHO clinical progression scale classes are as follows: 3–4 indicates no continuous supplemental oxygen needed; 5 indicates continuous supplemental oxygen only; 6 indicates continuous positive airway pressure or bi-level positive pressure ventilation or high-flow nasal oxygen; and 7–9 indicates invasive mechanical ventilation or other organ support. The forest plot of the patient and admission characteristics associated with patient-perceived recovery at 1 year used multivariable logistic regression and multiple imputation. EQ-5D-5L score before COVID-19 was retrospectively completed by participants. BMI=body-mass index.
In all, 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.
Importantly, the proportion of patients reporting full recovery was similar between 5 months (501 [26%] of 1965) and 1 year (232 [29%] of 804).
The same study team in an earlier publication from this study, had identified four groups or 'clusters' of symptom severity at five months, which were confirmed by this new study at one year. https://pubmed.ncbi.nlm.nih.gov/34627560/
It was found that 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.
Co-lead researchers, Dr Evans told Thailand Medical News
, "The limited recovery from 5 months to 1 year after hospitalization in our study across symptoms, mental health, exercise capacity, organ impairment, and quality-of-life is striking."
She further added, "The study findings showed that 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."
With regards to the lack of existing treatments for long COVID, Professor Dr Wain commented, "No specific therapeutics exist for long COVID and our data highlight that effective interventions are urgently required. Our study 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 study 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 commented, “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 exists, 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."
Thailand Medical News
would further like to add that Long COVID cannot be treated with a single protocol or therapeutic and that a personalized medicine approach is needed as it is a heterogenous condition that varies from individual to individual as many factors are at play including an individual's genetic make-up.
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