Post-acute sequelae of COVID-19 among hospitalized patients in Estonia: Nationwide matched cohort study

Abstract

Background Post-acute COVID-19 sequelae refers to a variety of health complications involving different organ systems that have been described among individuals after acute phase of illness. Data from unselected population groups with long-time follow up is needed to comprehensively describe the full spectrum of post-acute COVID-19 complications. Methods In this retrospective nationwide cohort study, we used data obtained from electronic health record database. Our primary cohort were adults hospitalized with confirmed COVID-19 and matched (age, sex, Charlson Comorbidity Index) unaffected controls from general population. Individuals included from February 2020 until March 2021 were followed up for 12 months. We estimated risks of all-cause mortality, readmission and incidence of 16 clinical sequelae after acute COVID-19 phase. Using a frailty Cox model, we compared incidences of outcomes in two cohorts. Results The cohort comprised 3949 patients older than 18 years who were alive 30 days after COVID-19 hospital admission and 15511 controls. Among cases 40.3% developed at least one incident clinical sequelae after the acute phase of SARS-CoV-2 infection, which was two times higher than in general population group. We report substantially higher risk of all-cause mortality (adjusted hazard ratio (aHR) = 2.57 (95%CI 2.23–2.96) and hospital readmission aHR = 1.73 (95%CI 1.58–1.90) among hospitalized COVID-19 patients. We found that the risks for new clinical sequalae were significantly higher in COVID-19 patients than their controls, especially for dementia aHR = 4.50 (95% CI 2.35–8.64), chronic lower respiratory disease aHR = 4.39 (95% CI 3.09–6.22), liver disease aHR 4.20 (95% CI 2.01–8.77) and other (than ischemic) forms of heart diseases aHR = 3.39 (95%CI 2.58–4.44). Conclusion Our results provide evidence that the post-acute COVID-19 morbidity within the first year after COVID-19 hospitalization is substantial. Risks of all-cause mortality, hospitalisation and majority of clinical sequelae were significantly higher in hospitalized COVID-19 patients than in general population controls and warrant targeted prevention efforts.

Risk of Incident New-Onset Arterial Hypertension After COVID-19 Recovery: A Systematic Review and Meta-analysis

“…Among them, 225 studies were excluded for not meeting the inclusion criteria, leaving 5 investigations fulfilling the inclusion criteria (Fig. 1) [12][13][14][15][16].…”

“…Similarly, few data were provided regarding the potential association between the severity of the index COVID-19 infection and the subsequent risk of new-onset HT. However, data from Al-Aly et al [ 14 ] and Tisler et al [ 16 ] suggested that this risk significantly increase in patients hospitalized and in those requiring intensive care treatments compared to those not hospitalized. Indeed, the hospitalization setting may indirectly reflect the severity of COVID-19 infection.…”

“…Overall, 19,293,346 patients (mean age 54.6 years, 54.6% males) were included in this analysis [12][13][14][15][16]. Among them 758,698 had confirmed COVID-19 infection.…”

Risk of ischemic stroke in patients recovered from COVID-19 infection: A systematic review and meta-analysis

“…After excluding duplicates and preliminary screening, 1258 full-text articles were assessed for eligibility, 1250 studies were excluded for not meeting the inclusion criteria, leaving eight investigations fulfilling the inclusion criteria (Figure 1). [22][23][24][25][26][27][28][29]…”

“…Overall, 23,559,428 adult patients were included in this analysis. [22][23][24][25][26][27][28][29] Among them 1,595,984 had confirmed COVID-19 infection (Table 1). Although the demographic characteristics and the pre-existing comorbidities were not systematically recorded in all the investigations, the cohorts mainly consisted of middle-aged patients who were more frequently males (mean age 56, 1 year, 54.3% males).…”