Investigating prognostic classifications of preexisting multiple long-term conditions for health outcomes 1 year after COVID-19 hospitalization: A UK prospective observational study

PHOSP-COVID Collaborative Group; Lucy E Gardiner; Daniel Lozano-Rojas; Nikki Smith; Jane Espley; Iain D Stewart; Kimon Ntotsis; Raminder Aul; Nawar Dair Bakerly; Paul Beirne; Charlotte E Bolton; Jeremy S Brown; Andrew Briggs; Trudie Chalder; James D Chalmers; Gourab Choudhury; Melanie J Davies; Anthony De Soyza; Annemarie B Docherty; Nicholas Easom; Carlos Echevarria; Claudia M Efstathiou; Omer Elneima; Jonathan Fuld; John R Geddes; Anne F Goemans; William Greenhalf; Neil J Greening; Beatriz Guillen-Guio; Victoria C Harris; Ewen M Harrison; Nicholas Hart; Liam G Heaney; Simon Heller; Ling-Pei Ho; Alex Horsley; Linzy Houchen-Wolloff; Luke Howard; John R Hurst; Muhammad Mamoon Iqbal; Joseph Jacob; Gisli Jenkins; Caroline Jolley; Mark Jones; Steven Kerr; Kamlesh Khunti; Olivia C Leavy; Keir Lewis; Matthew Richardson; Nazir I Lone; Janet M Lord; Will D C Man; Michael Marks; Hamish J C McAuley; Gerry P McCann; Stefan Neubauer; Peter J M Openshaw; Dhruv Parekh; Paul Peffer; Krishna  Poinasamy; Joanna C Porter; Jennifer K Quint; Najib M Rahman; Betty Raman; Matthew Richardson; Sarah D M Rowland-Jones; Matthew Rowland; Ruth M. Saunders; Janet T Scott; Malcolm G Semple; Marco Sereno; Ajay M Shah; Aziz Sheikh; Aarti Shikotra; Ananga Singapuri; Maxime  Taquet; David Thomas; Roger  Thompson; Matthew  Thorpe; Mark Toshner; Lin Wang; Dan G Wooton; Bang Zheng; Louise V Wain; Christopher E Brightling; Sally J Singh; Rod S Taylor; Rachael A Evans

doi:10.1016/j.ijid.2026.108695

Investigating prognostic classifications of preexisting multiple long-term conditions for health outcomes 1 year after COVID-19 hospitalization: A UK prospective observational study

PHOSP-COVID Collaborative Group
, Lucy E Gardiner
, Daniel Lozano-Rojas
, Nikki Smith
, Jane Espley
, Iain D Stewart
, Kimon Ntotsis
, Raminder Aul
, Nawar Dair Bakerly
, Paul Beirne
, Charlotte E Bolton
, Jeremy S Brown
, Andrew Briggs
, Trudie Chalder
, James D Chalmers
, Gourab Choudhury
, Melanie J Davies
, Anthony De Soyza
, Annemarie B Docherty
, Nicholas Easom

Carlos Echevarria, Claudia M Efstathiou, Omer Elneima, Jonathan Fuld, John R Geddes, Anne F Goemans, William Greenhalf, Neil J Greening, Beatriz Guillen-Guio, Victoria C Harris, Ewen M Harrison, Nicholas Hart, Liam G Heaney, Simon Heller, Ling-Pei Ho, Alex Horsley, Linzy Houchen-Wolloff, Luke Howard, John R Hurst, Muhammad Mamoon Iqbal, Joseph Jacob, Gisli Jenkins, Caroline Jolley, Mark Jones, Steven Kerr, Kamlesh Khunti, Olivia C Leavy, Keir Lewis, Matthew Richardson, Nazir I Lone, Janet M Lord, Will D C Man, Michael Marks, Hamish J C McAuley, Gerry P McCann, Stefan Neubauer, Peter J M Openshaw, Dhruv Parekh, Paul Peffer, Krishna Poinasamy, Joanna C Porter, Jennifer K Quint, Najib M Rahman, Betty Raman, Matthew Richardson, Sarah D M Rowland-Jones, Matthew Rowland, Ruth M. Saunders, Janet T Scott, Malcolm G Semple, Marco Sereno, Ajay M Shah, Aziz Sheikh, Aarti Shikotra, Ananga Singapuri, Maxime Taquet, David Thomas, Roger Thompson, Matthew Thorpe, Mark Toshner, Lin Wang, Dan G Wooton, Bang Zheng, Louise V Wain, Christopher E Brightling, Sally J Singh, Rod S Taylor, Rachael A Evans (Lead / Corresponding author)

Respiratory Medicine and Gastroenterology

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

35 Downloads (Pure)

Abstract

BACKGROUND: Preexisting multiple (two or more) long-term conditions (MLTCs) may negatively affect recovery after COVID-19. We investigated how preexisting MLTCs, including different categorization and patterns of MLTCs, affect 1-year health outcomes after severe COVID-19.

