Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol
- PMID: 34386785
- PMCID: PMC8343377
- DOI: 10.1016/j.lanepe.2021.100186
Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol
Abstract
Background: This study sought to establish the long-term effects of Covid-19 following hospitalisation.
Methods: 327 hospitalised participants, with SARS-CoV-2 infection were recruited into a prospective multicentre cohort study at least 3 months post-discharge. The primary outcome was self-reported recovery at least ninety days after initial Covid-19 symptom onset. Secondary outcomes included new symptoms, disability (Washington group short scale), breathlessness (MRC Dyspnoea scale) and quality of life (EQ5D-5L).
Findings: 55% of participants reported not feeling fully recovered. 93% reported persistent symptoms, with fatigue the most common (83%), followed by breathlessness (54%). 47% reported an increase in MRC dyspnoea scale of at least one grade. New or worse disability was reported by 24% of participants. The EQ5D-5L summary index was significantly worse following acute illness (median difference 0.1 points on a scale of 0 to 1, IQR: -0.2 to 0.0). Females under the age of 50 years were five times less likely to report feeling recovered (adjusted OR 5.09, 95% CI 1.64 to 15.74), were more likely to have greater disability (adjusted OR 4.22, 95% CI 1.12 to 15.94), twice as likely to report worse fatigue (adjusted OR 2.06, 95% CI 0.81 to 3.31) and seven times more likely to become more breathless (adjusted OR 7.15, 95% CI 2.24 to 22.83) than men of the same age.
Interpretation: Survivors of Covid-19 experienced long-term symptoms, new disability, increased breathlessness, and reduced quality of life. These findings were present in young, previously healthy working age adults, and were most common in younger females.
Funding: National Institute for Health Research, UK Medical Research Council, Wellcome Trust, Department for International Development and the Bill and Melinda Gates Foundation.
Keywords: Covid-19; long-Covid; long-term outcomes; post-Covid; post-acute Covid-19; quality of life; sequelae.
© 2021 The Authors.
Conflict of interest statement
CRD declares funding from the Medical Research Council, UK. JM reports a University of Cambridge Research Fellowship. WSL reports unrestricted investigator-initiated research funding from Pfizer for an unrelated multi-centre study in pneumonia, in which WSL is the CI and UK NIHR research funding for unrelated clinical trials in the fields of COVID-19, tuberculosis and community-acquired pneumonia. WSL's role on the Joint Committee on Vaccination and Immunisation (JCVI), UK and chair of COVID-19 Immunisation and as National Lead on British Thoracic Society community acquired pneumonia audit programme is unpaid and unrelated to this work. CB declares a British Heart Foundation Centre award, and a project grants from the Chief Scientist Office, Scottish Government CSO Long Term Effects and from Heart Research UK unrelated to this work. LG declares support from Pfizer & Gilead for attendance at an educational meeting in Nov 2018 and April 2019, for cost of conference registration fee, accommodation and flights unrelated to this work. PJMO reports personal fees from consultancy, grants from MRC, EU, NIHR Biomedical Research Centres, MRC/GSK, Wellcome Trust, NIHR (HPRU) and NIHR Senior Investigator Award. Personal fees from European Respiratory Society, grants from MRC Global Challenge Research fund, other from Nestle Discussion Forum (unpaid), Pfizer antivirals advisory board (unpaid) outside of the submitted work and the role of President of the British Society for Immunology was an unpaid appointment but PJMO's travel and accommodation at some meetings is provided by the Society. MGS reports grants from the National Institute for Health Research (NIHR), Medical Research Council. NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine and the University of Oxford. All other authors have no interests to declare.
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