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Observational Study
. 2023 Aug;10(1):e001667.
doi: 10.1136/bmjresp-2023-001667.

Cross-sectional study evaluating the impact of SARS-CoV-2 variants on Long COVID outcomes in UK hospital survivors

Anita Saigal  1   2 , Camila Nagoda Niklewicz  2 , Sindhu Bhaarrati Naidu  2 , Heba M Bintalib  3 , Amar Jitu Shah  3   2 , George Seligmann  2 , Alan Stewart Hunter  4 , Emmanuel Wey  4   5 , Ibrahim Abubakar  3   6 , Tabitha Mahungu  7 , David Miller  8 , Joseph Barnett  9 , Neel Gautam Jain  9 , Simon Brill  2 , James Goldring  2 , Hannah Jarvis  2 , Colette Smith  10 , Chibueze Ogbonnaya  11 , John R Hurst  3   2 , Marc C I Lipman  3   2 , Swapna Mandal  3   2
Affiliations
Observational Study

Cross-sectional study evaluating the impact of SARS-CoV-2 variants on Long COVID outcomes in UK hospital survivors

Anita Saigal et al. BMJ Open Respir Res. 2023 Aug.

Abstract

Objectives: 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.

Design: Prospective observational cross-sectional study.

Setting: Secondary care tertiary hospital in the UK.

Participants: 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).

Outcome measures: 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.

Results: 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).

Conclusions: 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.

Keywords: COVID-19; Respiratory Infection; Viral infection.

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Conflict of interest statement

Competing interests: JRH, SM and AS report personal fees, and JRH, SM, AS and AJS report non-financial support from pharmaceutical companies that make medicines and medical devices to treat respiratory disease, outside the submitted work.

Figures

Figure 1
Figure 1
Clinical outcomes at initial clinical review of wave 1 and 2 participants. PHQ, Patient Health Questionnaire; TSQ, Trauma Screening Questionnaire.
See this image and copyright information in PMC

References

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