RT Journal Article SR Electronic T1 SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study JF BMJ Open Respiratory Research JO BMJ Open Resp Res FD British Thoracic Society SP e001029 DO 10.1136/bmjresp-2021-001029 VO 8 IS 1 A1 Oliver Stirrup A1 Florencia Boshier A1 Cristina Venturini A1 José Afonso Guerra-Assunção A1 Adela Alcolea-Medina A1 Angela Beckett A1 Themoula Charalampous A1 Ana da Silva Filipe A1 Sharon Glaysher A1 Tabassum Khan A1 Raghavendran Kulasegaran Shylini A1 Beatrix Kele A1 Irene Monahan A1 Guy Mollett A1 Matthew Parker A1 Emanuela Pelosi A1 Paul Randell A1 Sunando Roy A1 Joshua Taylor A1 Sophie Weller A1 Eleri Wilson-Davies A1 Phillip Wade A1 Rachel Williams A1 The COG-UK-HOCI Variant substudy consortium A1 The COVID-19 Genomics UK (COG-UK) consortium A1 Andrew Copas A1 Maria-Teresa Cutino-Moguel A1 Nick Freemantle A1 Andrew C Hayward A1 Alison Holmes A1 Joseph Hughes A1 Tabitha Mahungu A1 Gaia Nebbia A1 David Partridge A1 Cassie Pope A1 James Price A1 Samuel Robson A1 Kordo Saeed A1 Thushan de Silva A1 Luke Snell A1 Emma Thomson A1 Adam A Witney A1 Judith Breuer YR 2021 UL http://bmjopenrespres.bmj.com/content/8/1/e001029.abstract AB 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.The sequence data analysed are included within publicly available datasets (https://www.cogconsortium.uk/data/). However, due to data governance restrictions it is not possible to share the associated patient characteristics and clinical outcome data for the analysis described, as these are considered sensitive and full anonymisation is not possible. The corresponding author (OTS) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned have been explained.