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 admit...
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2021-01-01
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| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/8/1/e001029.full |
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| author | 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 |
| author_facet | 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 |
| author_sort | Judith Breuer |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-8a895e04928046eab408c7338ade581c |
| institution | OA Journals |
| issn | 2052-4439 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj-art-8a895e04928046eab408c7338ade581c2025-08-20T02:22:29ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392021-01-018110.1136/bmjresp-2021-001029SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort studyJudith Breuer0Catherine F Houlihan1Nick Freemantle2David Partridge3Gaia Nebbia4Jacqui Prieto5Gee Yen Shin6Andrew Copas7Oliver Stirrup8Kenneth LaingRachel Williams9Helen WheelerPaul Randell10Ana da Silva Filipe11Maria-Teresa Cutino-Moguel12Tommy Rampling13Tabassum Khan14James Price15Eleni Nastouli16Katie Johnson17Sharon Glaysher18Scott Elliott19Helen UmplebyEmanuela Pelosi20Emma Thomson21Cristina Venturini22Anna Riddell23Alison CoxAndrew C Hayward24Malin BergströmDavid Harrington25Charlotte Williams26Tanzina Haque27Dianne IrishAdrienn AngyalMarios MargaritisMoira Spyer28Florencia Boshier29José Afonso Guerra-Assunção30Adela Alcolea-Medina31Angela Beckett32Themoula Charalampous33Raghavendran Kulasegaran Shylini34Beatrix Kele35Irene Monahan36Guy Mollett37Matthew Parker38Sunando Roy39Joshua Taylor40Sophie Weller41Eleri Wilson-Davies42Phillip Wade43Joseph Hughes44Tabitha Mahungu45Cassie Pope46Samuel Robson47Kordo Saeed48Thushan de Silva49Luke Snell50Adam A Witney51James Blackstone52Leanne Hockey53Georgia MarleyChristine Peters54Flavia FlavianiBindi Patel55Tom G S WilliamsRahul Batra56Jonathan D EdgeworthPinglawathee MadonaJennifer Hart57Juanita PangHelena TutillNadua BayzidMarius CoticLuke Green58Benjamin LindseyAmy StateAlison Cope59Peijun ZhangMax WhiteleyMarta Gallis RamalhoStella ChristouStavroula LoukaHailey HornsbyBenjamin FoulkesPaige WolversonJoe HefferNikki Smith60Salman GoudarziChris FearnKate CookKatie LovesonAdhyana MahamanaBuddhini SamaraweeraSiona SilveiraStephen AplinSarah JeremiahMatthew Harvey61Thea SassNgee Keong TanClaudia Cardoso PereiraDan FramptonMatt ByottJudith HeaneyEmilie SanchezStavroula M ParaskevopoulouInstitute of Child Health, University College London, London, UKspecialty trainee in infectious diseasesComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UKDepartment of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK2 Infection Sciences, Viapath Analytics, Guy`s and St Thomas` NHS Foundation Trust, London, UKUniversity of Southampton, Southampton, UKconsultant virologistInstitute for Global Health, University College London, London, UK4 Institute for Global Health, University College London, London, UK13 Ipsos MORI UK Ltd, London, UK2 Department of Pathology, Imperial College Healthcare NHS Foundation, London, UKMRC-University of Glasgow Centre for Virus Research, Glasgow, UK3Virology Department, Division of Infection, Barts Health NHS Trust, London, UK5UKHSA, Salisbury, UK15 Gynaecological Oncology, University of Birmingham, Birmingham, UKEmergency and Urgent Care Research in Cambridge (EUReCa), PACE Section, Department of Medicine, Cambridge University, Cambridge, UKNational Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK1 Department of Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UKDepartment of Respiratory Research & Innovation, Portsmouth Hospitals NHS Trust, Portsmouth, Portsmouth, UKDepartment of Respiratory Research & Innovation, Portsmouth Hospitals NHS Trust, Portsmouth, Portsmouth, UKSouthampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UKMRC-University of Glasgow Centre for Virus Research, Glasgow, UKDepartment of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK5Department of Virology, Barts Health NHS Trust, London, UK3 Institute of Epidemiology & Health Care, University College London, London, UKCT2 core medical trainee, University College Hospitalchief strategy and improvement officerconsultant virologistPopulation, Policy and Practice, University College London, London, UKDepartment of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UKDepartment of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UKCentre for Clinical Infection & Diagnostics Research, King’s College London, London, UKCentre for Enzyme Innovation, University of Portsmouth, Portsmouth, UKCentre for Clinical Infection & Diagnostics Research, King’s College London, London, UKDivision of Infection, The Royal London Hospital, Barts Health NHS Trust, London, UKDivision of Infection, The Royal London Hospital, Barts Health NHS Trust, London, UKInstitute for Infection and Immunity, St George’s University of London, London, UKMRC-University of Glasgow Centre for Virus Research, Glasgow, UK3 Jacobi Medical Center, Bronx, New York, USADepartment of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UKDepartment of Microbiology, South West London Pathology, St. George’s Hospital, London, UKDepartment of Virology, Royal Free London NHS Foundation Trust, London, UKSouthampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UKSheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UKMRC-University of Glasgow Centre for Virus Research, Glasgow, UKDepartment of Virology, Royal Free London NHS Foundation Trust, London, UKInstitute for Infection and Immunity, St George’s University of London, London, UKCentre for Enzyme Innovation, University of Portsmouth, Portsmouth, UK3Hamshire Hospitals Foundation TrustSheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UKCentre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, UKInstitute for Infection and Immunity, St George`s, University of London, London, UKComprehensive Clinical Trials Unit, University College London, London, UKComprehensive Clinical Trials Unit, University College London, London, UKQueen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UKArcus Biosciences, Hayward, CA, United StatesCentre for Clinical Infection & Diagnostics Research, King’s College London, London, UKPathology and Laboratory Medicine Program, Ontario Health, Toronto, Ontario, CanadaWarwick Medical SchoolDepartment of Virology, Northern General Hospital, Sheffield, UKlived experience expertBirmingham Children’s HospitalBackground 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.https://bmjopenrespres.bmj.com/content/8/1/e001029.full |
| spellingShingle | 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 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 |
| title | SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study |
| title_full | SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study |
| title_fullStr | SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study |
| title_full_unstemmed | SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study |
| title_short | SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study |
| title_sort | sars cov 2 lineage b 1 1 7 is associated with greater disease severity among hospitalised women but not men multicentre cohort study |
| url | https://bmjopenrespres.bmj.com/content/8/1/e001029.full |
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sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT helenatutill sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT naduabayzid sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT mariuscotic sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT lukegreen sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT benjaminlindsey sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT amystate sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT alisoncope sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT peijunzhang sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT maxwhiteley sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT martagallisramalho sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT stellachristou sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT stavroulalouka sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT haileyhornsby sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT benjaminfoulkes sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT paigewolverson sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT joeheffer sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT nikkismith sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT salmangoudarzi sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT chrisfearn sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT katecook sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT katieloveson sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT adhyanamahamana sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT buddhinisamaraweera sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT sionasilveira sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT stephenaplin sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT sarahjeremiah sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT matthewharvey sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT theasass sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT ngeekeongtan sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT claudiacardosopereira sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT danframpton sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT mattbyott sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT judithheaney sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT emiliesanchez sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy AT stavroulamparaskevopoulou sarscov2lineageb117isassociatedwithgreaterdiseaseseverityamonghospitalisedwomenbutnotmenmulticentrecohortstudy |