Abstract| UK study: the relationship between the inflammatory characteristics of long-term symptoms of COVID-19 and recovery 1 year after discharge

The Lancet Respiratory Medicine

Clinical inflammatory features of long-term symptoms of COVID-19 in the UK and their relationship to 1 year of rehabilitation after hospitalization: a prospective observational study

background

There are currently no effective pharmacological or non-pharmacological interventions for long-term COVID-19 patients. This study aimed to characterize recovery 1 year after discharge from hospital from COVID-19, identify factors associated with self-perceived recovery in patients, and identify potential treatment targets by analyzing the underlying inflammatory features of different types of recovery (overclassing of patients who were discharged for 5 months in the study).

method

The Post-Discharge COVID-19 Study (PHOSP-COVID) is a prospective longitudinal cohort study that recruits discharged adults (ages ≥18) infected with COVID-19 in the UK. At 5 months and 1 year after discharge, recovery is assessed based on patient-reported outcome measures, physical performance, and organ function, and is stratified by patient self-perceived recovery and type of recovery. A hierarchical logistic regression model was analyzed to restore the patient's self-perception after 1 year. Clustering of clinical results over 5 months was performed using the clustering large application k-medoids method. In a follow-up of 5 months, inflammatory proteins in the blood plasma were analyzed. The study is registered with the ISRCTN Registry under the number ISRCTN10980107 and recruitment efforts are ongoing.

outcome

2,320 participants who were discharged from hospital between 7 March 2020 and 18 April 2021 were assessed 5 months after discharge, and 807 (32.7%) participants completed follow-up for 5 months and 1 year. Of these 807 patients, 279 (35.6%) were female, 505 (64.4%) were male, with an average age of 58.7 (SD 12.5) years, and 224 (27.8%) had undergone invasive mechanical ventilation (WHO grades 7-9). The proportion of patients who reported full recovery did not change between 5 months (501 out of 1,965 [25.5%]) and 1 year (232 [28.9%] out of 804). Factors associated with less likely to report full recovery after 1 year were women (OR =0.68 [95% CI: 0.46-0.99]), obesity (0.50 [0.34-0.74]), and invasive mechanical ventilation (0.42 [0.23-0.76]). Cluster analysis (n=1,636) confirmed four types previously described: very severe, severe, moderately concomitant cognitive impairment, and mild illness, associated with physical health, mental health, and severity of cognitive impairment at 5 months. The study found that very severe and moderate tissue damage associated with cognitive impairment and repair of inflammatory mediators increased compared to mild disease, including IL-6 concentrations, which increased in both comparisons (n =626). From pre-COVID-19 infection (retrospective assessment; 0.88 [IQR: 0.74-1.00]) to 5 months of discharge (0.74 [0.64-0.88]) to 1 year of discharge (0.75 [0.62-0.88]), the median EQ-5D-5L utility index was significantly inadequate, with the smallest improvement in all outcome measures across the four categories of the cohort and at 1 year of discharge.

conclusion

Patients with COVID-19 had severe long-term symptoms 1 year after they were discharged from the hospital in a range of health areas, and a small proportion of the study's cohort felt a complete recovery. Patients' self-perceived health-related quality of life declined 1 year after discharge compared to before admission. Systemic inflammation and obesity are potentially treatable features that merit further investigation in clinical trials.

Funding

UK Research and Innovation and National Institute for Health Research.

The Lancet Infectious Diseases

Risk of hospitalization of SARS-CoV-2 Semikron and Delta strain infections in Denmark: an observational cohort study

background

Conducting severity estimates of the SARS-CoV-2 Semikron strain (B.1.1.529) is critical to assessing the public health impact of its rapid global spread. The team estimated in Denmark the risk of hospitalization associated with SARS-CoV-2 after infection with the Semikron strain (B.1.1.529) and the Delta strain (B.1.617.2). Denmark has high mRNA vaccine coverage and allows for extensive, free PCR testing.

method

The observational cohort study included all cases of SARS-CoV-2 infection confirmed by RT-PCR in Denmark and was collected from 21 November 2021 (the date of the first Omilon-positive sample) to 19 December 2021. Cases were identified through the National COVID-19 Surveillance System database, which included strain-specific RT-PCR results for the detection of Omikejong cases, as well as HOSPITALIZATION DATA RELATED TO SARS-CoV-2 (primary outcome of the study). Using a Poisson regression model with robust SEs, the hospitalization risk ratio (RR) of infection with Omexon compared with Delta after stratification by vaccination status was calculated, and a priori adjustments were made for re-infection status, sex, age, region, comorbidities, and time periods.

