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

Oliver Stirrup ORCID logo; Florencia Boshier; Cristina Venturini; José Afonso Guerra-Assunção; Adela Alcolea-Medina; Angela Beckett; Themoula Charalampous; Ana da Silva Filipe; Sharon Glaysher; Tabassum Khan; +33 more... Raghavendran Kulasegaran Shylini ORCID logo; Beatrix Kele; Irene Monahan; Guy Mollett; Matthew Parker; Emanuela Pelosi; Paul Randell; Sunando Roy; Joshua Taylor; Sophie Weller; Eleri Wilson-Davies; Phillip Wade; Rachel Williams; COG-UK-HOCI Variant substudy consortium; COVID-19 Genomics UK (COG-UK) consortium; Andrew Copas; Maria-Teresa Cutino-Moguel; Nick Freemantle; Andrew C Hayward; Alison Holmes; Joseph Hughes; Tabitha Mahungu; Gaia Nebbia; David Partridge; Cassie Pope; James Price ORCID logo; Samuel Robson; Kordo Saeed; Thushan de Silva; Luke Snell; Emma Thomson ORCID logo; Adam A Witney; Judith Breuer; COG-UK-HOCI Variant substudy consortium, COVID-19 Genomics UK (COG-UK) 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-e001029. ISSN 2052-4439 DOI: 10.1136/bmjresp-2021-001029
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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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