Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study,The Lancet Respiratory Medicine

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Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study
The Lancet Respiratory Medicine ( IF 38.7 ) Pub Date : 2021-10-07 , DOI: 10.1016/s2213-2600(21)00383-0
Rachael A Evans ₁ , Hamish McAuley ₁ , Ewen M Harrison ₂ , Aarti Shikotra ₁ , Amisha Singapuri ₁ , Marco Sereno ₁ , Omer Elneima ₁ , Annemarie B Docherty ₂ , Nazir I Lone ₃ , Olivia C Leavy ₄ , Luke Daines ₂ , J Kenneth Baillie ₅ , Jeremy S Brown ₆ , Trudie Chalder ₇ , Anthony De Soyza ₈ , Nawar Diar Bakerly ₉ , Nicholas Easom ₁₀ , John R Geddes ₁₁ , Neil J Greening ₁ , Nick Hart ₁₂ , Liam G Heaney ₁₃ , Simon Heller ₁₄ , Luke Howard ₁₅ , John R Hurst ₆ , Joseph Jacob ₁₆ , R Gisli Jenkins ₁₇ , Caroline Jolley ₁₈ , Steven Kerr ₁₉ , Onn M Kon ₂₀ , Keir Lewis ₂₁ , Janet M Lord ₂₂ , Gerry P McCann ₂₃ , Stefan Neubauer ₂₄ , Peter J M Openshaw ₁₇ , Dhruv Parekh ₂₅ , Paul Pfeffer ₂₆ , Najib M Rahman ₂₇ , Betty Raman ₂₈ , Matthew Richardson ₁ , Matthew Rowland ₂₉ , Malcolm G Semple ₃₀ , Ajay M Shah ₃₁ , Sally J Singh ₁ , Aziz Sheikh ₂ , David Thomas ₃₂ , Mark Toshner ₃₃ , James D Chalmers ₃₄ , Ling-Pei Ho ₃₅ , Alex Horsley ₃₆ , Michael Marks ₃₇ , Krisnah Poinasamy ₃₈ , Louise V Wain ₃₉ , Christopher E Brightling ₁ ,

Affiliation

Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK.
Usher Institute, University of Edinburgh, Edinburgh, UK.
Usher Institute, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.
Department of Health Sciences, University of Leicester, Leicester, UK.
Roslin Institute, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.
UCL Respiratory, Department of Medicine, University College London, London, UK.
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Teaching Hospitals Trust, Newcastle upon Tyne, UK.
Manchester Metropolitan University, Manchester, UK; Salford Royal NHS Foundation Trust, Manchester, UK.
Infection Research Group, Hull University Teaching Hospitals, Hull, UK.
NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Belfast Health & Social Care Trust, Belfast, UK.
Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
Imperial College Healthcare NHS Trust, London, UK, University College London, London, UK.
Centre for Medical Image Computing, University College London, London, UK; Lungs for Living Research Centre, University College London, London, UK.
National Heart and Lung Institute, Imperial College London, London, UK.
Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Roslin Institute, University of Edinburgh, Edinburgh, UK.
Imperial College Healthcare NHS Trust, London, UK, University College London, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
Hywel Dda University Health Board, Wales, UK; University of Swansea, Swansea, UK; Respiratory Innovation Wales, Llanelli, UK.
Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK.
NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Barts Health NHS Trust, London, UK; Queen Mary University of London, London, UK.
Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.
Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
Kadoorie Centre for Critical Care Research, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK; Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK.
King's College London British Heart Foundation Centre and King's College Hospital NHS Foundation Trust, London, UK.
Immunology and Inflammation, Imperial College London, London, UK.
Cambridge NIHR Biomedical Research Centre, Cambridge, UK; NIHR Cambridge Clinical Research Facility, Cambridge, UK.
University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
MRC Human Immunology Unit, University of Oxford, Oxford, UK.
Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK.
Asthma UK and British Lung Foundation, London, UK.
Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK; Department of Health Sciences, University of Leicester, Leicester, UK.

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. 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). 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. 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. UK Research and Innovation and National Institute for Health Research.

中文翻译：

COVID-19 住院后对身体、认知和心理健康的影响 (PHOSP-COVID)：英国多中心前瞻性队列研究

COVID-19 对因急性疾病住院后的身心健康和就业的影响尚不清楚。本研究的目的是确定与 COVID-19 相关的住院治疗对健康和就业的影响，确定与康复相关的因素，并描述康复表型。住院后 COVID-19 研究 (PHOSP-COVID) 是一项多中心、长期随访研究，对象为临床诊断为 COVID-19 的英国出院成人（年龄≥18 岁），其中包括评估出院后2至7个月，包括详细记录症状、生理生化检测。对患者感知康复的主要结果进行多变量逻辑回归，以年龄、性别、种族、体重指数、合并症和急性疾病的严重程度作为协变量。使用聚类大型应用程序 k-medoids 方法对呼吸困难、疲劳、心理健康、认知障碍和身体表现的结果进行事后聚类分析。该研究已在 ISRCTN 登记处注册 (ISRCTN10980107)。我们报告了 2020 年 3 月 5 日至 11 月 30 日期间出院的 1077 名患者的研究结果，这些患者在出院后平均 5·9 个月 (IQR 4·9–6·5) 接受了评估。参与者的平均年龄为 58 岁（SD 13）； 384 名 (36%) 为女性，710 名 (69%) 为白人，288 名 (27%) 接受过机械通气，540 名 (50%) 患有至少两种合并症。随访时，830 名参与者中只有 239 名 (29%) 感觉完全康复，806 名参与者中 158 名 (20%) 出现新的残疾（由华盛顿小组功能简集评估），641 名参与者中 124 名 (19%) 经历了新的残疾与健康相关的职业变化。与未能康复相关的因素包括女性、中年（40-59岁）、两种或多种合并症以及更严重的急性疾病。持续的健康负担很大，但与急性疾病的严重程度关系不大。确定了四个具有不同严重程度的精神和身体健康损害的群体 (n=767)：非常严重（131 名患者，17%）、严重（159 名患者，21%）、中度认知障碍（127 名患者，17%）和轻度（350，46%）。在聚类分析中使用的结果中，除了认知障碍之外，所有结果都密切相关。 113 名患者中有 3 名 (3%) 属于极严重集群，129 名患者中有 9 名 (7%) 属于严重集群，99 名患者中有 36 名 (36%) 属于中度集群，267 名患者中有 114 名 (43%) 属于轻度集群报告感觉已完全康复。持续升高的血清 C 反应蛋白与集群严重程度呈正相关。我们确定了与 COVID-19 入院后 6 个月内未能康复相关的因素（例如女性、中年、两种或多种合并症以及更多急性严重疾病）以及四种不同的恢复表型。身体和心理健康损害的严重程度密切相关，而认知健康损害则是独立的。在临床护理中，需要针对急性严重程度采取积极主动的方法，通过跨学科工作、广泛获得 COVID-19 整体临床服务以及分层护理的潜力。英国研究与创新和国家健康研究所。

更新日期：2021-10-07

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