UCL Respiratory, University College London, London, UK
Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK.
BMJ Open Respir Res. 2023 Aug;10(1). doi: 10.1136/bmjresp-2023-001667.
COVID-19 studies report on hospital admission outcomes across SARS-CoV-2 waves of infection but knowledge of the impact of SARS-CoV-2 variants on the development of Long COVID in hospital survivors is limited. We sought to investigate Long COVID outcomes, aiming to compare outcomes in adult hospitalised survivors with known variants of concern during our first and second UK COVID-19 waves, prior to widespread vaccination.
Prospective observational cross-sectional study.
Secondary care tertiary hospital in the UK.
This study investigated Long COVID in 673 adults with laboratory-positive SARS-CoV-2 infection or clinically suspected COVID-19, 6 weeks after hospital discharge. We compared adults with wave 1 (wildtype variant, admitted from February to April 2020) and wave 2 patients (confirmed Alpha variant on viral sequencing (B.1.1.7), admitted from December 2020 to February 2021).
Associations of Long COVID presence (one or more of 14 symptoms) and total number of Long COVID symptoms with SARS-CoV-2 variant were analysed using multiple logistic and Poisson regression, respectively.
322/400 (wave 1) and 248/273 (wave 2) patients completed follow-up. Predictors of increased total number of Long COVID symptoms included: pre-existing lung disease (adjusted count ratio (aCR)=1.26, 95% CI 1.07, 1.48) and more COVID-19 admission symptoms (aCR=1.07, 95% CI 1.02, 1.12). Weaker associations included increased length of inpatient stay (aCR=1.02, 95% CI 1.00, 1.03) and later review after discharge (aCR=1.00, 95% CI 1.00, 1.01). SARS-CoV-2 variant was not associated with Long COVID presence (OR=0.99, 95% CI 0.24, 4.20) or total number of symptoms (aCR=1.09, 95% CI 0.82, 1.44).
Patients with chronic lung disease or greater COVID-19 admission symptoms have higher Long COVID risk. SARS-CoV-2 variant was not predictive of Long COVID though in wave 2 we identified fewer admission symptoms, improved clinical trajectory and outcomes. Addressing modifiable factors such as length of stay and timepoint of clinical review following discharge may enable clinicians to move from Long COVID risk stratification towards improving its outcome.
COVID-19 研究报告了 SARS-CoV-2 感染波次的住院结局，但对 SARS-CoV-2 变异株对住院幸存者中长新冠发展的影响知之甚少。我们旨在调查长新冠结局，目的是比较在英国 COVID-19 第一波和第二波期间（在广泛接种疫苗之前），已知关注变异株的住院幸存者的结局，这些幸存者在住院期间感染了实验室确诊的 SARS-CoV-2 或疑似 COVID-19。
前瞻性观察性横断面研究。
英国二级保健三级医院。
本研究纳入了 673 名 SARS-CoV-2 感染或临床疑似 COVID-19 后 6 周的住院成人，比较了第一波（野生型变异株，2020 年 2 月至 4 月入院）和第二波（病毒测序证实的 Alpha 变异株[B.1.1.7]，2020 年 12 月至 2021 年 2 月入院）患者的长新冠结局。
使用多项逻辑回归和泊松回归分别分析长新冠存在（14 种症状中的一种或多种）和长新冠总症状数与 SARS-CoV-2 变异株的关联。
322/400（波 1）和 248/273（波 2）名患者完成了随访。长新冠总症状数增加的预测因素包括：既往肺部疾病（校正计数比[aCR]=1.26，95%CI 1.07，1.48）和更多的 COVID-19 入院症状（aCR=1.07，95%CI 1.02，1.12）。较弱的关联因素包括住院时间延长（aCR=1.02，95%CI 1.00，1.03）和出院后延迟复查（aCR=1.00，95%CI 1.00，1.01）。SARS-CoV-2 变异株与长新冠存在（比值比[OR]=0.99，95%CI 0.24，4.20）或总症状数（aCR=1.09，95%CI 0.82，1.44）均无关联。
患有慢性肺部疾病或更多 COVID-19 入院症状的患者长新冠风险更高。尽管在波 2 中我们发现入院症状减少、临床转归和结局改善，但 SARS-CoV-2 变异株不能预测长新冠。针对住院时间和出院后临床复查时间等可改变的因素，可能有助于临床医生从长新冠风险分层转变为改善其结局。
