TY - JOUR
T1 - SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men
T2 - Multicentre cohort study
AU - Stirrup, Oliver
AU - Boshier, Florencia
AU - Venturini, Cristina
AU - Guerra-Assunção, José Afonso
AU - Alcolea-Medina, Adela
AU - Beckett, Angela
AU - Charalampous, Themoula
AU - Da Silva Filipe, Ana
AU - Glaysher, Sharon
AU - Khan, Tabassum
AU - Kulasegaran Shylini, Raghavendran
AU - Kele, Beatrix
AU - Monahan, Irene
AU - Mollett, Guy
AU - Parker, Matthew
AU - Pelosi, Emanuela
AU - Randell, Paul
AU - Roy, Sunando
AU - Taylor, Joshua
AU - Weller, Sophie
AU - Wilson-Davies, Eleri
AU - Wade, Phillip
AU - Williams, Rachel
AU - Copas, Andrew
AU - Cutino-Moguel, Maria Teresa
AU - Freemantle, Nick
AU - Hayward, Andrew C.
AU - Holmes, Alison
AU - Hughes, Joseph
AU - Mahungu, Tabitha
AU - Nebbia, Gaia
AU - Partridge, David
AU - Pope, Cassie
AU - Price, James
AU - Robson, Samuel
AU - Saeed, Kordo
AU - De Silva, Thushan
AU - Snell, Luke
AU - Thomson, Emma
AU - Witney, Adam A.
AU - Breuer, Judith
N1 - Publisher Copyright:
© 2021 BMJ Publishing Group. All rights reserved.
PY - 2021/9/20
Y1 - 2021/9/20
N2 - Background 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.
AB - Background 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.
KW - COVID-19
KW - viral infection
UR - http://www.scopus.com/inward/record.url?scp=85115802884&partnerID=8YFLogxK
U2 - 10.1136/bmjresp-2021-001029
DO - 10.1136/bmjresp-2021-001029
M3 - Article
C2 - 34544733
AN - SCOPUS:85115802884
SN - 2052-4439
VL - 8
JO - BMJ Open Respiratory Research
JF - BMJ Open Respiratory Research
IS - 1
M1 - e001029
ER -