PREdictors of COVID-19 OUtcomeS (PRECIOUS) Full Application

BACKGROUND: COVID-19 has affected >68 million people worldwide; up to 32 million will need health and social support. Addressing long-term challenges and costs are a priority. AIM: To inform management approaches for rehabilitation services and people with COVID-19, by comprehensively describing long-term outcomes, predictors and costs associated with Long-COVID.OBJECTIVES•Describe long-term outcomes & predictors, by International Classification of Functioning, Disability & Health (ICF) domains. •describe direct & indirect costs of Long-COVID•disseminate findings via a Patient & Public Involvement (PPI)-led website, papers, presentations, social media & project partners METHODS DESIGN: Systematic identification & meta-analysis of international individual participant data (IPD).PPI will guide methods and dissemination.STAGE 1 will seek contribution of data from COVID-19 cohort studies and randomised controlled trials (RCTs), in any setting, where assessments are recorded >1 month of symptom onset. Datasets will be identified using a systematic search of electronic databases, trial registries, grey literature and forward and backward citation tracking for included studies, imposing no language restrictions; as well as via existing research networks. IPD will be securely stored, cleaned and mapped across ICF domains. STAGE 2: Data within each ICF domain will be standardised using an existing algorithm and long-term outcomes across each domain will be described; IPD meta-analyses and/or network meta-analysis will compare the effects of demographic, socio-economic, comorbidities, clinical and treatment variables on long-term outcomes using a one-step regression approach. Length of hospital stay, use of health services and return to work data will be extracted and summarised where available. Resource use will be presented in natural unit to account for differing healthcare systems. Costs will be described using UK sources, allowing comparison in a common currency. The impact of baseline predictors on long-term resource use will be analysed. FEASIBILITY: contribution of >8000 IPD from 13 studies has been secured.OUTCOMES, IMPACT & DISSEMINATION will describe the population in whom evidence is based, highlight gaps & applicability of findings and direct future research; map expected long-term impacts; provide information for COVID-survivors, families, GPs, clinicians, researchers and policy makers; inform resource allocation, prognosis and avenues for early intervention; develop a data-driven predictors model for use in clinical practice; quantify the cost of Long-COVID, direct resources and support to areas of need. A legacy dataset will facilitate future analyses. Outputs will be delivered via a website, peer-reviewed papers, engagement with health professionals via existing networks, people with COVID-19 & their families via PPI led activities and social media.DURATION: 2 years, (outputs from month 10).ETHICS: University ethics approval will allow use of anonymised data; procedures will follow a data management plan. COSTS: using existing international data will permit efficient and rapid analyses. Funding will support experienced researchers, statisticians, health economists and PPI partners, researchers in long-term conditions, rehabilitation, respiratory medicine, infectious diseases and care of the elderly. On completion, we will make our legacy database accessible, thereby reducing waste.