METHODS: Adults post-hospitalization after COVID-19 were recruited during 2020-2021. We compared recovery at 1 year after discharge using adjusted multivariable logistic regression in 1:1 propensity-matched adults (for age, sex, ethnicity, social deprivation, obesity, and smoking history) with and without preexisting MLTCs. In adults with MLTCs, different categorization such as number of conditions, number and types of body systems involved (e.g. respiratory, cardiovascular), and latent class analysis-derived patterns of condition co-occurrence were assessed for their association with recovery at 1 year.

RESULTS: A total of 647 adults with MLTCs were matched with 647 adults without MLTCs (n = 1294; 61.9% male, 79.6% of White ethnicity, median age 59 [interquartile range 52-67] years). The presence of MLTCs was associated with lower odds of feeling fully recovered (odds ratio 0.66 [95% confidence interval 0.51-0.85], P = 0.001). In those with MLTCs, recovery was negatively affected by number and type of body systems involved (e.g. respiratory [odds ratio 0.49 (95% confidence interval 0.34-0.69), P <0.001]) but not by the number of conditions (P >0.1). Four latent classes of MLTC co-occurrence were estimated with different risks of recovery (P <0.01).

CONCLUSION: Adults with preexisting MLTCs were 34% less likely to feel fully recovered at 1 year after COVID-19 hospitalization than adults without MLTCs. We describe prognostic classifications of MLTCs, with future work needed to understand whether they have prognostication in broader post-acute infection sequalae.

Original language	English
Article number	108695
Pages (from-to)	108695
Journal	International Journal of Infectious Diseases
Volume	168
Early online date	9 Apr 2026
DOIs	https://doi.org/10.1016/j.ijid.2026.108695
Publication status	Published - Jul 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

COVID-19
Long COVID
Multimorbidity
Multiple long-term conditions

ASJC Scopus subject areas

Microbiology (medical)
Infectious Diseases

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10.1016/j.ijid.2026.108695Licence: CC BY

Final published version
1201-9712/© 2026 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY license
Final published version, 2.07 MBLicence: CC BY

PHOS-COVID (Joint with University of Leicester)
Chalmers, J. (Investigator) & Dicker, A. (Investigator)
1/04/21 → 31/03/26
Project: Research

Cite this

PHOSP-COVID Collaborative Group, Gardiner, L. E., Lozano-Rojas, D., Smith, N., Espley, J., Stewart, I. D., Ntotsis, K., Aul, R., Bakerly, N. D., Beirne, P., Bolton, C. E., Brown, J. S., Briggs, A., Chalder, T., Chalmers, J. D., Choudhury, G., Davies, M. J., De Soyza, A., Docherty, A. B., ... Evans, R. A. (2026). Investigating prognostic classifications of preexisting multiple long-term conditions for health outcomes 1 year after COVID-19 hospitalization: A UK prospective observational study. International Journal of Infectious Diseases, 168, 108695. Article 108695. https://doi.org/10.1016/j.ijid.2026.108695

@article{6b6b8bff48834a38a5418f9bcdbb3415,

title = "Investigating prognostic classifications of preexisting multiple long-term conditions for health outcomes 1 year after COVID-19 hospitalization: A UK prospective observational study",

abstract = "BACKGROUND: Preexisting multiple (two or more) long-term conditions (MLTCs) may negatively affect recovery after COVID-19. We investigated how preexisting MLTCs, including different categorization and patterns of MLTCs, affect 1-year health outcomes after severe COVID-19.METHODS: Adults post-hospitalization after COVID-19 were recruited during 2020-2021. We compared recovery at 1 year after discharge using adjusted multivariable logistic regression in 1:1 propensity-matched adults (for age, sex, ethnicity, social deprivation, obesity, and smoking history) with and without preexisting MLTCs. In adults with MLTCs, different categorization such as number of conditions, number and types of body systems involved (e.g. respiratory, cardiovascular), and latent class analysis-derived patterns of condition co-occurrence were assessed for their association with recovery at 1 year.RESULTS: A total of 647 adults with MLTCs were matched with 647 adults without MLTCs (n = 1294; 61.9\% male, 79.6\% of White ethnicity, median age 59 [interquartile range 52-67] years). The presence of MLTCs was associated with lower odds of feeling fully recovered (odds ratio 0.66 [95\% confidence interval 0.51-0.85], P = 0.001). In those with MLTCs, recovery was negatively affected by number and type of body systems involved (e.g. respiratory [odds ratio 0.49 (95\% confidence interval 0.34-0.69), P <0.001]) but not by the number of conditions (P >0.1). Four latent classes of MLTC co-occurrence were estimated with different risks of recovery (P <0.01).CONCLUSION: Adults with preexisting MLTCs were 34\% less likely to feel fully recovered at 1 year after COVID-19 hospitalization than adults without MLTCs. We describe prognostic classifications of MLTCs, with future work needed to understand whether they have prognostication in broader post-acute infection sequalae.",