outcome

Between 21 November 2021 and 19 December 2021, of the 188,980 SARS-CoV-2 infections, 38,669 (20.5%) carried the Omikejong strain. During the study period, both hospitalizations associated with SARS-CoV-2 and Opichron cases increased. Overall, 124,313 (65.8%) of the 188,980 people were vaccinated, which was associated with a lower risk of hospitalization compared to cases without or with only one dose of the vaccine (adjusted RR value of 0.24, 95% CI: 0.22-0.26). The adjusted hospitalization risk RR for infection with Omiqueron was 0.64 compared to delta infection (95% CI: 0.56 to 0.75; 222 [0.6%] admissions out of 38,669 Omexjong cases, compared to 2,213 [1.5%] admissions in 150,311 Delta cases). Similar comparisons were made between vaccination scenarios, with a hospitalized RR of 0.57 (0.44-0.75) in cases without or only one dose of the vaccine, 0.71 (0.60-0.86) in cases of two doses of the vaccine, and 0.50 (0.32-0.76) in cases of three doses of the vaccine.

conclusion

The study found that in vaccinated and unvaccinated individuals, the risk of hospitalization of the Omiljunn strain was significantly lower compared to infection with the Delta strain, suggesting a reduction in the inherent severity of the Omiljun strain. The results of this study can guide ongoing modelling of the impact of the global Epidemic of the Omikejung variant, thereby guiding the preparation of health service systems.

Funding

None.

The Lancet Global Health

Efficacy of homologous and heterologous boosters in SARS-CoV-2 inactivated vaccines: a large-scale prospective cohort study

background

Some countries have authorized or started using vaccine boosters against COVID-19. Policymakers urgently need evidence of the effectiveness of additional vaccine injections and their clinical manifestations in individuals with full primary immunization schedules, particularly in countries where the inactivated SARS-CoV-2 vaccine is used in primary immunization schedules.

method

Using data at the individual level, the study assessed the effectiveness of CoronaVac (Cogena), AZD1222 (Oxford-AstraZeneca) or BNT162b2 (Pfizer) vaccine enhancement against individuals who had completed the CoronaVac primary immunization program through a nationwide forward-looking individual cohort (age ≥16 years) affiliated with the National Medical Fund Insurance Scheme of Chile and compared it with individuals who had not been vaccinated. The study evaluated individuals who were vaccinated between February 2, 2021 and the scheduled study end date of November 10, 2021; excluded individuals who might be diagnosed with SARS-CoV-2 (RT-PCR or antigen testing) on or before February 2, 2021, and individuals who had received at least one dose of any type of COVID-19 vaccine before February 2, 2021. This study estimated the effectiveness of the vaccine to enhance laboratory-confirmed symptomatic COVID-19 cases, COVID-19 outcomes (hospitalization, admission to intensive care unit [ICU]) and death. In this study, inverse probability weighting and stratified survival analysis models were used to estimate HR values, taking into account the vaccination status over time, and adjusting for relevant demographic, socioeconomic, and clinical confounding factors. This study estimated the change in risk from never being vaccinated, from primary immunization to booster vaccination.

outcome

Of the 11,174,257 people eligible for this study, 4,127,546 completed CoronaVac's primary immunization schedule (two doses) and received booster injections during the study period. 1,921,340 people (46.5%) received AZD1222 boosters, 2,019,260 (48.9%) received BNT162b2 boosters, and 186,946 (4.5%) received CoonaVac homologous boosters. The adjusted vaccine effectiveness (weighted stratified Cox model) was calculated to have an effectiveness of 78.8% (95% CI: 76.8%-80.6%) for coronaVac vaccination in preventing symptomatic COVID-19, 96.5% (96.2%-96.7%) for BNT162b2 boosters, and 93.2% (92.9%-93.6%) for AZD1222 boosters. The adjusted effectiveness of the vaccine for COVID-19-related hospitalizations, entry into the ICU, and death is as follows: 86.3% (83.7%-88.5%), 92.2% (88.7%-94.6%), and 86.7% (80.5%-91.0%), BNT162b2 boosters 96.1% (95.3%-96.9%), 96.2% (94.6%-97%) %3) and 96.8% (93.9%-98.3%), AZD1222 was 97.7% (97.3%-98.0%), 98.9% (98.5%-99.2%), and 98.1% (97.3%-98.6%).

conclusion

The findings suggest that synchronized or heterologous boosters given to individuals who have completed the CoronaVac primary vaccination program provide a high level of protection against COVID-19, including severe illness and death. In all outcomes, heterologous boosters showed higher vaccine efficacy than homologous boosters, providing support for mixed vaccination methods.

Funding

National Agency for Research and Development through the National Fund for Scientific and Technological Development, Millennium Science Initiative Program, and Fund for the Financing of Research Centers in Priority Areas.

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