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      Determinants of recovery from post-COVID-19 dyspnoea: analysis of UK prospective cohorts of hospitalised COVID-19 patients and community-based controls

      research-article
      Author(s): a , ag , b , c , ag , a , d , e , e , e , e , f , e , e , e , e , g , h , i , e , j , k , l , l , m , n , o , n , p , q , q , a , r , s , t , u , v , w , x , y , z , aa , ab , ac , ad , d , e , e , g , e , b , c , ae , ah , a , af , ah , ∗ , PHOSP-COVID Study Collaborative Group
      Publication date (Electronic):
      Journal: The Lancet Regional Health - Europe
      Publisher: The Author(s). Published by Elsevier Ltd.
      Keywords: COVID-19, Dyspnoea, Long COVID, Recovery, Cohort

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          Abstract

          Background

          The risk factors for recovery from COVID-19 dyspnoea are poorly understood. We investigated determinants of recovery from dyspnoea in adults with COVID-19 and compared these to determinants of recovery from non-COVID-19 dyspnoea.

          Methods

          We used data from two prospective cohort studies: PHOSP-COVID (patients hospitalised between March 2020 and April 2021 with COVID-19) and COVIDENCE UK (community cohort studied over the same time period). PHOSP-COVID data were collected during hospitalisation and at 5-month and 1-year follow-up visits. COVIDENCE UK data were obtained through baseline and monthly online questionnaires. Dyspnoea was measured in both cohorts with the Medical Research Council Dyspnoea Scale. We used multivariable logistic regression to identify determinants associated with a reduction in dyspnoea between 5-month and 1-year follow-up.

          Findings

          We included 990 PHOSP-COVID and 3309 COVIDENCE UK participants. We observed higher odds of improvement between 5-month and 1-year follow-up among PHOSP-COVID participants who were younger (odds ratio 1.02 per year, 95% CI 1.01–1.03), male (1.54, 1.16–2.04), neither obese nor severely obese (1.82, 1.06–3.13 and 4.19, 2.14–8.19, respectively), had no pre-existing anxiety or depression (1.56, 1.09–2.22) or cardiovascular disease (1.33, 1.00–1.79), and shorter hospital admission (1.01 per day, 1.00–1.02). Similar associations were found in those recovering from non-COVID-19 dyspnoea, excluding age (and length of hospital admission).

          Interpretation

          Factors associated with dyspnoea recovery at 1-year post-discharge among patients hospitalised with COVID-19 were similar to those among community controls without COVID-19.

          Funding

          PHOSP-COVID is supported by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the doi 10.13039/501100000272, National Institute for Health Research; (NIHR) rapid response panel to tackle COVID-19. The views expressed in the publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care.

          COVIDENCE UK is supported by the UK Research and Innovation, the National Institute for Health Research, and Barts Charity. The views expressed are those of the authors and not necessarily those of the funders.

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          Most cited references31

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          The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

          Erik von Elm, Douglas G. Altman, Matthias Egger … (2008)
          Much of biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalizability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. Eighteen items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.
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            Attributes and predictors of long COVID

            Carole H. Sudre, Benjamin Murray, Thomas Varsavsky … (2021)
            Reports of long-lasting coronavirus disease 2019 (COVID-19) symptoms, the so-called 'long COVID', are rising but little is known about prevalence, risk factors or whether it is possible to predict a protracted course early in the disease. We analyzed data from 4,182 incident cases of COVID-19 in which individuals self-reported their symptoms prospectively in the COVID Symptom Study app1. A total of 558 (13.3%) participants reported symptoms lasting ≥28 days, 189 (4.5%) for ≥8 weeks and 95 (2.3%) for ≥12 weeks. Long COVID was characterized by symptoms of fatigue, headache, dyspnea and anosmia and was more likely with increasing age and body mass index and female sex. Experiencing more than five symptoms during the first week of illness was associated with long COVID (odds ratio = 3.53 (2.76-4.50)). A simple model to distinguish between short COVID and long COVID at 7 days (total sample size, n = 2,149) showed an area under the curve of the receiver operating characteristic curve of 76%, with replication in an independent sample of 2,472 individuals who were positive for severe acute respiratory syndrome coronavirus 2. This model could be used to identify individuals at risk of long COVID for trials of prevention or treatment and to plan education and rehabilitation services.
            Article 0 comments Cited 1035 times – based on 0 reviews     Review now
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              A minimal common outcome measure set for COVID-19 clinical research

