ArticleBMJ open2026
Defining the preadmission factors that modify risk of acute complications, survival and long-term recovery from COVID-19: prospective, longitudinal, multisite, cohort study based in England.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo understand the pre-admission factors associated with COVID-19 clinical outcome with and without controlling for acute COVID-19 severity score.
designWe ran a prospective, longitudinal, multicentre cohort study.
settingPatients were recruited from four hospitals and one community General Practice in England
participants425 patients with COVID-19 from the start of the UK pandemic in April 2020 through the first three waves with study completing in 2022. PRIMARY AND SECONDARY OUTCOME MEASURES: Data were collected and analysed to identify demographic factors and preadmission symptoms for hospitalised patients that were associated with COVID-19 disease severity at recruitment, acute clinical course and long-term recovery. Analysis methods included logistic regression, time-to-event analysis, mixed-effect models and K-medoids clustering.
resultsThe cohort was skewed to patients with severe COVID (60%). Preadmission symptom cluster was associated with risk of thrombosis (OR 2.7 (95% CI 1.6 to 6.1), p=0.021) and renal disease (OR 3.3 (95% CI 1.4 to 8.0), p=0.008). Duration of symptoms less than 1 week was associated with pneumothorax (OR 3.1 (95% CI 1.2 to 8.3), p=0.025). Renal complications were more likely to be seen in the first wave compared with the second wave of the pandemic (OR 3.4 (95% CI 1.5 to 7.5), p=0.003). Using a logistic regression model, survival to discharge was associated with white (vs unknown) ethnicity (OR 6.6 (95% CI 2.8 to 15.2), p<0.0001), lower age (<40 years vs >60 years, OR 4.9 (95% CI 1.2 to 20.0), p=0.027) and absence of comorbidities (OR 2.7 (95% CI 1.2 to 5.9), p=0.016). However, using a survival model, hazard of death was increased for all hospitalised who had duration of symptoms less than 1 week (HR 5.6 (95% CI 1.3 to 24.4), p=0.023) or had comorbidities (HR 33.3 (95% CI 3.1 to 333.3), p=0.0035). Over 80% of patients reported long-term sequelae with neuromuscular and cognitive effects dominating early on and mood disturbance and breathlessness persisting to 12 months. Gender had the strongest association with dyspnoea (OR 99.8 (95% CI 2.4 to 4123.1, p=0.02) and persistent mood disorder (OR 8.3 (95% CI 1.7 to 39.9), p=0.008) and associated with persistent gastrointestinal problems (loose bowels (OR 3.3 (95% CI 1.1 to 10.8), p=0.045), abdominal pain (OR 5.0 (95% CI 1.4 to 18.1), p=0.014), constipation (OR 3.8 (95% CI 1.6 to 9.2), p=0.003)) and cognitive problems (OR 2.3 (95% CI 1.1 to -4.8), p=0.024).
conclusionsThese results support an association between specific demographic factors and early infection symptoms that impact on acute and long-term outcomes of COVID-19 in this cohort after accounting for COVID-19 disease severity at enrolment. Understanding the disease mechanisms that explain these relationships is needed to inform targeted therapeutics to prevent and/or manage these complications.
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