Study highlights the rapid increase in the number of patients with long-term COVID and the lack of treatments

A new British study of more than 2,000 patients hospitalized with COVID-19 was presented at the European Conference on Clinical Microbiology and Infectious Diseases (ECCMID 2022, Lisbon 23-26), and published in Lancet Respiratory Medicine He explains that, one year after contracting COVID-19, only one in four patients feel fully comfortable again. The study is led by Professor Christopher Brightling, Dr Rachel Evans and Professor Louise Wayne, from the National Institute for Health Research, Leicester Center for Biomedical Research, University of Leicester, UK and colleagues.

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

This research used data from the posthospital COVID-19 (PHOSP-COVID) study that evaluated adults (aged 18 years and over) who were hospitalized with COVID-19 across the UK and subsequently discharged. Patients from 39 UK National Health Service (NHS) hospitals, who agreed to five-month and one-year follow-up assessments in addition to their clinical care, were included. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge. The researchers also took blood samples from the participants in the five-month visit to be analyzed for the presence of various inflammatory proteins.

A total of 2,320 participants who were discharged from hospital were assessed between 7 March 2020 and 18 April 2021, 5 months after hospital discharge, and 807 (33%) of the participants completed visits that lasted 5 months and 1 year at the time of analysis. (The study is in progress). The median age of these 807 patients was 59 years, and 279 (36%) were women and 28% had received invasive mechanical ventilation. The proportion of patients reporting complete recovery was similar between 5 months (501 .). [26%] 1965) and one year (232 [29%] from 804).

In an earlier publication of this study, the authors identified four groups, or “groups”, of symptom severity at five months, which this new study confirmed in one year. Of the 2,320 participants, 1636 had sufficient data to allocate them to a group: 319 (20%) had a severe physical and mental health disability, 493 (30%) had a severe physical and mental health disability, and 179 (11%) had a severe physical or mental health disability of moderate physical disability. Impaired health with cognitive impairment, and 645 (39%) moderate mental and physical impairment. Obesity, decreased ability to exercise, a greater number of symptoms, and increased levels of C-reactive protein, a biomarker of inflammation, were associated with more severe clusters. In both the severe and moderate cognitive impairment groups, levels of the inflammatory biomarker interleukin-6 (IL-6) were higher when compared to the mild group.

“The limited recovery from 5 months to 1 year after hospitalization in our study in terms of symptoms, mental health, ability to exercise, organ dysfunction, and quality of life is astonishing,” says Dr. Evans.

She adds, “We found that female sex and obesity were major risk factors for not recovering in one year… In our groups, female sex and obesity were also associated with more severe persistent health impairments including lower exercise performance and health-related quality of life in our groups. In one year, It is likely to highlight a group that may need more intensive interventions such as supervised rehabilitation.”

Regarding the prolonged lack of current treatments for COVID-19, Professor Wayne says: “There are no specific treatments for COVID for a prolonged period, and our data highlight that effective interventions are urgently needed. Our findings on persistent systemic inflammation, particularly in very severe and moderate cases with Perception of disability groups, indicating that these groups may respond to anti-inflammatory strategies. The concordance of the severity of poor physical and mental health in prolonged COVID highlights the need not only for close integration of physical and mental health care for patients with prolonged COVID, including assessment and interventions, but also to transfer knowledge among healthcare professionals to improve patient care.The results also indicate the need for complex interventions that target both physical and mental health disabilities to alleviate symptoms.However, there are specific therapeutic approaches to PTSD that may be in place. A stress disorder is also needed.”

Our study highlights the urgent need for health care services to support this large and rapidly increasing number of patients with a high burden of symptoms, including reduced ability to exercise and significantly reduced health-related quality of life one year after hospital discharge. Without effective treatments, prolonged COVID-19 could become a new, prevalent long-term condition. Our study also provides the rationale for investigating long-term COVID treatments with a precision medicine approach to target treatments to an individual patient profile to restore health-related quality of life. “

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

source:

European Society of Clinical Microbiology and Infectious Diseases

Journal reference:

PHOSP-COVID . Collaborative Group. , (2022) Clinical characteristics with inflammatory profiling of COVID-19 and association with 1-year recovery after hospitalization in the United Kingdom: a prospective observational study. Lancet Respiratory Medicine. doi.org/10.1016/S2213-2600 (22)00127-8.

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