EClinicalMedicine (Mar 2023)
Prevalence of physical frailty, including risk factors, up to 1 year after hospitalisation for COVID-19 in the UK: a multicentre, longitudinal cohort studyResearch in context
- Hamish J.C. McAuley,
- Rachael A. Evans,
- Charlotte E. Bolton,
- Christopher E. Brightling,
- James D. Chalmers,
- Annemarie B. Docherty,
- Omer Elneima,
- Paul L. Greenhaff,
- Ayushman Gupta,
- Victoria C. Harris,
- Ewen M. Harrison,
- Ling-Pei Ho,
- Alex Horsley,
- Linzy Houchen-Wolloff,
- Caroline J. Jolley,
- Olivia C. Leavy,
- Nazir I. Lone,
- William D-C Man,
- Michael Marks,
- Dhruv Parekh,
- Krisnah Poinasamy,
- Jennifer K. Quint,
- Betty Raman,
- Matthew Richardson,
- Ruth M. Saunders,
- Marco Sereno,
- Aarti Shikotra,
- Amisha Singapuri,
- Sally J. Singh,
- Michael Steiner,
- Ai Lyn Tan,
- Louise V. Wain,
- Carly Welch,
- Julie Whitney,
- Miles D. Witham,
- Janet Lord,
- Neil J. Greening,
- K. Abel,
- H. Adamali,
- D. Adeloye,
- O. Adeyemi,
- R. Adrego,
- L.A. Aguilar Jimenez,
- S. Ahmad,
- N. Ahmad Haider,
- R. Ahmed,
- N. Ahwireng,
- M. Ainsworth,
- B. Al-Sheklly,
- A. Alamoudi,
- M. Ali,
- M. Aljaroof,
- A.M. All,
- L. Allan,
- R.J. Allen,
- L. Allerton,
- L. Allsop,
- P. Almeida,
- D. Altmann,
- M. Alvarez Corral,
- S. Amoils,
- D. Anderson,
- C. Antoniades,
- G. Arbane,
- A. Arias,
- C. Armour,
- L. Armstrong,
- N. Armstrong,
- D. Arnold,
- H. Arnold,
- A. Ashish,
- A. Ashworth,
- M. Ashworth,
- S. Aslani,
- H. Assefa-Kebede,
- C. Atkin,
- P. Atkin,
- R. Aul,
- H. Aung,
- L. Austin,
- C. Avram,
- A. Ayoub,
- M. Babores,
- R. Baggott,
- J. Bagshaw,
- D. Baguley,
- L. Bailey,
- J.K. Baillie,
- S. Bain,
- M. Bakali,
- M. Bakau,
- E. Baldry,
- D. Baldwin,
- M. Baldwin,
- C. Ballard,
- A. Banerjee,
- B. Bang,
- R.E. Barker,
- L. Barman,
- S. Barratt,
- F. Barrett,
- D. Basire,
- N. Basu,
- M. Bates,
- A. Bates,
- R. Batterham,
- H. Baxendale,
- H. Bayes,
- M. Beadsworth,
- P. Beckett,
- M. Beggs,
- M. Begum,
- P. Beirne,
- D. Bell,
- R. Bell,
- K. Bennett,
- E. Beranova,
- A. Bermperi,
- A. Berridge,
- C. Berry,
- S. Betts,
- E. Bevan,
- K. Bhui,
- M. Bingham,
- K. Birchall,
- L. Bishop,
- K. Bisnauthsing,
- J. Blaikely,
- A. Bloss,
- A. Bolger,
- C.E. Bolton,
- J. Bonnington,
- A. Botkai,
- C. Bourne,
- M. Bourne,
- K. Bramham,
- L. Brear,
- G. Breen,
- J. Breeze,
- A. Briggs,
- E. Bright,
- C.E. Brightling,
- S. Brill,
- K. Brindle,
- L. Broad,
- A. Broadley,
- C. Brookes,
- M. Broome,
- A. Brown,
- A. Brown,
- J. Brown,
- J. Brown,
- J.S. Brown,
- M. Brown,
- M. Brown,
- V. Brown,
- T. Brugha,
- N. Brunskill,
- M. Buch,
- P. Buckley,
- A. Bularga,
- E. Bullmore,
- L. Burden,
- T. Burdett,
- D. Burn,
- G. Burns,
- A. Burns,
- J. Busby,
- R. Butcher,
- A. Butt,
- S. Byrne,
- P. Cairns,
- P.C. Calder,
- E. Calvelo,
- H. Carborn,
- B. Card,
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- T. Chalder,
- J.D. Chalmers,
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- N. Chaudhuri,
- A. Checkley,
- J. Chen,
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- C. Childs,
- E.R. Chilvers,
- H. Chinoy,
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- K. Chong-James,
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- N. Choudhury,
- P. Chowienczyk,
- C. Christie,
- M. Chrystal,
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- G. Coakley,
- Z. Coburn,
- S. Coetzee,
- J. Cole,
- C. Coleman,
- F. Conneh,
- D. Connell,
- B. Connolly,
- L. Connor,
- A. Cook,
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- D. Copeland,
- T. Cosier,
- M. Coulding,
- C. Coupland,
- E. Cox,
- T. Craig,
- P. Crisp,
- D. Cristiano,
- M.G. Crooks,
- A. Cross,
- I. Cruz,
- P. Cullinan,
- D. Cuthbertson,
- L. Daines,
- M. Dalton,
- P. Daly,
- A. Daniels,
- P. Dark,
- J. Dasgin,
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- G.A. Davies,
- K. Davies,
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- J. Dawson,
- E. Daynes,
- A. De Soyza,
- B. Deakin,
- A. Deans,
- C. Deas,
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- S. Defres,
- A. Dell,
- K. Dempsey,
- E. Denneny,
- J. Dennis,
- A. Dewar,
- R. Dharmagunawardena,
- N. Diar-Bakerly,
- C. Dickens,
- A. Dipper,
- S. Diver,
- S.N. Diwanji,
- M. Dixon,
- R. Djukanovic,
- H. Dobson,
- S.L. Dobson,
- A.B. Docherty,
- A. Donaldson,
- T. Dong,
- N. Dormand,
- A. Dougherty,
- R. Dowling,
- S. Drain,
- K. Draxlbauer,
- K. Drury,
- H.J.C. Drury,
- P. Dulawan,
- A. Dunleavy,
- S. Dunn,
- C. Dupont,
- J. Earley,
- N. Easom,
- C. Echevarria,
- S. Edwards,
- C. Edwardson,
- H. El-Taweel,
- A. Elliott,
- K. Elliott,
- Y. Ellis,
- A. Elmer,
- O. Elneima,
- D. Evans,
- H. Evans,
- J. Evans,
- R. Evans,
- R.A. Evans,
- R.I. Evans,
- T. Evans,
- C. Evenden,
- L. Evison,
- L. Fabbri,
- S. Fairbairn,
- A. Fairman,
- K. Fallon,
- D. Faluyi,
- C. Favager,
- T. Fayzan,
- J. Featherstone,
- T. Felton,
- J. Finch,
- S. Finney,
- J. Finnigan,
- L. Finnigan,
- H. Fisher,
- S. Fletcher,
- R. Flockton,
- M. Flynn,
- H. Foot,
- D. Foote,
- A. Ford,
- D. Forton,
- E. Fraile,
- C. Francis,
- R. Francis,
- S. Francis,
- A. Frankel,
- E. Fraser,
- R. Free,
- N. French,
- X. Fu,
- J. Fuld,
- J. Furniss,
- L. Garner,
- N. Gautam,
- J.R. Geddes,
- J. George,
- P. George,
- M. Gibbons,
- M. Gill,
- L. Gilmour,
- F. Gleeson,
- J. Glossop,
- S. Glover,
- N. Goodman,
- C. Goodwin,
- B. Gooptu,
- H. Gordon,
- T. Gorsuch,
- M. Greatorex,
- P.L. Greenhaff,
- W. Greenhalf,
- A. Greenhalgh,
- N.J. Greening,
- J. Greenwood,
- H. Gregory,
- R. Gregory,
- D. Grieve,
- D. Griffin,
- L. Griffiths,
- A.-M. Guerdette,
- B. Guillen Guio,
- M. Gummadi,
- A. Gupta,
- S. Gurram,
- E. Guthrie,
- Z. Guy,
- H.H. Henson,
- K. Hadley,
- A. Haggar,
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- I. Hall,
- L. Hall,
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- R. Hamil,
- A. Hancock,
- K. Hancock,
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- S. Haq,
- H.E. Hardwick,
- E. Hardy,
- T. Hardy,
- B. Hargadon,
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- E. Harris,
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- J. Haworth,
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- J. Hazeldine,
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- L.G. Heaney,
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- J.L. Heeney,
- M. Heightman,
- S. Heller,
- M. Henderson,
- L. Hesselden,
- M. Hewitt,
- V. Highett,
- T. Hillman,
- T. Hiwot,
- L.P. Ho,
- A. Hoare,
- M. Hoare,
- J. Hockridge,
- P. Hogarth,
- A. Holbourn,
- S. Holden,
- L. Holdsworth,
- D. Holgate,
- M. Holland,
- L. Holloway,
- K. Holmes,
- M. Holmes,
- B. Holroyd-Hind,
- L. Holt,
- A. Hormis,
- A. Horsley,
- A. Hosseini,
- M. Hotopf,
- L. Houchen-Wolloff,
- K. Howard,
- L.S. Howard,
- A. Howell,
- E. Hufton,
- A.D. Hughes,
- J. Hughes,
- R. Hughes,
- A. Humphries,
- N. Huneke,
- E. Hurditch,
- J. Hurst,
- M. Husain,
- T. Hussell,
- J. Hutchinson,
- W. Ibrahim,
- F. Ilyas,
- J. Ingham,
- L. Ingram,
- D. Ionita,
- K. Isaacs,
- K. Ismail,
- T. Jackson,
- J. Jacob,
- W.Y. James,
- W. Jang,
- C. Jarman,
- I. Jarrold,
- H. Jarvis,
- R. Jastrub,
- B. Jayaraman,
- R.G. Jenkins,
- P. Jezzard,
- K. Jiwa,
- C. Johnson,
- S. Johnson,
- D. Johnston,
- C.J. Jolley,
- D. Jones,
- G. Jones,
- H. Jones,
- H. Jones,
- I. Jones,
- L. Jones,
- M.G. Jones,
- S. Jones,
- S. Jose,
- T. Kabir,
- G. Kaltsakas,
- V. Kamwa,
- N. Kanellakis,
- S. Kaprowska,
- Z. Kausar,
- N. Keenan,
- S. Kelly,
- G. Kemp,
- S. Kerr,
- H. Kerslake,
- A.L. Key,
- F. Khan,
- K. Khunti,
- S. Kilroy,
- B. King,
- C. King,
- L. Kingham,
- J. Kirk,
- P. Kitterick,
- P. Klenerman,
- L. Knibbs,
- S. Knight,
- A. Knighton,
- O. Kon,
- S. Kon,
- S.S. Kon,
- S. Koprowska,
- A. Korszun,
- I. Koychev,
- C. Kurasz,
- P. Kurupati,
- C. Laing,
- H. Lamlum,
- G. Landers,
- C. Langenberg,
- D. Lasserson,
- L. Lavelle-Langham,
- A. Lawrie,
- C. Lawson,
- C. Lawson,
- A. Layton,
- A. Lea,
- O.C. Leavy,
- D. Lee,
- J.-H. Lee,
- E. Lee,
- K. Leitch,
- R. Lenagh,
- D. Lewis,
- J. Lewis,
- K.E. Lewis,
- V. Lewis,
- N. Lewis-Burke,
- X. Li,
- T. Light,
- L. Lightstone,
- W. Lilaonitkul,
- L. Lim,
- S. Linford,
- A. Lingford-Hughes,
- M. Lipman,
- K. Liyanage,
- A. Lloyd,
- S. Logan,
- D. Lomas,
- N.I. Lone,
- R. Loosley,
- J.M. Lord,
- H. Lota,
- W. Lovegrove,
- A. Lucey,
- E. Lukaschuk,
- A. Lye,
- C. Lynch,
- S. MacDonald,
- G. MacGowan,
- I. Macharia,
- J. Mackie,
- L. Macliver,
- S. Madathil,
- G. Madzamba,
- N. Magee,
- M.M. Magtoto,
- N. Mairs,
- N. Majeed,
- E. Major,
- F. Malein,
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- C. Manisty,
- R. Manley,
- K. March,
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- P. Marino,
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- J. Martin,
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- P. Mehta,
- J. Meiring,
- L. Melling,
- M. Mencias,
- D. Menzies,
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- L. Milligan,
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- A. Mohamed,
- N. Mohamed,
- S. Mohammed,
- P.L. Molyneaux,
- W. Monteiro,
- S. Moriera,
- A. Morley,
- L. Morrison,
- R. Morriss,
- A. Morrow,
- A.J. Moss,
- P. Moss,
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- N. Msimanga,
- E. Mukaetova-Ladinska,
- U. Munawar,
- J. Murira,
- U. Nanda,
- H. Nassa,
- M. Nasseri,
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- R. Needham,
- P. Neill,
- S. Neubauer,
- D.E. Newby,
- H. Newell,
- T. Newman,
- J. Newman,
- A. Newton-Cox,
- T. Nicholson,
- D. Nicoll,
- A. Nikolaidis,
- C.M. Nolan,
- M.J. Noonan,
- C. Norman,
- P. Novotny,
- J. Nunag,
- L. Nwafor,
- U. Nwanguma,
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- K. O'Donnell,
- D. O'Regan,
- L. O’Brien,
- N. Odell,
- G. Ogg,
- O. Olaosebikan,
- C. Oliver,
- Z. Omar,
- P.J.M. Openshaw,
- L. Orriss-Dib,
- L. Osborne,
- R. Osbourne,
- M. Ostermann,
- C. Overton,
- J. Owen,
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- E. Pacpaco,
- S. Paddick,
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- S. Palmer,
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- K. Paques,
- K. Paradowski,
- M. Pareek,
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- H. Parfrey,
- C. Pariante,
- S. Parker,
- M. Parkes,
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- J. Pendlebury,
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- C. Pennington,
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- J. Phipps,
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- S. Stockdale,
- J. Stockley,
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- B. Thamu,
- D. Thickett,
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- T. Thompson,
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- T. Thornton,
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- R.S. Thwaites,
- J. Tilley,
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- G.F. Tiongson,
- M. Tobin,
- J. Tomlinson,
- C. Tong,
- M. Toshner,
- R. Touyz,
- K.A. Tripp,
- E. Tunnicliffe,
- A. Turnbull,
- E. Turner,
- S. Turner,
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- S. Turney,
- L. Turtle,
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- R. Ugwuoke,
- R. Upthegrove,
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- M. Ventura,
- J. Vere,