keywords = "COVID-19, Long COVID, Multimorbidity, Multiple long-term conditions",

author = "\{PHOSP-COVID Collaborative Group\} and Gardiner, \{Lucy E\} and Daniel Lozano-Rojas and Nikki Smith and Jane Espley and Stewart, \{Iain D\} and Kimon Ntotsis and Raminder Aul and Bakerly, \{Nawar Dair\} and Paul Beirne and Bolton, \{Charlotte E\} and Brown, \{Jeremy S\} and Andrew Briggs and Trudie Chalder and Chalmers, \{James D\} and Gourab Choudhury and Davies, \{Melanie J\} and \{De Soyza\}, Anthony and Docherty, \{Annemarie B\} and Nicholas Easom and Carlos Echevarria and Efstathiou, \{Claudia M\} and Omer Elneima and Jonathan Fuld and Geddes, \{John R\} and Goemans, \{Anne F\} and William Greenhalf and Greening, \{Neil J\} and Beatriz Guillen-Guio and Harris, \{Victoria C\} and Harrison, \{Ewen M\} and Nicholas Hart and Heaney, \{Liam G\} and Simon Heller and Ling-Pei Ho and Alex Horsley and Linzy Houchen-Wolloff and Luke Howard and Hurst, \{John R\} and Iqbal, \{Muhammad Mamoon\} and Joseph Jacob and Gisli Jenkins and Caroline Jolley and Mark Jones and Steven Kerr and Kamlesh Khunti and Leavy, \{Olivia C\} and Keir Lewis and Matthew Richardson and Lone, \{Nazir I\} and Lord, \{Janet M\} and Man, \{Will D C\} and Michael Marks and McAuley, \{Hamish J C\} and McCann, \{Gerry P\} and Stefan Neubauer and Openshaw, \{Peter J M\} and Dhruv Parekh and Paul Peffer and Krishna Poinasamy and Porter, \{Joanna C\} and Quint, \{Jennifer K\} and Rahman, \{Najib M\} and Betty Raman and Matthew Richardson and Rowland-Jones, \{Sarah D M\} and Matthew Rowland and Saunders, \{Ruth M.\} and Scott, \{Janet T\} and Semple, \{Malcolm G\} and Marco Sereno and Shah, \{Ajay M\} and Aziz Sheikh and Aarti Shikotra and Ananga Singapuri and Maxime Taquet and David Thomas and Roger Thompson and Matthew Thorpe and Mark Toshner and Lin Wang and Wooton, \{Dan G\} and Bang Zheng and Wain, \{Louise V\} and Brightling, \{Christopher E\} and Singh, \{Sally J\} and Taylor, \{Rod S\} and Evans, \{Rachael A\}",

note = "Publisher Copyright: Copyright {\textcopyright} 2026. Published by Elsevier Ltd.",

