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

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

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.

COVID-19, viral infection
2052-4439
Stirrup, Oliver
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Boshier, Florencia
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Venturini, Cristina
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Guerra-Assunção, José Afonso
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Alcolea-Medina, Adela
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Beckett, Angela
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Charalampous, Themoula
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da Silva Filipe, Ana
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Glaysher, Sharon
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Khan, Tabassum
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Kulasegaran Shylini, Raghavendran
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Kele, Beatrix
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Monahan, Irene
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Mollett, Guy
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Parker, Matthew
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Pelosi, Emanuela
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Randell, Paul
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Roy, Sunando
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Taylor, Joshua
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Weller, Sophie
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Wilson-Davies, Eleri
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Wade, Phillip
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Williams, Rachel
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Copas, Andrew
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Cutino-Moguel, Maria-Teresa
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Freemantle, Nick
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Hayward, Andrew C
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Holmes, Alison
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Hughes, Joseph
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Mahungu, Tabitha
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Nebbia, Gaia
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Partridge, David
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Pope, Cassie
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Price, James
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Robson, Samuel
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Saeed, Kordo
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de Silva, Thushan
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Snell, Luke
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Thomson, Emma
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Witney, Adam A
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Breuer, Judith
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COG-UK-HOCI Variant substudy consortium
Stirrup, Oliver
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Boshier, Florencia
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Venturini, Cristina
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Guerra-Assunção, José Afonso
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Alcolea-Medina, Adela
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Beckett, Angela
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Charalampous, Themoula
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da Silva Filipe, Ana
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Glaysher, Sharon
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Khan, Tabassum
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Kulasegaran Shylini, Raghavendran
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Kele, Beatrix
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Monahan, Irene
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Mollett, Guy
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Parker, Matthew
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Randell, Paul
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Roy, Sunando
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Taylor, Joshua
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Weller, Sophie
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Wilson-Davies, Eleri
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Hughes, Joseph
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Pope, Cassie
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Price, James
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Robson, Samuel
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Saeed, Kordo
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de Silva, Thushan
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Snell, Luke
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Thomson, Emma
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Witney, Adam A
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Breuer, Judith
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Stirrup, Oliver, Boshier, Florencia, Venturini, Cristina, Guerra-Assunção, José Afonso and Alcolea-Medina, Adela , COG-UK-HOCI Variant substudy consortium (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 (1), [e001029]. (doi:10.1136/bmjresp-2021-001029).

Record type: Article

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.

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More information

Accepted/In Press date: 8 August 2021
Published date: 20 September 2021
Additional Information: Funding Information: Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: OTS has received funding for the submitted work through the COG-UK-HOCI study, funded by COG-UK consortium, supported by funding from UK Research & Innovation, National Institute of Health Research and Wellcome Sanger Institute; the COG-UK consortium funded sequencing costs for the submitted work; NF reports grants from UKRI, during the conduct of the study; personal fees from Aimmune, personal fees from ALK, personal fees from AstraZeneca, personal fees from MSD, personal fees from Sanofi Aventis, personal fees from Novartis, personal fees from Ipsen, personal fees from Gedeon Richter, personal fees from Galderma, personal fees from Vertex, outside the submitted work. The remaining authors do not have any declarations of interest. All other authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work. Funding Information: Funding This report was produced by members of the COG-UK-HOCI Variant substudy consortium. COG-UK-HOCI is part of COG-UK. COG-UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) and Genome Research Limited, operating as the Wellcome Sanger Institute. Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: COVID-19, viral infection

Identifiers

Local EPrints ID: 451724
URI: http://eprints.soton.ac.uk/id/eprint/451724
ISSN: 2052-4439
PURE UUID: 9fc7ccdc-6641-4ec7-8184-81f9d78347c5
ORCID for Kordo Saeed: ORCID iD orcid.org/0000-0003-0123-0302

Catalogue record

Date deposited: 21 Oct 2021 16:33
Last modified: 10 Apr 2024 02:01

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Contributors

Author: Oliver Stirrup
Author: Florencia Boshier
Author: Cristina Venturini
Author: José Afonso Guerra-Assunção
Author: Adela Alcolea-Medina
Author: Angela Beckett
Author: Themoula Charalampous
Author: Ana da Silva Filipe
Author: Sharon Glaysher
Author: Tabassum Khan
Author: Raghavendran Kulasegaran Shylini
Author: Beatrix Kele
Author: Irene Monahan
Author: Guy Mollett
Author: Matthew Parker
Author: Emanuela Pelosi
Author: Paul Randell
Author: Sunando Roy
Author: Joshua Taylor
Author: Sophie Weller
Author: Eleri Wilson-Davies
Author: Phillip Wade
Author: Rachel Williams
Author: Andrew Copas
Author: Maria-Teresa Cutino-Moguel
Author: Nick Freemantle
Author: Andrew C Hayward
Author: Alison Holmes
Author: Joseph Hughes
Author: Tabitha Mahungu
Author: Gaia Nebbia
Author: David Partridge
Author: Cassie Pope
Author: James Price
Author: Samuel Robson
Author: Kordo Saeed ORCID iD
Author: Thushan de Silva
Author: Luke Snell
Author: Emma Thomson
Author: Adam A Witney
Author: Judith Breuer
Corporate Author: COG-UK-HOCI Variant substudy consortium

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