Abstract
Background: Persistence of respiratory symptoms, particularly breathlessness, after acute coronavirus disease 2019 (COVID-19) infection has emerged as a significant clinical problem. We aimed to characterise and identify risk factors for patients with persistent breathlessness following COVID-19 hospitalisation.
Methods: PHOSP-COVID is a multicentre prospective cohort study of UK adults hospitalised for COVID-19. Clinical data were collected during hospitalisation and at a follow-up visit. Breathlessness was measured by a numeric rating scale of 0–10. We defined post-COVID-19 breathlessness as an increase in score of ⩾1 compared to the pre-COVID-19 level. Multivariable logistic regression was used to identify risk factors and to develop a prediction model for post-COVID-19 breathlessness.
Results: We included 1226 participants (37% female, median age 59 years, 22% mechanically ventilated). At a median 5 months after discharge, 50% reported post-COVID-19 breathlessness. Risk factors for post- COVID-19 breathlessness were socioeconomic deprivation (adjusted OR 1.67, 95% CI 1.14–2.44), preexisting depression/anxiety (adjusted OR 1.58, 95% CI 1.06–2.35), female sex (adjusted OR 1.56, 95% CI 1.21–2.00) and admission duration (adjusted OR 1.01, 95% CI 1.00–1.02). Black ethnicity (adjusted OR 0.56, 95% CI 0.35–0.89) and older age groups (adjusted OR 0.31, 95% CI 0.14–0.66) were less likely to report post-COVID-19 breathlessness. Post-COVID-19 breathlessness was associated with worse performance on the shuttle walk test and forced vital capacity, but not with obstructive airflow limitation. The prediction model had fair discrimination (concordance statistic 0.66, 95% CI 0.63–0.69) and good calibration (calibration slope 1.00, 95% CI 0.80–1.21).
Conclusions: Post-COVID-19 breathlessness was commonly reported in this national cohort of patients hospitalised for COVID-19 and is likely to be a multifactorial problem with physical and emotional components.
| Original language | English |
|---|---|
| Article number | 00274-2022 |
| Number of pages | 15 |
| Journal | ERJ Open Research |
| Volume | 9 |
| Issue number | 1 |
| Early online date | 22 Dec 2022 |
| DOIs | |
| Publication status | Published - 1 Jan 2023 |
Bibliographical note
Funding Information:Support statement: PHOSP-COVID is supported by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19 (grant references MR/V027859/1 and COV0319). Core funding was provided by NIHR Leicester Biomedical Research Centre to support the PHOSP-COVID coordination team and NIHR Biomedical Research Centres, Clinical Research Facilities and NIHR Health Protection Research Unit, and Translational Research Collaborations networks across the country. The study was also supported by the UK Health Data Research BREATHE Hub. Funding information for this article has been deposited with the Crossref Funder Registry.
Acknowledgements: This study and the PHOSP-COVID consortium are supported by a grant to the University of Leicester from the MRC-UK Research and Innovation and the Department of Health and Social Care (DHSC) through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19. The NIHR Leicester Biomedical Research Centre is a partnership between the University Hospitals of Leicester National Health Service Trust, the University of Leicester and Loughborough University. The study was also supported by the Health Data Research UK Breathe Hub. This study would not be possible without all the participants who have given their time and support. We thank all the participants and their families. We thank the many research administrators, healthcare and social-care professionals who contributed to setting up and delivering the study at all of the 65 NHS trusts/Health Boards and 25 research institutions across the UK, as well as all the supporting staff at the NIHR Clinical Research Network, NIHR Biomedical Research Centres, Health Research Authority, Research Ethics Committee, DHSC, Public Health Scotland and Public Health England, and support from the ISARIC Coronavirus Clinical Characterisation Consortium. We thank Kate Holmes at the NIHR Office for Clinical Research Infrastructure (NOCRI) for her support in coordinating the charities group. The PHOSP-COVID industry framework was formed to provide advice and support in commercial discussions, and we thank the Association of the British Pharmaceutical Industry as well as Ivana Poparic and Peter Sargent at NOCRI for coordinating this. We are very grateful to all the charities that have provided insight to the study: Action Pulmonary Fibrosis, Alzheimer’s Research UK, Asthma + Lung UK, British Heart Foundation, Diabetes UK, Cystic Fibrosis Trust, Kidney Research UK, MQ Mental Health, Muscular Dystrophy UK, Stroke Association Blood Cancer UK, McPin Foundations, and Versus Arthritis. We thank the NIHR Leicester Biomedical Research Centre patient and public involvement group and the Long Covid Support Group. The authors would like to acknowledge the support of the eDRIS Team (Public Health Scotland) for their involvement in obtaining approvals, provisioning, and linking data and the use of the secure analytical platform within the National Safe Haven. The views expressed in the publication are those of the authors and not necessarily those of the National Health Service, MRC-UK, NIHR or DHSC.
Publisher Copyright:
© The authors 2023.
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine