BMJ Open Respiratory Research (Jan 2021)
SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study
- Judith Breuer,
- Catherine F Houlihan,
- Nick Freemantle,
- David Partridge,
- Gaia Nebbia,
- Jacqui Prieto,
- Gee Yen Shin,
- Andrew Copas,
- Oliver Stirrup,
- Kenneth Laing,
- Rachel Williams,
- Helen Wheeler,
- Paul Randell,
- Ana da Silva Filipe,
- Maria-Teresa Cutino-Moguel,
- Tommy Rampling,
- Tabassum Khan,
- James Price,
- Eleni Nastouli,
- Katie Johnson,
- Sharon Glaysher,
- Scott Elliott,
- Helen Umpleby,
- Emanuela Pelosi,
- Emma Thomson,
- Cristina Venturini,
- Anna Riddell,
- Alison Cox,
- Andrew C Hayward,
- Malin Bergström,
- David Harrington,
- Charlotte Williams,
- Tanzina Haque,
- Dianne Irish,
- Adrienn Angyal,
- Marios Margaritis,
- Moira Spyer,
- Florencia Boshier,
- José Afonso Guerra-Assunção,
- Adela Alcolea-Medina,
- Angela Beckett,
- Themoula Charalampous,
- Raghavendran Kulasegaran Shylini,
- Beatrix Kele,
- Irene Monahan,
- Guy Mollett,
- Matthew Parker,
- Sunando Roy,
- Joshua Taylor,
- Sophie Weller,
- Eleri Wilson-Davies,
- Phillip Wade,
- Joseph Hughes,
- Tabitha Mahungu,
- Cassie Pope,
- Samuel Robson,
- Kordo Saeed,
- Thushan de Silva,
- Luke Snell,
- Adam A Witney,
- James Blackstone,
- Leanne Hockey,
- Georgia Marley,
- Christine Peters,
- Flavia Flaviani,
- Bindi Patel,
- Tom G S Williams,
- Rahul Batra,
- Jonathan D Edgeworth,
- Pinglawathee Madona,
- Jennifer Hart,
- Juanita Pang,
- Helena Tutill,
- Nadua Bayzid,
- Marius Cotic,
- Luke Green,
- Benjamin Lindsey,
- Amy State,
- Alison Cope,
- Peijun Zhang,
- Max Whiteley,
- Marta Gallis Ramalho,
- Stella Christou,
- Stavroula Louka,
- Hailey Hornsby,
- Benjamin Foulkes,
- Paige Wolverson,
- Joe Heffer,
- Nikki Smith,
- Salman Goudarzi,
- Chris Fearn,
- Kate Cook,
- Katie Loveson,
- Adhyana Mahamana,
- Buddhini Samaraweera,
- Siona Silveira,
- Stephen Aplin,
- Sarah Jeremiah,
- Matthew Harvey,
- Thea Sass,
- Ngee Keong Tan,
- Claudia Cardoso Pereira,
- Dan Frampton,
- Matt Byott,
- Judith Heaney,
- Emilie Sanchez,
- Stavroula M Paraskevopoulou
Affiliations
- Judith Breuer
- Institute of Child Health, University College London, London, UK
- Catherine F Houlihan
- specialty trainee in infectious diseases
- Nick Freemantle
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
- David Partridge
- Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Gaia Nebbia
- 2 Infection Sciences, Viapath Analytics, Guy`s and St Thomas` NHS Foundation Trust, London, UK
- Jacqui Prieto
- University of Southampton, Southampton, UK
- Gee Yen Shin
- consultant virologist
- Andrew Copas
- Institute for Global Health, University College London, London, UK
- Oliver Stirrup
- 4 Institute for Global Health, University College London, London, UK
- Kenneth Laing
- Rachel Williams
- 13 Ipsos MORI UK Ltd, London, UK
- Helen Wheeler
- Paul Randell
- 2 Department of Pathology, Imperial College Healthcare NHS Foundation, London, UK
- Ana da Silva Filipe
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
- Maria-Teresa Cutino-Moguel
- 3Virology Department, Division of Infection, Barts Health NHS Trust, London, UK
- Tommy Rampling
- 5UKHSA, Salisbury, UK
- Tabassum Khan
- 15 Gynaecological Oncology, University of Birmingham, Birmingham, UK
- James Price
- Emergency and Urgent Care Research in Cambridge (EUReCa), PACE Section, Department of Medicine, Cambridge University, Cambridge, UK
- Eleni Nastouli
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK
- Katie Johnson
- 1 Department of Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Sharon Glaysher
- Department of Respiratory Research & Innovation, Portsmouth Hospitals NHS Trust, Portsmouth, Portsmouth, UK
- Scott Elliott
- Department of Respiratory Research & Innovation, Portsmouth Hospitals NHS Trust, Portsmouth, Portsmouth, UK
- Helen Umpleby
- Emanuela Pelosi
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Emma Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
- Cristina Venturini