year = "2026",

month = jul,

doi = "10.1016/j.ijid.2026.108695",

language = "English",

volume = "168",

pages = "108695",

journal = "International Journal of Infectious Diseases",

issn = "1201-9712",

publisher = "Elsevier",

}

PHOSP-COVID Collaborative Group, Gardiner, LE, Lozano-Rojas, D, Smith, N, Espley, J, Stewart, ID, Ntotsis, K, Aul, R, Bakerly, ND, Beirne, P, Bolton, CE, Brown, JS, Briggs, A, Chalder, T, Chalmers, JD, Choudhury, G, Davies, MJ, De Soyza, A, Docherty, AB, Easom, N, Echevarria, C, Efstathiou, CM, Elneima, O, Fuld, J, Geddes, JR, Goemans, AF, Greenhalf, W, Greening, NJ, Guillen-Guio, B, Harris, VC, Harrison, EM, Hart, N, Heaney, LG, Heller, S, Ho, L-P, Horsley, A, Houchen-Wolloff, L, Howard, L, Hurst, JR, Iqbal, MM, Jacob, J, Jenkins, G, Jolley, C, Jones, M, Kerr, S, Khunti, K, Leavy, OC, Lewis, K, Richardson, M, Lone, NI, Lord, JM, Man, WDC, Marks, M, McAuley, HJC, McCann, GP, Neubauer, S, Openshaw, PJM, Parekh, D, Peffer, P, Poinasamy, K, Porter, JC, Quint, JK, Rahman, NM, Raman, B, Richardson, M, Rowland-Jones, SDM, Rowland, M, Saunders, RM, Scott, JT, Semple, MG, Sereno, M, Shah, AM, Sheikh, A, Shikotra, A, Singapuri, A, Taquet, M, Thomas, D, Thompson, R, Thorpe, M, Toshner, M, Wang, L, Wooton, DG, Zheng, B, Wain, LV, Brightling, CE, Singh, SJ, Taylor, RS & Evans, RA 2026, 'Investigating prognostic classifications of preexisting multiple long-term conditions for health outcomes 1 year after COVID-19 hospitalization: A UK prospective observational study', International Journal of Infectious Diseases, vol. 168, 108695, pp. 108695. https://doi.org/10.1016/j.ijid.2026.108695

Investigating prognostic classifications of preexisting multiple long-term conditions for health outcomes 1 year after COVID-19 hospitalization: A UK prospective observational study. / PHOSP-COVID Collaborative Group; Gardiner, Lucy E; Lozano-Rojas, Daniel et al.
In: International Journal of Infectious Diseases, Vol. 168, 108695, 07.2026, p. 108695.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Investigating prognostic classifications of preexisting multiple long-term conditions for health outcomes 1 year after COVID-19 hospitalization

T2 - A UK prospective observational study

AU - PHOSP-COVID Collaborative Group

AU - Gardiner, Lucy E

AU - Lozano-Rojas, Daniel

AU - Smith, Nikki

AU - Espley, Jane

AU - Stewart, Iain D

AU - Ntotsis, Kimon

AU - Aul, Raminder

AU - Bakerly, Nawar Dair

AU - Beirne, Paul

AU - Bolton, Charlotte E

AU - Brown, Jeremy S

AU - Briggs, Andrew

AU - Chalder, Trudie

AU - Chalmers, James D

AU - Choudhury, Gourab

AU - Davies, Melanie J

AU - De Soyza, Anthony

AU - Docherty, Annemarie B

AU - Easom, Nicholas

AU - Echevarria, Carlos

AU - Efstathiou, Claudia M

AU - Elneima, Omer

AU - Fuld, Jonathan

AU - Geddes, John R

AU - Goemans, Anne F

AU - Greenhalf, William

AU - Greening, Neil J

AU - Guillen-Guio, Beatriz

AU - Harris, Victoria C

AU - Harrison, Ewen M

AU - Hart, Nicholas

AU - Heaney, Liam G

AU - Heller, Simon

AU - Ho, Ling-Pei

AU - Horsley, Alex

AU - Houchen-Wolloff, Linzy

AU - Howard, Luke

AU - Hurst, John R

AU - Iqbal, Muhammad Mamoon

AU - Jacob, Joseph

AU - Jenkins, Gisli

AU - Jolley, Caroline

AU - Jones, Mark

AU - Kerr, Steven

AU - Khunti, Kamlesh

AU - Leavy, Olivia C

AU - Lewis, Keir

AU - Richardson, Matthew

AU - Lone, Nazir I

AU - Lord, Janet M

AU - Man, Will D C

AU - Marks, Michael

AU - McAuley, Hamish J C

AU - McCann, Gerry P

AU - Neubauer, Stefan

AU - Openshaw, Peter J M

AU - Parekh, Dhruv

AU - Peffer, Paul

AU - Poinasamy, Krishna

AU - Porter, Joanna C

AU - Quint, Jennifer K

AU - Rahman, Najib M

AU - Raman, Betty

AU - Richardson, Matthew

AU - Rowland-Jones, Sarah D M

AU - Rowland, Matthew

AU - Saunders, Ruth M.

