SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study

Stirrup, O. et al. (2021) SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study. BMJ Open Respiratory Research, 8, e001029. (doi: 10.1136/bmjresp-2021-001029) (PMID:34544733) (PMCID:PMC8453594)

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Abstract

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.

Item Type:Articles
Keywords:Respiratory infection, COVID-19, viral infection.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Thomson, Professor Emma and Hughes, Dr Joseph and Mollett, Mr Guy and Da Silva Filipe, Dr Ana
Authors: Stirrup, O., Boshier, F., Venturini, C., Guerra-Assunção, J. A., Alcolea-Medina, A., Beckett, A., Charalampous, T., da Silva Filipe, A., Glaysher, S., Khan, T., Kulasegaran Shylini, R., Kele, B., Monahan, I., Mollett, G., Parker, M., Pelosi, E., Randell, P., Roy, S., Taylor, J., Weller, S., Wilson-Davies, E., Wade, P., Williams, R., Copas, A., Cutino-Moguel, M.-T., Freemantle, N., Hayward, A. C., Holmes, A., Hughes, J., Mahungu, T., Nebbia, G., Partridge, D., Pope, C., Price, J., Robson, S., Saeed, K., de Silva, T., Snell, L., Thomson, E., Witney, A. A., Breuer, J., Blackstone, J., Hockey, L., Marley, G., Harrington, D., Riddell, A., Peters, C., Flaviani, F., Patel, B., Williams, T. G. S., Batra, R., Edgeworth, J. D., Madona, P., Cox, A., Hart, J., Haque, T., Irish, D., Pang, J., Williams, C., Tutill, H., Bayzid, N., Cotic, M., Green, L., Lindsey, B., State, A., Cope, A., Johnson, K., Angyal, A., Zhang, P., Whiteley, M., Ramalho, M. G., Christou, S., Louka, S., Hornsby, H., Foulkes, B., Wolverson, P., Heffer, J., Smith, N., Goudarzi, S., Fearn, C., Cook, K., Loveson, K., Elliott, S., Mahamana, A., Samaraweera, B., Silveira, S., Aplin, S., Jeremiah, S., Umpleby, H., Wheeler, H., Harvey, M., Sass, T., Prieto, J., Laing, K., Tan, N. K., Pereira, C. C., Nastouli, E., Houlihan, C. F., Frampton, D., Rampling, T., Byott, M., Heaney, J., Shin, G. Y., Spyer, M., Bergstrom, M., Sanchez, E., Paraskevopoulou, S. M., and Margaritis, M.
College/School:College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Virus Research
Journal Name:BMJ Open Respiratory Research
Publisher:BMJ Publishing Group
ISSN:2052-4439
ISSN (Online):2052-4439
Published Online:20 September 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in BMJ Open Respiratory Research 8: e001029
Publisher Policy:Reproduced under a Creative Commons License

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