SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study
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Abstract
SARS-CoV-2 lineage B.1.1.7 has been associated with an increased rate of transmission and disease severity among subjects testing positive in the community. Its impact on hospitalised patients is less well documented.
Methods
We collected viral sequences and clinical data of patients admitted with SARS-CoV-2 and hospital-onset COVID-19 infections (HOCIs), sampled 16 November 2020 to 10 January 2021, from eight hospitals participating in the COG-UK-HOCI study. Associations between the variant and the outcomes of all-cause mortality and intensive therapy unit (ITU) admission were evaluated using mixed effects Cox models adjusted by age, sex, comorbidities, care home residence, pregnancy and ethnicity.
Findings
Sequences were obtained from 2341 inpatients (HOCI cases=786) and analysis of clinical outcomes was carried out in 2147 inpatients with all data available. The HR for mortality of B.1.1.7 compared with other lineages was 1.01 (95% CI 0.79 to 1.28, p=0.94) and for ITU admission was 1.01 (95% CI 0.75 to 1.37, p=0.96). Analysis of sex-specific effects of B.1.1.7 identified increased risk of mortality (HR 1.30, 95% CI 0.95 to 1.78, p=0.096) and ITU admission (HR 1.82, 95% CI 1.15 to 2.90, p=0.011) in females infected with the variant but not males (mortality HR 0.82, 95% CI 0.61 to 1.10, p=0.177; ITU HR 0.74, 95% CI 0.52 to 1.04, p=0.086).
Interpretation
In common with smaller studies of patients hospitalised with SARS-CoV-2, we did not find an overall increase in mortality or ITU admission associated with B.1.1.7 compared with other lineages. However, women with B.1.1.7 may be at an increased risk of admission to intensive care and at modestly increased risk of mortality.
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SciScore for 10.1101/2021.06.24.21259107: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Analyses were conducted in R version 4.0.2, using tidyverse collection of packages with all plots generated using ggplot2 and survminer 15– 18. ggplot2suggested: (ggplot2, RRID:SCR_014601)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Although ours is substantially the largest study of …
SciScore for 10.1101/2021.06.24.21259107: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Analyses were conducted in R version 4.0.2, using tidyverse collection of packages with all plots generated using ggplot2 and survminer 15– 18. ggplot2suggested: (ggplot2, RRID:SCR_014601)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Although ours is substantially the largest study of hospitalized patients with confirmed lineage B.1.1.7 and non-B.1.1.7 SARS-Cov-2 infection, it has a number of limitations. Primarily, whilst evaluation of disease severity among only hospital inpatients can give useful information on disease course and progression, analysis of only these patients cannot provide information on disease severity across all SARS-CoV-2 infections in the population as a whole. In addition, ITU admission can be difficult to interpret as a measure of disease severity among inpatients. For instance, admission to ITU may reflect the presence of severe disease but also local decisions around the benefit or lack thereof to frail patients, which may be influenced by bed numbers and availability of respiratory support in non-critical care settings. Our primary analysis also includes cases of hospital-acquired infection, but exclusion of these HOCI cases from our analyses yielded similar findings (Table S1). A further limitation of our analysis is that we do not have any information on vaccination status for individual patients. Our dataset covers a period in which a national vaccination program was being initiated for HCWs and the elderly population in the UK, starting with those aged 80 years and above from 8th December 2020. This is a potential explanation for the observed protective interaction effect between care home residence and B.1.1.7 on mortality, as care home residents were prioritised for vacc...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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