Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study

Abstract

Background The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. MethodsThe Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A posthoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). Findings We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5•9 months (IQR 4•9-6•5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40-59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity.Interpretation We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments w...

Post-COVID-19 syndrome, low-grade inflammation and inflammatory markers: a cross-sectional study

“…Evans et al. 8 evaluated 1170 patients, discharged from the hospital following treatment for COVID-19 and identified 4 clusters of patients suffering from PCS, according to mental and physical impairment. They analysed plasma CRP according to the clusters and found that patients included in clusters 1 and 2, with very severe and severe impairment, showed frequencies of CRP >1.0 mg/dL of 16.5% and 18%, respectively.…”

“…However, available data on biomarkers in PCS are very scarce 18 , poorly systematised and with conflicting results. Elevation of C-reactive protein (CRP) serum levels has been reported 8 , while other studies found no association 27 .…”

“…Fatigue, myalgia, dyspnea, anosmia, ageusia, autonomic dysregulation (manifested as orthostatic hypotension, tachycardia, thermoregulatory or gastrointestinal disturbances), anxiety, depression and cognitive problems are frequently reported 5 , 6 . These prolonged symptoms significantly affect patients' quality of life 7 , 8 , cause economic and productivity losses and increase the burden of care 9 . The condition has been called Long Covid or Post-COVID syndrome (PCS) 7 , and there is currently no consensus on its definition or diagnostic criteria.…”

Prevalence of Post COVID-19 Condition in Primary Care: A Cross Sectional Study

“…Estimating the prevalence of persistent symptoms is not easy due to differences in populations and methods used, and some studies reporting mixed data from hospitalized and non-hospitalized patients. Estimates therefore vary greatly across different studies [8][9][10][11][12][13][14][15][16][17].…”

Development and validation of the Symptom Burden Questionnaire™ for Long Covid: A Rasch analysis

“…The SBQ™-LC's conceptual framework was developed from systematic literature reviews of Long COVID symptoms [4,25]. Existing symptom measures (n = 6) with good face validity in the context of Long COVID were reviewed to establish whether a new PRO instrument of symptom burden was needed [26][27][28][29][30][31]. When mapped to the conceptual framework, symptom coverage of these measures ranged from 25.0% to 64.1% (mean = 42.4% SD 16.8).…”