Mapping landscape function with hyperspectral remote sensing of natural grasslands on gold mines

Thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy. School of Animal, Plant and Environmental Science, University of the Witwatersrand, Johannesburg, South Africa. October 2016.Mining has negative impacts on the environment in many different ways. One method developed to quantify some of these impacts is Landscape Function Analysis (LFA) and this has been accepted by some mining companies and regulators. In brief, LFA aims at quantifying the organization of vegetative and landscape components in a landscape into patches along a transect and quantifying, in a relative manner, three basic processes important to landscape functioning, namely: soil stability or susceptibility to erosion, infiltration or runoff, and nutrient cycling or organic matter decomposition. However, LFA is limited in large heterogeneous environments, such as those around mining operations, due to its localized nature, and the man hours required to collect a representative set of measurements for such large and complex environments. Remote sensing using satellite-acquired data can overcome these limitations by sampling the entire environment in a rapid and objective manner. What is required is a method of connecting these satellite-based measurements to LFA measurements and then being able to extrapolate these measurements across the entire mine surface. The aim of this research was to develop a method to use satellite-based hyperspectral imagery to predict landscape function analysis (LFA) using partial least squares regression (PLSR). This was broken down into three objectives: (1) Collection of the LFA data in the field and validation of the LFA indices against other environmental variables collected at the same time, (2) validation of PLSR models predicting LFA indices and various environmental variables from ground-based spectra, and (3) production of risk maps based on predicting LFA indices and above-ground biomass using PLSR models and Hyperion satellite-based hyperspectral imagery. Although the study was based in grasslands at two mining regions, West Wits and Vaal River, a suitable Hyperion image was only available for Vaal River. A minimum of 374 points were sampled for LFA indices, ground-based spectra, above-ground biomass and soil cores along 2880 m of LFA transect from both mine sites. Soil cores were weighed fresh before sieving with a 2 mm sieve to separate root and stone fractions. The sieved soil fraction was tested for pH, EC, SOM, and for the West Wits samples, organic nitrogen and total extractable inorganic nitrogen. There was one modification to the LFA method where grass patches were collapsed into homogenous units as it was deemed not feasible to sample 180 m transects at grass tuft scales of 10 – 30 cm, but other patch definitions followed the LFA manual (Tongway and Hindley, 2004). Evidence suggested that some of the different patch types, in particular the bare/biological soil crust – bare grass – sparse grass patch types, represented successional stages in a continuum although this was not conclusive. There also was evidence that the presence or absence of cattle play a role in some processes active in these grasslands and erosion is mainly through deflation, rain splash and sheet wash. Generally the environmental variables supported the LFA indices although the nutrient cycling index was representative of above-ground nutrient cycling but not below-ground nutrient cycling. Models derived with PLSR to predict the LFA indices from ground-based spectral measurements were strong at both mine sites (West Wits: LFA stability r2 = 0.63, P < 0.0001; LFA infiltration r2 = 0.75, P < 0.0001; LFA nutrient cycling r2 = 0.73, P < 0.0001; Vaal River: LFA stability r2 = 0.39, P < 0.0001, LFA infiltration r2 = 0.72, P < 0.0001, LFA nutrient cycling r2 = 0.54, P < 0.0001), as were PLSR models predicting above-ground biomass (West Wits above-ground biomass r2 = 0.55, P = 0.0003; Vaal River above-ground biomass r2 = 0.79, P < 0.0001) and soil moisture (West Wits soil moisture r2 = 0.45, P = 0.0017; Vaal River soil moisture r2 = 0.68, P < 0.0001). However, for soil organic matter (r2 = 0.50, P < 0.0001) and EC (r2 = 0.63, P < 0.0001), Vaal River had strong prediction models while West Wits had weak models for these variables (r2 = 0.31, P = 0.019 and r2 = 0.10 and P < 0.18, respectively). For EC, the wide range of soil values at Vaal River in association with gypsum crusts, and low values throughout West Wits explained these model results but for soil organic matter, no clear explanation for these site differences was identified. Patch-based models could accurately discriminate between spectrally well-defined patch types such S. plumosum patches but were less successful with patch types that were spectrally similar such as the bare/biological soil crust – bare grass – sparse grass patch continuum. Clustering similar patch types together before PLSR modelling did improve these patch-based spectral models. To test the method proposed to predict LFA indices from satellite-based hyperspectral imagery, a Hyperion image matching 6 transects at Vaal River was acquired by NASA’s EO-1 satellite and downloaded from the USGS Glovis website. LFA transects were partitioned to match and extract pixel spectra from the Hyperion data cube. Thirty-one spectra were separated into calibration (20) and validation (11) data. PLSR models were derived from the calibration data, tested with validation data to select the optimum model, and then applied to the entire Hyperion data cube to produce prediction maps for five LFA indices and above-ground biomass. The patch area index (PAI) produced particularly strong models (r2 = 0.79, P = 0.0003, n =11) with validation data, whereas the landscape organization index (LOI) produced weak models. It is argued that this difference between these two essentially similar indices is related to the fact that the PAI is a 2-dimensional index and the LOI is a 1-dimensional index. This difference in these two indices allowed the PAI to compensate for some burned pixels on the transects by “seeing” the density pattern of grass tufts and patches whereas the linear nature of the LOI was more susceptible to the changing dimensions of patch structure due to the effects of fire. Although validation models for the three LFA indices of soil stability, infiltration and nutrient cycling were strong (r2 = 0.72, P = 0.004; r2 = 0.66, P = 0.008; r2 = 0.70, P = 0.005, n = 9 respectively), prediction maps were confounded by the presence of fire on some transects. The poor quality of the Hyperion imagery also meant great care had to be taken in the selection of models to avoid poor quality prediction maps. The 31 bands from the VNIR (478 – 885 nm) portion of the Hyperion spectra were generally the best for PLSR modelling and prediction maps, presumably because of better signal-to-noise ratios due to higher energy in the shorter wavelengths. With two satellite-based hyperspectral sensors already operational, namely the US Hyperion and the Chinese HJ-1A HSI, and a number expected to be launched by various space agencies in the next few years, this research presents a method to use the strengths of LFA and hyperspectral imagery to model and predict LFA index values and thereby produce risk maps of large, heterogeneous landscapes such as mining environments. As this research documents a method of partitioning the landscape rather than the pixel spectra into pure endmembers, it makes a valuable contribution to the fields of landscape ecology and hyperspectral remote sensing.LG201