AU - Scott, Janet T

AU - Semple, Malcolm G

AU - Sereno, Marco

AU - Shah, Ajay M

AU - Sheikh, Aziz

AU - Shikotra, Aarti

AU - Singapuri, Ananga

AU - Taquet, Maxime

AU - Thomas, David

AU - Thompson, Roger

AU - Thorpe, Matthew

AU - Toshner, Mark

AU - Wang, Lin

AU - Wooton, Dan G

AU - Zheng, Bang

AU - Wain, Louise V

AU - Brightling, Christopher E

AU - Singh, Sally J

AU - Taylor, Rod S

AU - Evans, Rachael A

PY - 2026/7

Y1 - 2026/7

N2 - BACKGROUND: Preexisting multiple (two or more) long-term conditions (MLTCs) may negatively affect recovery after COVID-19. We investigated how preexisting MLTCs, including different categorization and patterns of MLTCs, affect 1-year health outcomes after severe COVID-19.METHODS: Adults post-hospitalization after COVID-19 were recruited during 2020-2021. We compared recovery at 1 year after discharge using adjusted multivariable logistic regression in 1:1 propensity-matched adults (for age, sex, ethnicity, social deprivation, obesity, and smoking history) with and without preexisting MLTCs. In adults with MLTCs, different categorization such as number of conditions, number and types of body systems involved (e.g. respiratory, cardiovascular), and latent class analysis-derived patterns of condition co-occurrence were assessed for their association with recovery at 1 year.RESULTS: A total of 647 adults with MLTCs were matched with 647 adults without MLTCs (n = 1294; 61.9% male, 79.6% of White ethnicity, median age 59 [interquartile range 52-67] years). The presence of MLTCs was associated with lower odds of feeling fully recovered (odds ratio 0.66 [95% confidence interval 0.51-0.85], P = 0.001). In those with MLTCs, recovery was negatively affected by number and type of body systems involved (e.g. respiratory [odds ratio 0.49 (95% confidence interval 0.34-0.69), P <0.001]) but not by the number of conditions (P >0.1). Four latent classes of MLTC co-occurrence were estimated with different risks of recovery (P <0.01).CONCLUSION: Adults with preexisting MLTCs were 34% less likely to feel fully recovered at 1 year after COVID-19 hospitalization than adults without MLTCs. We describe prognostic classifications of MLTCs, with future work needed to understand whether they have prognostication in broader post-acute infection sequalae.

AB - BACKGROUND: Preexisting multiple (two or more) long-term conditions (MLTCs) may negatively affect recovery after COVID-19. We investigated how preexisting MLTCs, including different categorization and patterns of MLTCs, affect 1-year health outcomes after severe COVID-19.METHODS: Adults post-hospitalization after COVID-19 were recruited during 2020-2021. We compared recovery at 1 year after discharge using adjusted multivariable logistic regression in 1:1 propensity-matched adults (for age, sex, ethnicity, social deprivation, obesity, and smoking history) with and without preexisting MLTCs. In adults with MLTCs, different categorization such as number of conditions, number and types of body systems involved (e.g. respiratory, cardiovascular), and latent class analysis-derived patterns of condition co-occurrence were assessed for their association with recovery at 1 year.RESULTS: A total of 647 adults with MLTCs were matched with 647 adults without MLTCs (n = 1294; 61.9% male, 79.6% of White ethnicity, median age 59 [interquartile range 52-67] years). The presence of MLTCs was associated with lower odds of feeling fully recovered (odds ratio 0.66 [95% confidence interval 0.51-0.85], P = 0.001). In those with MLTCs, recovery was negatively affected by number and type of body systems involved (e.g. respiratory [odds ratio 0.49 (95% confidence interval 0.34-0.69), P <0.001]) but not by the number of conditions (P >0.1). Four latent classes of MLTC co-occurrence were estimated with different risks of recovery (P <0.01).CONCLUSION: Adults with preexisting MLTCs were 34% less likely to feel fully recovered at 1 year after COVID-19 hospitalization than adults without MLTCs. We describe prognostic classifications of MLTCs, with future work needed to understand whether they have prognostication in broader post-acute infection sequalae.

KW - COVID-19

KW - Long COVID

KW - Multimorbidity

KW - Multiple long-term conditions

U2 - 10.1016/j.ijid.2026.108695

DO - 10.1016/j.ijid.2026.108695

M3 - Article

C2 - 41966515

SN - 1201-9712

VL - 168

SP - 108695

JO - International Journal of Infectious Diseases

JF - International Journal of Infectious Diseases

M1 - 108695

ER -

PHOSP-COVID Collaborative Group, Gardiner LE, Lozano-Rojas D, Smith N, Espley J, Stewart ID et al. Investigating prognostic classifications of preexisting multiple long-term conditions for health outcomes 1 year after COVID-19 hospitalization: A UK prospective observational study. International Journal of Infectious Diseases. 2026 Jul;168:108695. 108695. Epub 2026 Apr 9. doi: 10.1016/j.ijid.2026.108695

Investigating prognostic classifications of preexisting multiple long-term conditions for health outcomes 1 year after COVID-19 hospitalization: A UK prospective observational study

Abstract

UN SDGs

Keywords

ASJC Scopus subject areas

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Projects

PHOS-COVID (Joint with University of Leicester)

Cite this