In a recent study published in Nature Medicine, researchers comprehensively assessed the risk and burden of COVID-19 acute sequelae (PASC) in hospitalized and non-hospitalized acute COVID-19 settings two years after infection. evaluated.
study: Acute aftereffects of the new coronavirus infection two years later. Image credit: DraganaGordic/Shutterstock.com
background
Post-acute effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection include metabolic disorders (dyslipidemia and diabetes), cardiovascular disease, psychiatric disorders, neurological problems, gastrointestinal ( GI) Includes increased risk and health burden such as disability and kidney damage. .
However, this data is mainly limited to the first year after the outbreak of acute COVID-19. Addressing this research gap will provide valuable insights into the post-acute and long-term course of COVID-19 and will influence treatment recommendations after COVID-19.
About research
In the current study, researchers characterize the risk and burden of PASC across organ systems up to 2 years after acute novel coronavirus disease (COVID-19) outbreak, which may be influenced by treatment pathways and capacity planning. It might help.
The researchers used the U.S. Department of Veterans Affairs (VA) National Medical Records to study a group of 138,818 individuals who survived beyond the first 30.0 days from acute infection and an uninfected U.S. Veterans Health Administration (VHA) group. A group of 5,985,227 users (control) was created. .
Participants in this trial were followed for 2 years to assess hospitalization, mortality, and 80 prespecified PASC outcome risks between hospitalized and non-hospitalized participants.
Post-acute phase of COVID-19 was categorized into the following periods: 30-90 days, 91-180 days, 181-360 days, 361-540 days, and 541-720 days.
Inverse probability weighting was used for baseline factors such as age, race, sex, body mass index (BMI), smoking behavior, area deprivation index (ADI), and medical conditions. Sensitivity analyzes were performed using conditional modeling techniques to correct for vaccination status and healthcare consumption during the follow-up period.
In addition, the researchers evaluated outcomes for individuals who had one or more medical visits during the analysis period.
During follow-up, the researchers further evaluated the association between SARS-CoV-2 infection and new-onset tumors as a negative control. COVID-19 was identified using polymerase chain reaction (PCR) and SARS-CoV-2 antigen testing.
result
The mean ages of participants in the SARS-CoV-2 infected and non-infected groups were 61 and 63 years, respectively. The proportion of women in the corresponding groups was 11% and 9.9%, respectively. Of the 138,818 SARS-CoV-2-infected persons in acute coronavirus disease 2019, 20,580 were hospitalized and 118,238 were not hospitalized.
The median follow-up for the uninfected and infected groups was 719.0 and 715.0 days, representing 11,181,224 and 255,119 years of follow-up, respectively, for a total of 11,436,344 years of follow-up.
In non-hospitalized individuals, the increased risk of death ceased to be significant beyond 6 months post-infection (estimated risk period: 3 months to 1 year), whereas it remained significant up to 2 years post-infection in hospitalized individuals. remained increased.
Among PASC outcomes, 69% and 35% of outcomes, including the risk of neurological, cardiovascular, psychiatric, and renal outcomes, became non-significant at 2 years post-infection in non-hospitalized and hospitalized patients. Ta.
Cumulatively over a 2-year period, acute sequelae of COVID-19 accounted for 80 and 643 disability-adjusted life years (DALYs) per 1,000 nonhospitalized and hospitalized persons, respectively. 25% and 21% of the cumulative 2-year DALYs in non-hospitalized and inpatients were from subsequent follow-up years.
The risk of PASC outcomes such as coagulopathy, fatigue, pulmonary disease, musculoskeletal disease, diabetes, and gastrointestinal disorders remained increased 2 years after infection in nonhospitalized patients compared with controls.
Similar results were obtained in sensitivity analyzes, which indicated that the main findings were robust. There was no relationship between COVID-19 and tumor incidence during the analysis period.
Among nonhospitalized individuals, 24 cases of PASC remained at elevated risk, including several musculoskeletal, neurological, and gastrointestinal sequelae, indicating a prolonged risk period for the organs involved. shown.
Among individuals hospitalized with acute COVID-19, the 50 PASC risk representing hospitalization, death, and all organ systems was still significantly higher at 2 years, and recovery among those hospitalized with acute COVID-19 was significantly higher. It indicates that the process is long and difficult.
Conclusion
Overall, the results of the study suggest that the probability of some post-acute sequelae decreased over time and, while not statistically significant, the decrease was less significant in individuals hospitalized with acute-phase COVID-19. It showed that it was not dramatic. The findings of this study highlight the cumulative burden of health loss caused by PASC and call attention to the care requirements of patients suffering from the long-term health effects of SARS-CoV-2.
Population health policies should continue to prioritize measures to reduce the risk of post-acute and long-term COVID-19 sequelae in persons infected with SARS-CoV-2.
The burden of health loss not only impacts the quality of life of patients, but can lead to reduced life expectancy, employee engagement, economic productivity and social well-being.