Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study

Abstract

Objective To evaluate the excess risk and relative hazards for developing incident clinical sequelae after the acute phase of SARS-CoV-2 infection in adults aged 18-65. Design Retrospective cohort study. Setting Three merged data sources from a large United States health plan: a large national administrative claims database, an outpatient laboratory testing database, and an inpatient hospital admissions database. Participants Individuals aged 18-65 with continuous enrollment in the health plan from January 2019 to the date of a diagnosis of SARS-CoV-2 infection. Three comparator groups, matched by propensity score, to individuals infected with SARS-CoV-2: a 2020 comparator group, an historical 2019 comparator group, and an historical comparator group with viral lower respiratory tract illness. Main outcome measures More than 50 clinical sequelae after the acute phase of SARS-CoV-2 infection (defined as the date of first SARS-CoV-2 diagnosis (index date) plus 21 days) were identified using ICD-10 (international classification of diseases, 10th revision) codes. Excess risk in the four months after acute infection and hazard ratios with Bonferroni corrected 95% confidence intervals were calculated. Results 14% of adults aged ≤65 who were infected with SARS-CoV-2 (27 074 of 193 113) had at least one new type of clinical sequelae that required medical care after the acute phase of the illness, which was 4.95% higher than in the 2020 comparator group. The risk for specific new sequelae attributable to SARS-Cov-2 infection after the acute phase, including chronic respiratory failure, cardiac arrythmia, hypercoagulability, encephalopathy, peripheral neuropathy, amnesia (memory difficulty), diabetes, liver test abnormalities, myocarditis, anxiety, and fatigue, was significantly greater than in the three comparator groups (2020, 2019, and viral lower respiratory tract illness groups) (all P<0.001). Significant risk differences because of SARS-CoV-2 infection ranged from 0.02 to 2.26 per 100 people (all P<0.001), and hazard ratios ranged from 1.24 to 25.65 compared with the 2020 comparator group. Conclusions The results indicate the excess risk of developing new clinical sequelae after the acute phase of SARS-CoV-2 infection, including specific types of sequelae less commonly seen in other viral illnesses. Although individuals who were older, had pre-existing conditions, and were admitted to hospital because of covid-19 were at greatest excess risk, younger adults (aged ≤50), those with no pre-existing conditions, or those not admitted to hospital for covid-19 also had an increased risk of developing new clinical sequelae. The greater risk for incident sequelae after the acute phase of SARS-CoV-2 infection is relevant for healthcare planning.

Editorial: Long COVID, or Post-COVID Syndrome, and the Global Impact on Health Care

“…There have been recent hypotheses regarding the cause of cognitive impairment associated with long COVID [ 2 , 3 ]. However, the prevalence of the systemic effects of long COVID are now emerging from the analysis of global patient electronic records and registries, including in the USA and the UK [ 4 , 5 ].…”

“…In May 2021, Daugherty and colleagues published the findings from a retrospective analysis of three US patient databases to evaluate the prevalence of persistent symptoms after the acute phase of SARS-CoV-2 infection in 193,113 adults between 18–65 years of age [ 5 ]. The study included an outpatient laboratory testing database, an extensive US national administrative claims database, and a database of hospital admissions, with clinical sequelae identified by ICD-10 codes and defined as being present from 21 days after the date of first SARS-CoV-2 diagnosis [ 5 ]. This study identified more than 50 clinical sequelae, or types of long COVID, in patients who had recovered from the acute phase of SARS-CoV-2 infection [ 5 ].…”

From Editor-in-Chief: On current issue, important cardiovascular documents and trials, COVID-19 sequels, and welcome to the new Editors

“…The recent upsurge in India has brought to our attention -mucormycosis, a rare complication developing in patients with COVID-19, diabetes and inappropriate use of dexamethasone (12). We have now evidence available on COVID sequelae we have been concerned about, pulmonary and cardiovascular consequences -4-6 months follow-up studies after COVID-19 that looked at hospitalizations and death rate (13,14). In a study of 73 435 nonhospitalized and 13 645 hospitalized patients with COVID-19 authors demonstrated a 1.46 times higher risk of death and increased hospitalizations during 6 months with respiratory, CV and other conditions in COVID-19 patients as compared to patients without COVID-19.…”

“…Excess in CV burden and hospitalizations after mild, moderate severe forms of COVID-19 were due to hypertension, arrhythmias, chest pain, HF, and coronary atherosclerosis (13). Recent analysis of 4 months follow-up after acute phase of about 250 000 patients with COVID-19 demonstrated increased risk of hospitalizations with respiratory failure, arrhythmias, diabetes, myocarditis, hypercoagulability after acute disease, risk was higher in older age patients with comorbidities, though younger adults were also at risk (14). These studies testify that COVID-19 is associated with poorer prognosis than seasonal influenza, CV hospitalizations may be due to new onset but also due to worsening of pre-existing conditions.…”

The covid-19 pandemic took power from the people

“…Limping from one crisis to the next is negligence, and quitting a failed approach is often better than gritting it out 10. More evidence continues to emerge on the growing burden of long term sequelae of SARS-CoV-2 infection, and how they overlap and differ from the sequelae of other viral illnesses 1112. This adds to the existing pressures on health services of managing patients at a distance, providing mental health services for pandemic and climate emergencies, and finding solutions to workforce pressures and doctors’ training needs 131415…”