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Study highlights rapidly growing patient population with long COVID and lack of treatments

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A new UK study of over 2,000 patients after hospitalization with COVID-19 presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2022, Lisbon 23-26) and published in Respiratory Medicine The Lancet shows that a year after having COVID-19, only about one in four patients are feeling perfectly well again. The study is led by Professor Christopher Brightling, Dr Rachael Evans and Professor Louise Wain, National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, UK and their colleagues.

The authors found that being female rather than male (32% less likely), being obese (half as likely) and having had mechanical ventilation in hospital (58% less likely ) were all associated with a lower likelihood of feeling fully recovered at one year. . The most common persistent symptoms of COVID-19 were fatigue, muscle aches, physical slowness, lack of sleep and shortness of breath.

This research used data from the COVID-19 Post Hospitalization Study (PHOSP-COVID) which assessed adults (aged 18+) who had been hospitalized with COVID-19 across the UK and who were then released. Patients from 39 UK National Health Service (NHS) hospitals were included, who accepted five-month and one-year follow-up assessments in addition to their clinical care. Recovery was assessed using measures of patient-reported outcome, physical performance, and organ function at 5 months and 1 year after hospital discharge. The researchers also took blood samples from the participants during the five-month visit to analyze it for the presence of various inflammatory proteins.

A total of 2320 participants discharged from hospital between March 7, 2020 and April 18, 2021 were assessed 5 months post-discharge and 807 (33%) participants completed 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% were receiving invasive mechanical ventilation. The proportion of patients reporting full recovery was similar between 5 months (501 [26%] of 1965) and 1 year (232 [29%] of 804).

In an earlier publication of this study, the authors identified four clusters or “clusters” of symptom severity at five months, which were confirmed by this new study at one year. Of the 2,320 participants, 1,636 had sufficient data to allocate them to a group: 319 (20%) had very severe physical and mental impairment, 493 (30%) had severe physical and mental impairment, 179 (11% ) moderate physical and mental impairment. health problems with cognitive impairment and 645 (39%) mild mental and physical health problems. Obesity, reduced exercise capacity, more symptoms and increased levels of C-reactive protein, an inflammatory biomarker, were associated with the most severe clusters. In the very severe and moderate clusters with cognitive impairment, levels of the inflammatory biomarker interleukin-6 (IL-6) were higher compared to the mild cluster.

Dr Evans says: “The limited recovery from 5 months to 1 year after hospitalization in our study of symptoms, mental health, exercise capacity, organ impairment and quality of life is striking.”

She adds: “We found that female gender and obesity were major risk factors for not recovering at 1 year…In our clusters, female gender and obesity were also associated with health problems more severe ongoing outcomes, including reduced physical performance and health-related quality of life at 1 year, potentially highlighting a group that may need higher intensity interventions such as supervised rehabilitation.”

Regarding the lack of existing treatments for long COVID, Professor Wain says: “No specific treatment exists for long COVID and our data underscores that effective interventions are urgently needed. Our findings of persistent systemic inflammation, in particularly in very severe and moderate patients with impairment groups, suggest that these groups may respond to anti-inflammatory assessment and interventions, but also for knowledge transfer between healthcare professionals to improve care. to patients. This result also suggests the need for complex interventions targeting both physical and mental health disorders to alleviate symptoms. However, specific therapeutic approaches to manage post-traumatic stress disorder might also be needed .”

Our study highlights an urgent need for health care services to support this large and rapidly growing patient population in whom there is a substantial burden of symptoms, including reduced exercise capacity and impaired quality of life. significantly reduced health 1 year after discharge from hospital. Without effective treatments, long COVID could become a new, widespread long-term illness. Our study also provides a rationale to investigate treatments for long COVID with a precision medicine approach to target treatments to each patient’s profile to restore their health-related quality of life.

Professor Christopher Brightling, National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, UK

Source:

Journal reference:

The PHOSP-COVID Collaborative Group., (2022) Clinical characteristics with inflammatory profiling of long COVID and association with one-year recovery from hospitalization in the UK: a prospective observational study. Lancet Respiratory Medicine. doi.org/10.1016/S2213-2600(22)00127-8.