Publications by authors named "Krisnah Poinasamy"

Background: People hospitalised for coronavirus disease 2019 (COVID-19) have elevated incidence of diabetes. However, it is unclear whether this is due to shared risk factors, confounding or stress hyperglycaemia in response to acute illness.

Methods: We analysed a multicentre prospective cohort study (PHOSP-COVID) of people ≥18 years discharged from NHS hospitals across the United Kingdom following COVID-19.

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Background: In patients with coronavirus disease 2019 (COVID-19) requiring supplemental oxygen, dexamethasone reduces acute severity and improves survival, but longer-term effects are unknown. We hypothesised that systemic corticosteroid administration during acute COVID-19 would be associated with improved health-related quality of life (HRQoL) 1 year after discharge.

Methods: Adults admitted to hospital between February 2020 and March 2021 for COVID-19 and meeting current guideline recommendations for dexamethasone treatment were included using two prospective UK cohort studies (Post-hospitalisation COVID-19 and the International Severe Acute Respiratory and emerging Infection Consortium).

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Background: COVID-19 is known to be associated with increased risks of cognitive and psychiatric outcomes after the acute phase of disease. We aimed to assess whether these symptoms can emerge or persist more than 1 year after hospitalisation for COVID-19, to identify which early aspects of COVID-19 illness predict longer-term symptoms, and to establish how these symptoms relate to occupational functioning.

Methods: The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study of adults (aged ≥18 years) who were hospitalised with a clinical diagnosis of COVID-19 at participating National Health Service hospitals across the UK.

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Article Synopsis
  • Pulmonary embolism (PE) is a serious complication of COVID-19 that can lead to chronic thromboembolic pulmonary disease (CTEPD) and chronic thromboembolic pulmonary hypertension (CTEPH), but the true burden and best screening methods for these conditions are still not clear.
  • During the study from 2017 to 2022, only a small percentage of CTEPH cases were linked to previous COVID-19 infections, with the CTEPH rates returning to pre-pandemic levels after the second year of the pandemic.
  • The findings suggest that while the risk of developing CTEPH after hospitalization for COVID-19 is low, using simple clinical risk scores can help identify patients who may need further evaluation.
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  • The PHOSP-COVID study examined long-term outcomes in COVID-19 hospitalised patients with pre-existing airway diseases compared to those without.* -
  • Out of 615 participants with airway diseases, many reported lower recovery rates, higher anxiety and depression levels, and greater mobility issues one year post-discharge.* -
  • Overall, individuals with pre-existing airway conditions experienced worse health-related quality of life and more persistent symptoms like breathlessness and fatigue after recovering from COVID-19.*
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Background: Pre-existing cardiovascular disease (CVD) or cardiovascular risk factors have been associated with an increased risk of complications following hospitalisation with COVID-19, but their impact on the rate of recovery following discharge is not known.

Objectives: To determine whether the rate of patient-perceived recovery following hospitalisation with COVID-19 was affected by the presence of CVD or cardiovascular risk factors.

Methods: In a multicentre prospective cohort study, patients were recruited following discharge from the hospital with COVID-19 undertaking two comprehensive assessments at 5 months and 12 months.

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  • One in ten COVID-19 infections lead to long COVID, characterized by prolonged symptoms, but the underlying mechanisms remain unclear.
  • In a study of 657 individuals, certain inflammatory markers were linked to long COVID symptoms, revealing connections to cardiorespiratory issues, fatigue, anxiety, gastrointestinal problems, cognitive impairments, and potential nerve tissue repair disturbances.
  • Findings suggest that targeting specific inflammatory pathways could offer new therapeutic options for treating different subtypes of long COVID in future clinical trials.*
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A proportion of patients infected with severe acute respiratory syndrome coronavirus 2 experience a range of neuropsychiatric symptoms months after infection, including cognitive deficits, depression and anxiety. The mechanisms underpinning such symptoms remain elusive. Recent research has demonstrated that nervous system injury can occur during COVID-19.

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  • Post-COVID cognitive deficits, often described as 'brain fog', are commonly seen in patients and significantly impair daily functioning, but their exact biological causes are still unclear.
  • A study with 1,837 adults hospitalized due to COVID-19 identified two specific biomarker profiles from their blood tests that can predict cognitive issues 6 to 12 months post-infection.
  • The first profile involves high fibrinogen levels linked to cognitive impairments, while the second profile, marked by elevated D-dimer levels, connects more with subjective cognitive issues and work performance, with fatigue and shortness of breath playing a mediating role.
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Introduction: Over half of post-COVID-hospitalisation adults have persistent symptoms 2 years after discharge, providing a challenge for individuals and healthcare systems. We therefore aimed to describe a typology of UK healthcare pathways post-hospital discharge as a first step towards understanding clinical effectiveness and cost-effectiveness of different healthcare pathways.