Can indices of landscape function analysis (LFA) be derived from ground-based spectroscopy? A case study from gold mines on the Highveld of South Africa

The Minerals and Petroleum Resources Act (MRPDA) No 28 of 2002 of South Africa states that the holder of a mining permit remains liable for environmental consequences until a closure certificate has been issued, but does not stipulate the environmental standards required to obtain such a certificate. Monitoring of surface mining environments requires a consistent, repeatable and efficient method of monitoring that can be applicable to heterogeneous landscapes on large properties. To this end, this study forms a component towards the development and local testing of an internationally accepted, monitoring toolkit to monitor mine rehabilitation. Landscape Function Analysis (LFA) is a technique to rapidly determine broad biogeochemical processes occurring at the soil surface in heterogeneous landscapes. However, LFA is time consuming. Hyperspectral remote sensing (HSRS) is an alternative technique for monitoring large landscapes and is sensitive to both plant response to stress and soil minerals. The aim of this study is to derive LFA indices from HSRS (i.e. surface reflectance) data acquired with a hand-held spectrometer in order to predict landscape condition on deep-level gold mining surface environments in the Highveld region. The first objective was to test the potential of Partial Least Squares Regression (PLSR) modelling to predict LFA indices from the spectral data. The second objective was to test the potential for using Vegetation Indices (VI), calculated from hyperspectral data, to predict LFA indices. Twenty-three VIs, covering plant pigments (i.e. chlorophyll, carotenoids and anthocyanins), plant structural components (cellulose and lignin) and plant water content, were tested. The study was carried out in winter (dry season) as this is the season when disturbance is most visible, and both seasonal (deciduous) vegetation growth and annual species are absent. The study was carried out at two gold and uranium mining operations in the Highveld grassland biome: West Wits Operations near Carletonville (Gauteng Province) and Vaal River Operations near Klerksdorp (North West Province). At Vaal River, data was collected from high and low disturbance sites replicated three times, in each of four of the dominant vegetation types: wet grasslands, non-rocky grasslands, rocky grasslands and woody shrub sites representing increasing structural complexity. At West Wits Operations (n = 6 sampling plots), only non-rocky grasslands were sampled. Twenty five circular quadrats of 50 cm diameter were evenly distributed on five gradsects within each plot (Total quadrats = 750). Paired data acquired from each quadrat were reflectance data (44 cm field of view), LFA data (50 cm circular quadrat), and a photograph for later allocation of the remaining LFA data. Time constraints collecting LFA data reduced the total number of quadrats sampled in the field from 750 quadrats to 150 quadrats. Difficulties in accurately pairing the LFA and HSRS data further reduced the number of quadrats I used for statistical analyses to 105.The results of ranking the three LFA indices showed that stability was above the threshold value for sustainability, while infiltration was below threshold and nutrient cycling was close to threshold for all vegetation types and disturbance levels combined. These results suggest that soils were crusted and promoting run-off, and that disturbance was mainly impacting the vegetation component, rather than the soil component of the landscape. A comparison of non-rocky grasslands between the two mining regions showed that West Wits had higher LFA indices for infiltration and nutrient cycling (t-test, P ≤ 0.01, DF = 36.8 and 26.4 respectively) than Vaal River. All three LFA indices: stability, infiltration and nutrient cycling, differed between vegetation types (One-way ANOVA, P < 0.05, DF = 3, 101) with wet grasslands having consistently higher LFA indices than the other three vegetation types. Disturbance levels, combining vegetation types and mining region, also differed (t-tests, P < 0.01, DF = 81.8, 102.3 and 100.08 for stability, infiltration and nutrient cycling respectively), with high disturbance quadrats having