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Anna Riddell
- 5Department of Virology, Barts Health NHS Trust, London, UK
- Alison Cox
- Andrew C Hayward
- 3 Institute of Epidemiology & Health Care, University College London, London, UK
- Malin Bergström
- David Harrington
- CT2 core medical trainee, University College Hospital
- Charlotte Williams
- chief strategy and improvement officer
- Tanzina Haque
- consultant virologist
- Dianne Irish
- Adrienn Angyal
- Marios Margaritis
- Moira Spyer
- Population, Policy and Practice, University College London, London, UK
- Florencia Boshier
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- José Afonso Guerra-Assunção
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Adela Alcolea-Medina
- Centre for Clinical Infection & Diagnostics Research, King’s College London, London, UK
- Angela Beckett
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, UK
- Themoula Charalampous
- Centre for Clinical Infection & Diagnostics Research, King’s College London, London, UK
- Raghavendran Kulasegaran Shylini
- Division of Infection, The Royal London Hospital, Barts Health NHS Trust, London, UK
- Beatrix Kele
- Division of Infection, The Royal London Hospital, Barts Health NHS Trust, London, UK
- Irene Monahan
- Institute for Infection and Immunity, St George’s University of London, London, UK
- Guy Mollett
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
- Matthew Parker
- 3 Jacobi Medical Center, Bronx, New York, USA
- Sunando Roy
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Joshua Taylor
- Department of Microbiology, South West London Pathology, St. George’s Hospital, London, UK
- Sophie Weller
- Department of Virology, Royal Free London NHS Foundation Trust, London, UK
- Eleri Wilson-Davies
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Phillip Wade
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
- Tabitha Mahungu
- Department of Virology, Royal Free London NHS Foundation Trust, London, UK
- Cassie Pope
- Institute for Infection and Immunity, St George’s University of London, London, UK
- Samuel Robson
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, UK
- Kordo Saeed
- 3Hamshire Hospitals Foundation Trust
- Thushan de Silva
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Luke Snell
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, UK
- Adam A Witney
- Institute for Infection and Immunity, St George`s, University of London, London, UK
- James Blackstone
- Comprehensive Clinical Trials Unit, University College London, London, UK
- Leanne Hockey
- Comprehensive Clinical Trials Unit, University College London, London, UK
- Georgia Marley
- Christine Peters
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
- Flavia Flaviani
- Bindi Patel
- Arcus Biosciences, Hayward, CA, United States
- Tom G S Williams
- Rahul Batra
- Centre for Clinical Infection & Diagnostics Research, King’s College London, London, UK
- Jonathan D Edgeworth
- Pinglawathee Madona
- Jennifer Hart
- Pathology and Laboratory Medicine Program, Ontario Health, Toronto, Ontario, Canada
- Juanita Pang
- Helena Tutill
- Nadua Bayzid
- Marius Cotic
- Luke Green
- Warwick Medical School
- Benjamin Lindsey
- Amy State
- Alison Cope
- Department of Virology, Northern General Hospital, Sheffield, UK
- Peijun Zhang
- Max Whiteley
- Marta Gallis Ramalho
- Stella Christou
- Stavroula Louka
- Hailey Hornsby
- Benjamin Foulkes
- Paige Wolverson
- Joe Heffer
- Nikki Smith
- lived experience expert
- Salman Goudarzi
- Chris Fearn
- Kate Cook
- Katie Loveson
- Adhyana Mahamana
- Buddhini Samaraweera
- Siona Silveira
- Stephen Aplin
- Sarah Jeremiah
- Matthew Harvey
- Birmingham Children’s Hospital
- Thea Sass
- Ngee Keong Tan
- Claudia Cardoso Pereira
- Dan Frampton
- Matt Byott
- Judith Heaney
- Emilie Sanchez
- Stavroula M Paraskevopoulou
- DOI
- https://doi.org/10.1136/bmjresp-2021-001029
- Journal volume & issue
-
Vol. 8,
no. 1
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.