- C. Vickers,
- B. Vinson,
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- L.V. Wain,
- T. Wainwright,
- L.O. Wajero,
- S. Walder,
- S. Walker,
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- E. Wall,
- T. Wallis,
- S. Walmsley,
- J.A. Walsh,
- S. Walsh,
- L. Warburton,
- T.J.C. Ward,
- K. Warwick,
- H. Wassall,
- S. Waterson,
- E. Watson,
- L. Watson,
- J. Watson,
- J. Weir McCall,
- C. Welch,
- H. Welch,
- B. Welsh,
- S. Wessely,
- S. West,
- H. Weston,
- H. Wheeler,
- S. White,
- V. Whitehead,
- J. Whitney,
- S. Whittaker,
- B. Whittam,
- V. Whitworth,
- A. Wight,
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- M. Wilkins,
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- S.A. Williams-Howard,
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- J. Willoughby,
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- D. Wilson,
- I. Wilson,
- N. Window,
- M. Witham,
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- C. Wood,
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- J. Woods,
- D.G. Wootton,
- J. Wormleighton,
- J. Worsley,
- D. Wraith,
- C. Wrey Brown,
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- L. Wright,
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- I. Wynter,
- M. Xu,
- N. Yasmin,
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- T. Yates,
- K.P. Yip,
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Affiliations
- Hamish J.C. McAuley
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
- Rachael A. Evans
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
- Charlotte E. Bolton
- University of Nottingham, Nottingham, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Christopher E. Brightling
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- James D. Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Annemarie B. Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
- Omer Elneima
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Paul L. Greenhaff
- University of Nottingham, Nottingham, UK
- Ayushman Gupta
- University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Victoria C. Harris
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
- Ewen M. Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
- Ling-Pei Ho
- MRC Human Immunology Unit, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Alex Horsley
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Manchester, UK
- Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK; Therapy Department, University Hospitals of Leicester, NHS Trust, Leicester, UK
- Caroline J. Jolley
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK; Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
- Olivia C. Leavy
- Department of Health Sciences, University of Leicester, Leicester, UK
- Nazir I. Lone
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
- William D-C Man
- Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, UK; National Heart and Lung Institute, Imperial College London, London, UK; Faculty of Life Sciences and Medicine, King's College London, UK
- Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK; Division of Infection and Immunity, University College London, London, UK
- Dhruv Parekh
- University of Birmingham, Birmingham, UK; University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Krisnah Poinasamy
- Asthma and Lung UK, London, UK
- Jennifer K. Quint
- National Heart and Lung Institute, Imperial College London, London, UK
- Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Matthew Richardson
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Ruth M. Saunders
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Marco Sereno
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Amisha Singapuri
