Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study
Evans, Rachael A McAuley, Hamish Harrison, Ewen M Shikotra, Aarti Singapuri, Amisha Sereno, Marco Elneima, Omer Docherty, Annemarie B Lone, Nazir I Leavy, Olivia C
Evans, Rachael A
McAuley, Hamish
Harrison, Ewen M
Shikotra, Aarti
Singapuri, Amisha
Sereno, Marco
Elneima, Omer
Docherty, Annemarie B
Lone, Nazir I
Leavy, Olivia C
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Affiliation
University of Leicester; University of Edinburgh; Royal Infirmary of Edinburgh, NHS Lothian; University College London; King's College London; Newcastle University; Newcastle upon Tyne Teaching Hospitals Trust; Manchester Metropolitan University; Salford Royal NHS Foundation Trust; Hull University Teaching Hospitals; University of Oxford; Oxford Health NHS Foundation Trust; Guy's and St Thomas' NHS Foundation Trust; Queen's University Belfast; Belfast Health & Social Care Trust; University of Sheffield; Imperial College London; Hywel Dda University Health Board; University of Swansea; Respiratory Innovation Wales; University of Birmingham; Queen Elizabeth Hospital Birmingham; Barts Health NHS Trust; Queen Mary University of London; University of Liverpool; Alder Hey Children's Hospital; King's College London British Heart Foundation Centre; King's College Hospital NHS Foundation Trust; Cambridge NIHR Biomedical Research Centre; NIHR Cambridge Clinical Research Facility; University of Dundee, Ninewells Hospital and Medical School; University of Manchester; London School of Hygiene & Tropical Medicine; University College London Hospital; Asthma UK and British Lung Foundation
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Publication date
2021-10-07
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Abstract
Background: The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes.
Methods: The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A post-hoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107).
Findings: We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5·9 months (IQR 4·9-6·5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40-59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity.
Interpretation: We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments were independent. In clinical care, a proactive approach is needed across the acute severity spectrum, with interdisciplinary working, wide access to COVID-19 holistic clinical services, and the potential to stratify care.
Citation
Evans RA, McAuley H, Harrison EM, Shikotra A, Singapuri A, Sereno M, Elneima O, Docherty AB, Lone NI, Leavy OC, Daines L, Baillie JK, Brown JS, Chalder T, De Soyza A, Diar Bakerly N, Easom N, Geddes JR, Greening NJ, Hart N, Heaney LG, Heller S, Howard L, Hurst JR, Jacob J, Jenkins RG, Jolley C, Kerr S, Kon OM, Lewis K, Lord JM, McCann GP, Neubauer S, Openshaw PJM, Parekh D, Pfeffer P, Rahman NM, Raman B, Richardson M, Rowland M, Semple MG, Shah AM, Singh SJ, Sheikh A, Thomas D, Toshner M, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Wain LV, Brightling CE; PHOSP-COVID Collaborative Group. Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study. Lancet Respir Med. 2021 Nov;9(11):1275-1287. doi: 10.1016/S2213-2600(21)00383-0. Epub 2021 Oct 7. Erratum in: Lancet Respir Med. 2022 Jan;10(1):e9. doi: 10.1016/S2213-2600(21)00540-3. Erratum in: Lancet Respir Med. 2024 Jun;12(6):e41. doi: 10.1016/S2213-2600(24)00142-5.
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Article