Post-COVID-19 assessment in a specialist clinical service: a 12-month, single-centre, prospective study in 1325 individuals
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Abstract
Post-COVID-19 complications require simultaneous characterisation and management to plan policy and health system responses. We describe the 12-month experience of the first UK dedicated post-COVID-19 clinical service to include hospitalised and non-hospitalised patients.
Methods
In a single-centre, observational analysis, we report the demographics, symptoms, comorbidities, investigations, treatments, functional recovery, specialist referral and rehabilitation of 1325 individuals assessed at the University College London Hospitals post-COVID-19 service between April 2020 and April 2021, comparing by referral route: posthospitalised (PH), non-hospitalised (NH) and post emergency department (PED). Symptoms associated with poor recovery or inability to return to work full time were assessed using multivariable logistic regression.
Results
1325 individuals were assessed (PH: 547, 41.3%; PED: 212, 16%; NH: 566, 42.7%). Compared with the PH and PED groups, the NH group were younger (median 44.6 (35.6–52.8) years vs 58.3 (47.0–67.7) years and 48.5 (39.4–55.7) years), more likely to be female (68.2%, 43.0% and 59.9%), less likely to be of ethnic minority (30.9%, 52.7% and 41.0%) or seen later after symptom onset (median (IQR): 194 (118–298) days, 69 (51–111) days and 76 (55–128) days; all p<0.0001). All groups had similar rates of onward specialist referral (NH 18.7%, PH 16.1% and PED 18.9%, p=0.452) and were more likely to require support for breathlessness (23.7%, 5.5% and 15.1%, p<0.001) and fatigue (17.8%, 4.8% and 8.0%, p<0.001). Hospitalised patients had higher rates of pulmonary emboli, persistent lung interstitial abnormalities and other organ impairment. 716 (54.0%) individuals reported <75% optimal health (median 70%, IQR 55%–85%). Less than half of employed individuals could return to work full time at first assessment.
Conclusion
Post-COVID-19 symptoms were significant in PH and NH patients, with significant ongoing healthcare needs and utilisation. Trials of interventions and patient-centred pathways for diagnostic and treatment approaches are urgently required.
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SciScore for 10.1101/2021.05.25.21257730: (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 We used multivariable logistic regression models, adjusted for age (modelled as a continuous variable) and gender (male vs. female as reference group), to investigate symptoms associated with a) optimal (≥75%) patient-reported functional recovery at first presentation and b) patient-reported ability to return to full-time employment at first presentation. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All analyses were performed using Python 3.7.6. Pythonsuggested: (IPython, RRID:SCR_001658)Results from OddPub: We did not detect open data. We also did not detect open …
SciScore for 10.1101/2021.05.25.21257730: (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 We used multivariable logistic regression models, adjusted for age (modelled as a continuous variable) and gender (male vs. female as reference group), to investigate symptoms associated with a) optimal (≥75%) patient-reported functional recovery at first presentation and b) patient-reported ability to return to full-time employment at first presentation. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All analyses were performed using Python 3.7.6. Pythonsuggested: (IPython, RRID:SCR_001658)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:Our findings have several limitations. We report outcomes from a single centre, unlikely to be representative of the whole UK population. As post-COVID clinics are established around the UK and in other countries, prospective data collection and comparison will enable variations to be investigated. We used subjective symptom and functional status data, which may have self-reporting bias. We report real-world, clinical findings, therefore data regarding pre-morbid status, baseline characteristics, investigations and follow-up (particularly for patients with persistent disease for 12 months or more) are more limited than in dedicated research cohorts. NH patients were self-selecting whilst PH patients were included as part of routine follow-up. This selection bias precludes both making precise estimates of the burden of Long COVID amongst NH patients and also making comparisons between the NH patients and other patient groups. In our basic logistic regression models, we modelled age as a linear variable, which may have obscured true non-linear effects of age in these models. Our models were based on cross-sectional data at presentation to the clinic. Our findings have several implications for research and policy. First, we identify differences in longer-term effects of SARS-CoV-2 infection in PH versus individuals, supporting the existence of a number of different phenotypes of Long COVID. Further correlation of symptom clusters, functional impacts and diagnostic information is...
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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