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Sally J. Singh
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Michael Steiner
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
- Ai Lyn Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
- Louise V. Wain
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; Department of Health Sciences, University of Leicester, Leicester, UK
- Carly Welch
- University of Birmingham, Birmingham, UK
- Julie Whitney
- The School of Life Course & Population Sciences, King's College London, UK
- Miles D. Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Janet Lord
- University of Birmingham, Birmingham, UK
- Neil J. Greening
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK; Corresponding author. Department of Respiratory Science, Institute for Lung Health, NIHR Leicester Biomedical Research Centre (Respiratory), Glenfield Hospital, Leicester, LE3 9QP, UK.
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- P.L. Greenhaff
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- A. Greenhalgh
- N.J. Greening
- J. Greenwood
- H. Gregory
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- A.-M. Guerdette
- B. Guillen Guio
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- A. Gupta
- S. Gurram
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- E. Harris
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- Journal volume & issue
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Vol. 57
p. 101896
Abstract
Summary: Background: The scale of COVID-19 and its well documented long-term sequelae support a need to understand long-term outcomes including frailty. Methods: This prospective cohort study recruited adults who had survived hospitalisation with clinically diagnosed COVID-19 across 35 sites in the UK (PHOSP-COVID). The burden of frailty was objectively measured using Fried's Frailty Phenotype (FFP). The primary outcome was the prevalence of each FFP group—robust (no FFP criteria), pre-frail (one or two FFP criteria) and frail (three or more FFP criteria)—at 5 months and 1 year after discharge from hospital. For inclusion in the primary analysis, participants required complete outcome data for three of the five FFP criteria. Longitudinal changes across frailty domains are reported at 5 months and 1 year post-hospitalisation, along with risk factors for frailty status. Patient-perceived recovery and health-related quality of life (HRQoL) were retrospectively rated for pre-COVID-19 and prospectively rated at the 5 month and 1 year visits. This study is registered with ISRCTN, number ISRCTN10980107. Findings: Between March 5, 2020, and March 31, 2021, 2419 participants were enrolled with FFP data. Mean age was 57.9 (SD 12.6) years, 933 (38.6%) were female, and 429 (17.7%) had received invasive mechanical ventilation. 1785 had measures at both timepoints, of which 240 (13.4%), 1138 (63.8%) and 407 (22.8%) were frail, pre-frail and robust, respectively, at 5 months compared with 123 (6.9%), 1046 (58.6%) and 616 (34.5%) at 1 year. Factors associated with pre-frailty or frailty were invasive mechanical ventilation, older age, female sex, and greater social deprivation. Frail participants had a larger reduction in HRQoL compared with before their COVID-19 illness and were less likely to describe themselves as recovered. Interpretation: Physical frailty and pre-frailty are common following hospitalisation with COVID-19. Improvement in frailty was seen between 5 and 12 months although two-thirds of the population remained pre-frail or frail. This suggests comprehensive assessment and interventions targeting pre-frailty and frailty beyond the initial illness are required. Funding: UK Research and Innovation and National Institute for Health Research.