Methods: In 2021, we surveyed hospital sites taking part in the UK Post-hospital COVID-19 (PHOSP-COVID) study.

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  • A study aimed to determine how common issues like swallowing, communication, voice, and cognitive problems are among patients who were hospitalized for COVID-19 in the UK.
  • It involved data from over 2,000 patients collected through questionnaires at two different times after their discharge, focusing on the complications faced after intensive care unit (ICU) treatment.
  • The results showed that many experienced difficulties: 20% with swallowing issues, 34% with voice problems, 23% with communication challenges, and a significant 70% reported cognitive problems, highlighting the need for urgent research and rehabilitation strategies.
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Background: Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea.

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  • A study on long-term outcomes after COVID-19 hospitalization found that frailty is prevalent among survivors, with many participants categorizing as frail or pre-frail five months and one year after discharge.
  • The research involved 2419 adults, showing that 63.8% were pre-frail and 13.4% frail at five months, which improved somewhat by one year, with 34.5% being robust.
  • Factors like older age, female sex, and prior invasive mechanical ventilation were linked to higher frailty rates, and those who were frail reported significant declines in health-related quality of life and recovery perceptions compared to their pre-COVID states.
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Background: Persistence of respiratory symptoms, particularly breathlessness, after acute coronavirus disease 2019 (COVID-19) infection has emerged as a significant clinical problem. We aimed to characterise and identify risk factors for patients with persistent breathlessness following COVID-19 hospitalisation.

Methods: PHOSP-COVID is a multicentre prospective cohort study of UK adults hospitalised for COVID-19.

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Introduction: Many adults hospitalised with COVID-19 have persistent symptoms such as fatigue, breathlessness and brain fog that limit day-to-day activities. These symptoms can last over 2 years. Whilst there is limited controlled studies on interventions that can support those with ongoing symptoms, there has been some promise in rehabilitation interventions in improving function and symptoms either using face-to-face or digital methods, but evidence remains limited and these studies often lack a control group.

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Background: Most studies of immunity to SARS-CoV-2 focus on circulating antibody, giving limited insights into mucosal defences that prevent viral replication and onward transmission. We studied nasal and plasma antibody responses one year after hospitalisation for COVID-19, including a period when SARS-CoV-2 vaccination was introduced.

Methods: In this follow up study, plasma and nasosorption samples were prospectively collected from 446 adults hospitalised for COVID-19 between February 2020 and March 2021 via the ISARIC4C and PHOSP-COVID consortia.

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Shared symptoms and genetic architecture between coronavirus disease (COVID-19) and lung fibrosis suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to progressive lung damage. The UK Interstitial Lung Disease Consortium (UKILD) post-COVID-19 study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 on the basis of risk strata. The PHOSP-COVID-19 (Post-Hospitalization COVID-19) study was used to capture routine and research follow-up within 240 days from discharge.

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Background: The number of individuals recovering from severe COVID-19 is increasing rapidly. However, little is known about physical behaviours that make up the 24-h cycle within these individuals. This study aimed to describe physical behaviours following hospital admission for COVID-19 at eight months post-discharge including associations with acute illness severity and ongoing symptoms.

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Given the large numbers of people infected and high rates of ongoing morbidity, research is clearly required to address the needs of adult survivors of COVID-19 living with ongoing symptoms (long COVID). To help direct resource and research efforts, we completed a research prioritisation process incorporating views from adults with ongoing symptoms of COVID-19, carers, clinicians and clinical researchers. The final top 10 research questions were agreed at an independently mediated workshop and included: identifying underlying mechanisms of long COVID, establishing diagnostic tools, understanding trajectory of recovery and evaluating the role of interventions both during the acute and persistent phases of the illness.

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Background: The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes.

Methods: The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing.

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Introduction: The COVID-19 pandemic has led to over 100 million cases worldwide. The UK has had over 4 million cases, 400 000 hospital admissions and 100 000 deaths. Many patients with COVID-19 suffer long-term symptoms, predominantly breathlessness and fatigue whether hospitalised or not.

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Persistent ill health after acute COVID-19-referred to as long COVID, the post-acute COVID-19 syndrome, or the post-COVID-19 condition-has emerged as a major concern. We undertook an international consensus exercise to identify research priorities with the aim of understanding the long-term effects of acute COVID-19, with a focus on people with pre-existing airways disease and the occurrence of new-onset airways disease and associated symptoms. 202 international experts were invited to submit a minimum of three research ideas.

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