              John C Marshall, Srinivas Murthy, Janet V. Diaz … (2020)
              Summary Clinical research is necessary for an effective response to an emerging infectious disease outbreak. However, research efforts are often hastily organised and done using various research tools, with the result that pooling data across studies is challenging. In response to the needs of the rapidly evolving COVID-19 outbreak, the Clinical Characterisation and Management Working Group of the WHO Research and Development Blueprint programme, the International Forum for Acute Care Trialists, and the International Severe Acute Respiratory and Emerging Infections Consortium have developed a minimum set of common outcome measures for studies of COVID-19. This set includes three elements: a measure of viral burden (quantitative PCR or cycle threshold), a measure of patient survival (mortality at hospital discharge or at 60 days), and a measure of patient progression through the health-care system by use of the WHO Clinical Progression Scale, which reflects patient trajectory and resource use over the course of clinical illness. We urge investigators to include these key data elements in ongoing and future studies to expedite the pooling of data during this immediate threat, and to hone a tool for future needs.
              Article 0 comments Cited 790 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Lancet Reg Health Eur
                Journal ID (iso-abbrev): Lancet Reg Health Eur
                Title: The Lancet Regional Health - Europe
                Publisher: The Author(s). Published by Elsevier Ltd.
                ISSN (Electronic): 2666-7762
                Publication date PMC-release: 28 April 2023
                Publication date (Electronic): 28 April 2023
                Electronic Location Identifier: 100635
                Affiliations
                [a ]Usher Institute, University of Edinburgh, Edinburgh, UK
                [b ]Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
                [c ]Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
                [d ]Department of Population Health Sciences, University of Leicester, Leicester, UK
                [e ]The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
                [f ]NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
                [g ]University Hospitals of Leicester NHS Trust, Leicester, UK
                [h ]Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester, Leicester, UK
                [i ]Therapy Department, University Hospitals of Leicester, NHS Trust, Leicester, UK
                [j ]Barts Health NHS Trust, London, UK
                [k ]Queen Mary University of London, London, UK
                [l ]UCL Respiratory, University College London, London, UK
                [m ]Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
                [n ]The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
                [o ]Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
                [p ]Population Health Science Institute, Newcastle University, Newcastle, UK
                [q ]Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
                [r ]Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
                [s ]National Heart Lung Institute, Imperial College London, London, UK
                [t ]University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
                [u ]Medical Research Council (MRC) Human Immunology Unit, University of Oxford, Oxford, UK
                [v ]Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
                [w ]Manchester University NHS Foundation Trust, Manchester, UK
                [x ]Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
                [y ]Hospital for Tropical Diseases, University College London Hospital, London, UK
                [z ]Division of Infection and Immunity, University College London, London, UK
                [aa ]Asthma and Lung UK, London, UK
                [ab ]Radcliffe Department of Medicine, University of Oxford, Oxford, UK
                [ac ]Oxford University Hospitals NHS Foundation Trust, Oxford, UK
                [ad ]Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
                [ae ]Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
                [af ]Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
                Author notes
                [∗ ]Correspondong author. Usher Institute, University of Edinburgh, Doorway 3, Old Medical School, Teviot Place, Edinburgh, United Kingdom.
                [ag]

                Joint first authors.

                [ah]

                Joint last authors.

                [ai]

                Members of the PHOSP-COVID Study Collaborative Group are listed in the appendix.

                Article
                Publisher Item ID: S2666-7762(23)00054-6 Publisher ID: 100635
                DOI: 10.1016/j.lanepe.2023.100635
                PMC ID: 10145209
                PubMed ID: 37261214
                SO-VID: 371ebc04-7382-4553-84f4-559ad2cf6f2f
                Copyright © © 2023 The Author(s)
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 16 January 2023
                Date revision received : 17 March 2023
                Date accepted : 27 March 2023
                Categories
                Subject: Articles

                Keywords: covid-19,dyspnoea,long covid,recovery,cohort
                Data availability:
                Keywords: covid-19, dyspnoea, long covid, recovery, cohort

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