Defining the pre-admission factors that modify risk of acute complications, survival and long-term recovery from COVID-19.

To understand the immune correlates of protection to COVID-19, we ran a longitudinal prospective multicentre study recruiting 425 patients with COVID-19 from the start of the UK pandemic in April 2020 through the first 3 waves with study completing in 2022. Here we identify the demographic factors and pre-admission symptoms impacting on COVID-19 disease severity, acute clinical course and long-term recovery to be considered in subsequent serological analysis. Preadmission symptom cluster and duration of symptoms associated with risk of thrombosis/renal disease and pneumothorax respectively. Renal complications were more likely to be seen in the first wave compared to the second wave of the pandemic. Survival to discharge was independently associated with ethnicity, age (<40YRSVS >60yrs) and absence of comorbidities however hazard of death was increased for all hospitalised patients who had received at least one COVID vaccine (as high-risk patient) pre-admission, had shorter time from symptom onset to admission, or had comorbidities. Most patients reported long term sequelae with neuromuscular and cognitive effects dominating early on and mood disturbance and breathlessness persisted to 12 months. Whilst COVID-19 severity score was the dominant risk factor for persistent dyspnoea, gender was the dominant risk factor for persistent mood disorder and associated with a greater risk of persistent gastrointestinal and cognitive problems.