lower LFA indices than low disturbance quadrats. When comparing LFA indices between disturbance levels within each vegetation type, low disturbance sites generally still had higher LFA indices than high disturbance sites (P < 0.05). These findings support the initial selection of distinct vegetation types and disturbance levels, with exceptions to this pattern believed to be a result of low replication (n = 5) for these vegetation types. The twenty-three VIs were not useful for predicting LFA indices from HSRS data under my experimental conditions. All the VIs had generally low indices as expected (in the case of chlorophyll and plant water-based VIs) for winter senesced Highveld grasses. All linear regressions between LFA indices and VIs had very weak coefficients of determination (r2 < 26%). The lignin index (NDLI) had the strongest coefficient of determination for both the stability (r2 = 25%, P < 0.01) and the nutrient cycling indices (r2 = 25%, P < 0.01). The infiltration index had the strongest coefficient of determination with the standard normalised difference vegetation index (NDVI) (r2 = 16%, P < 0.01). VIs had generally very low indices due to the winter senesced state of the Highveld vegetation. PLSR modelling produced much stronger regression coefficients of determination than did the VIs. The best PLSR model was a 15-component model to predict nutrient cycling (r2 = 54%, P < 0.01). A 13-component model predicting stability had an r2 = 38 % (P < 0.01), while a 17-component model was derived for infiltration (r2 = 32%, P < 0.01). In all three cases, these models were able to account for more than 90% of the spectral variability within the first two components. However, more than 16 components were required to account for 90% of the variability in the LFA measurements. It may be possible to reduce the number of components required for the PLSR modelling of the latter with a more standardised approach to the LFA data collection, i.e. having one observer who acquires all the LFA data in the field, and increased replication

Nitrogen fixation and cycling in Natal valley bushveld Acacia species.

Thesis (M.Sc.)-University of Natal, Pietermaritzburg, 1995.Five species, Acacia karroo, A. robusta, A. nilotica, A. sieberana and A. tortilis, were inoculated with Rhizobium and grown in potted sand in a temperature controlled greenhouse. After six months, results showed a higher percentage plant nitrogen for all five species when inoculated plants were compared to uninoculated controls. Inoculated treatments of A. karroo and A. sieberana had the greatest growth in shoot length and biomass. Acacia robusta showed the highest nitrogenase activity when nodules were tested using acetylene reduction methods. Inoculants of A. tortilis showed the poorest growth for all parameters measured. A. karroo and A. nilotica were studied at a field site at Ashburton, 15km east of Pietermaritzburg. Acacia karroo and A. nilotica had similar mean percentage leaf nitrogen, but A. karroo had a significantly higher mean percentage stern nitrogen than A. nilotica. Rainfall, canopy throughfall and stemflow from A. karroo and A. nilotica were collected in late spring and examined for inorganic nitrogen content. Acacia nilotica yielded the highest nitrate levels in both throughfall and stemflow samples. Acacia karroo produced lower nitrate concentrations in samples of both throughfall and stemflow, than was found in rainfall. Both A. nilotica and A. karroo exhibited higher concentrations of ammonium in samples of throughfall and stemflow as compared to levels. Soil analyses yielded highest levels of organic nitrogen at the surface (0 - 5 cm) but this decreased significantly at 20 cm deep. Surface organic nitrogen was highest under A. karroo canopies and lowest in open grassland. At 20 cm, there was little difference in organic nitrogen content between soils sampled from open patches and those under canopies of A. nilotica or A. karroo. Nitrate showed little variation with species, but highest levels were found in the top five centimetres and levels were higher under grasslands than under canopies. Ammonium showed no significant differences between different depths but was higher in open grassland sites than under canopies. No pattern could be found to relate tree size to soil organic nitrogen content

