med-Rxiv - Epidemiology of post-COVID syndrome following hospitalisation with coronavirus: a retrospective cohort study

[sharon sanders]

Epidemiology of post-COVID syndrome following hospitalisation with coronavirus: a retrospective cohort study

Daniel Ayoubkhani, Kamlesh Khunti, Vah? Nafilyan, Thomas Maddox, Ben Humberstone, Sir Ian Diamond, Amitava Banerjee
doi: https://doi.org/10.1101/2021.01.15.21249885

Abstract


Objectives

The epidemiology of post-COVID syndrome (PCS) is currently undefined. We quantified rates of organ-specific impairment following recovery from COVID-19 hospitalisation compared with those in a matched control group, and how the rate ratio (RR) varies by age, sex, and ethnicity.

Design

Observational, retrospective, matched cohort study.

Setting

NHS hospitals in England.

Participants

47,780 individuals (mean age 65 years, 55% male) in hospital with COVID-19 and discharged alive by 31 August 2020, matched to controls on demographic and clinical characteristics.


Outcome measures

Rates of hospital readmission, all-cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney and liver diseases until 30 September 2020.


Results

Mean follow-up time was 140 days for COVID-19 cases and 153 days for controls. 766 (95% confidence interval: 753 to 779) readmissions and 320 (312 to 328) deaths per 1,000 person-years were observed in COVID-19 cases, 3.5 (3.4 to 3.6) and 7.7 (7.2 to 8.3) times greater, respectively, than in controls. Rates of respiratory, diabetes and cardiovascular events were also significantly elevated in COVID-19 cases, at 770 (758 to 783), 127 (122 to 132) and 126 (121 to 131) events per 1,000 person-years, respectively. RRs were greater for individuals aged <70 than ≥ 70 years, and in ethnic minority groups than the White population, with the biggest differences observed for respiratory disease: 10.5 [9.7 to 11.4] for <70 years versus 4.6 [4.3 to 4.8] for ≥ 70 years, and 11.4 (9.8 to 13.3) for Non-White versus 5.2 (5.0 to 5.5) for White.

Conclusions

Individuals discharged from hospital following COVID-19 face elevated rates of multi-organ dysfunction compared with background levels, and the increase in risk is neither confined to the elderly nor uniform across ethnicities. The diagnosis, treatment and prevention of PCS require integrated rather than organ- or disease-specific approaches. Urgent research is required to establish risk factors for PCS.


https://www.medrxiv.org/content/10.1101/2021.01.15.21249885v1

 

[sharon sanders]

At above link....



Principal findings


In the largest study to-date to examine PCS in individuals hospitalised with COVID-19, comprising 47,780 COVID-19 cases with matched controls, we describe three major findings.

Firstly, COVID-19 hospitalisation was associated with increased risk of readmission and death following discharge, relative to that in individuals of similar demographic and clinical profiles over the same period; nearly a third of people post COVID-19 hospital discharge were re-admitted and more than 1 in 10 died.

Secondly, rates of post-discharge multi-organ dysfunction were elevated in individuals with COVID-19 compared with those in the matched control group, suggesting extrapulmonary pathophysiology. Diabetes and MACE were particularly common, both when considering all post-discharge events (which may reflect a combination of new-onset cases and exasperation of pre-existing conditions) and only incident cases.

Finally, the absolute risk of post-discharge adverse events was greater for individuals aged ≥ 70 years than <70 years, and for individuals of White ethnic background than in the Non-White group. However, when contrasted against the background rates of adverse events that might be expected to occur in these groups in the general population, younger and ethnic minority individuals faced greater relative risks than those aged ≥ 70 years and those in the White group, respectively.