1 year after hospitalisation for COVID-19, only a minority of people feel fully recovered; obesity, being female, and mechanical ventilation in hospital are all risk factors for not feeling fully recovered

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In a new UK study of more than 2000 patients, presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2022, Lisbon), and published in The Lancet Respiratory Medicine, research showed that only around one in four patients feel fully well again 1 year after hospitalisation for COVID-19.

For their study, researchers from the University of Leicester used data from the post-hospitalisation COVID-19 (PHOSP-COVID) prospective, longitudinal cohort study, which assessed adults aged 18 years and over who had been hospitalised with COVID-19 across the UK and subsequently discharged. The researchers assessed the recovery of 2320 participants discharged from 39 UK hospitals between 7 March 2020 and 18 April 2021, who were assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge. Blood samples were taken at the 5-month visit to analyse for the presence of various inflammatory proteins.

All participants were assessed at 5 months after discharge and 807 (33%) participants completed both the 5-month and 1-year visits at the time of the analysis—the study is ongoing. The 807 patients had a mean age of 59 years, 36% were women, and 28% received invasive mechanical ventilation. The proportion of patients reporting full recovery was similar between 5 months (26%) and 1 year (29%).

Female sex and obesity major risk factors for not recovering

Being female, obese, and having had mechanical ventilation in hospital make someone 32%, 50%, and 58% respectively less likely to feel fully recovered 1 year after COVID-19 hospitalisation, the authors said. 

Dr Rachael Evans,a researcher at the National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, and one of the study authors, said: ‘We found female sex and obesity were major risk factors for not recovering at one year.’

The authors said fatigue, muscle pain, physically slowing down, poor sleep, and breathlessness were the most common ongoing symptoms of long COVID. They commented how the total number and range of ongoing symptoms at one year was ‘striking’, positively associated with the severity of long COVID, and emphasises the ‘multisystem nature of long COVID’

Several inflammatory mediators increased

An earlier publication from this study identified four groups or ‘clusters’  of symptom severity at 5 months, which were confirmed by this new study at 1 year, the authors said. The authors reported that 20% had very severe physical and mental health impairment, 30% had severe physical and mental health impairment, 11% moderate physical health impairment with cognitive impairment, and 39% mild mental and physical health impairment.

They added how having obesity, reduced exercise capacity, a greater number of symptoms, and increased levels of C-reactive protein were associated with the ‘more severe clusters’. In both the very severe and the moderate with cognitive impairment clusters, levels of interleukin-6 (IL-6) were higher when compared with the mild cluster.

Dr Evans said: ‘The limited recovery from 5 months to 1 year after hospitalisation in our study across symptoms, mental health, exercise capacity, organ impairment, and quality of life is striking.’ 

She added: ‘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’, and suggested that this potentially highlighted a group that ’might need higher intensity interventions such as supervised rehabilitation’

Professor Louise Wain, National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, also one of the study authors, pointed out that currently there are no specific therapeutics for long COVID and emphasised how ‘effective interventions are urgently required’. She explained how the persistent systemic inflammation they identified, particularly in those in the very severe and moderate with cognitive impairment clusters, suggested that these groups ‘might respond to anti-inflammatory strategies’.

‘We found that a minority of participants felt fully recovered 1 year after hospital discharge, with minimal improvement after a 5-month assessment,’ said the authors.

Professor Wain expressed how the findings suggested the need for complex interventions that target ‘both physical and mental health impairments to alleviate symptoms’, and that specific therapeutic approaches to manage post-traumatic stress disorder might also be needed. The authors pointed out how ‘pharmacological and non-pharmacological interventions are urgently needed’, with a ‘precision-medicine approach with potential treatable traits of systemic inflammation and obesity’.

Professor Christopher Brightling, National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, and one of the study authors, expressed how their study highlighted the ‘urgent need for healthcare services to support the 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’.

He warned that without effective treatments, long COVID could become a ‘highly prevalent new long-term condition’.

This article was originally published on Medscape, part of the Medscape Professional Network.

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