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Common, low-frequency, rare, and ultra-rare coding variants contribute to COVID-19 severity

The combined impact of common and rare exonic variants in COVID-19 host genetics is currently insufficiently understood. Here, common and rare variants from whole-exome sequencing data of about 4000 SARS-CoV-2-positive individuals were used to define an interpretable machine-learning model for predicting COVID-19 severity. First, variants were converted into separate sets of Boolean features, depending on the absence or the presence of variants in each gene. An ensemble of LASSO logistic regression models was used to identify the most informative Boolean features with respect to the genetic bases of severity. The Boolean features selected by these logistic models were combined into an Integrated PolyGenic Score that offers a synthetic and interpretable index for describing the contribution of host genetics in COVID-19 severity, as demonstrated through testing in several independent cohorts. Selected features belong to ultra-rare, rare, low-frequency, and common variants, including those in linkage disequilibrium with known GWAS loci. Noteworthily, around one quarter of the selected genes are sex-specific. Pathway analysis of the selected genes associated with COVID-19 severity reflected the multi-organ nature of the disease. The proposed model might provide useful information for developing diagnostics and therapeutics, while also being able to guide bedside disease management. © 2021, The Author(s)

Determinants of recovery from post-COVID-19 dyspnoea: analysis of UK prospective cohorts of hospitalised COVID-19 patients and community-based controls

Background The risk factors for recovery from COVID-19 dyspnoea are poorly understood. We investigated determinants of recovery from dyspnoea in adults with COVID-19 and compared these to determinants of recovery from non-COVID-19 dyspnoea. Methods We used data from two prospective cohort studies: PHOSP-COVID (patients hospitalised between March 2020 and April 2021 with COVID-19) and COVIDENCE UK (community cohort studied over the same time period). PHOSP-COVID data were collected during hospitalisation and at 5-month and 1-year follow-up visits. COVIDENCE UK data were obtained through baseline and monthly online questionnaires. Dyspnoea was measured in both cohorts with the Medical Research Council Dyspnoea Scale. We used multivariable logistic regression to identify determinants associated with a reduction in dyspnoea between 5-month and 1-year follow-up. Findings We included 990 PHOSP-COVID and 3309 COVIDENCE UK participants. We observed higher odds of improvement between 5-month and 1-year follow-up among PHOSP-COVID participants who were younger (odds ratio 1.02 per year, 95% CI 1.01–1.03), male (1.54, 1.16–2.04), neither obese nor severely obese (1.82, 1.06–3.13 and 4.19, 2.14–8.19, respectively), had no pre-existing anxiety or depression (1.56, 1.09–2.22) or cardiovascular disease (1.33, 1.00–1.79), and shorter hospital admission (1.01 per day, 1.00–1.02). Similar associations were found in those recovering from non-COVID-19 dyspnoea, excluding age (and length of hospital admission). Interpretation Factors associated with dyspnoea recovery at 1-year post-discharge among patients hospitalised with COVID-19 were similar to those among community controls without COVID-19. Funding PHOSP-COVID is supported by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19. The views expressed in the publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care. COVIDENCE UK is supported by the UK Research and Innovation, the National Institute for Health Research, and Barts Charity. The views expressed are those of the authors and not necessarily those of the funders

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p&lt;0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p&lt;0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p&lt;0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP &gt;5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

Background No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. Methods The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. Findings 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7–9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46–0·99]), obesity (0·50 [0·34–0·74]) and invasive mechanical ventilation (0·42 [0·23–0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74–1·00]), at 5 months (0·74 [0·64–0·88]) to 1 year (0·75 [0·62–0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. Interpretation The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. Funding UK Research and Innovation and National Institute for Health Research