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Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study
Daniel Ayoubkhani1, Kamlesh Khunti2, Vahé Nafilyan1
1Office for National Statistics, Government Buildings, Newport, UK.
Insights
Individuals discharged after COVID-19 face higher risks of organ dysfunction, readmission, and death compared to the general population. These risks affect younger individuals and ethnic minorities disproportionately, highlighting the need for integrated post-COVID care.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- COVID-19 (Coronavirus Disease 2019) is a global pandemic with significant short- and long-term health consequences.
- Understanding the spectrum of organ-specific dysfunction after hospital discharge is crucial for effective patient management and public health strategies.
Purpose of the Study:
- To quantify the rates of organ-specific dysfunction in individuals after COVID-19 hospital discharge.
- To compare these rates with a matched control group from the general population.
- To analyze variations in risk by age, sex, and ethnicity.
Main Methods:
- Retrospective cohort study utilizing electronic health records from NHS hospitals in England.
- Inclusion of 47,780 individuals discharged after COVID-19, matched with controls from approximately 50 million individuals.
- Follow-up until September 30, 2020, assessing hospital readmissions, all-cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases.
Main Results:
- Nearly one-third of COVID-19 survivors were readmitted, and over 10% died within a mean follow-up of 140 days, at rates 4 and 8 times higher than controls, respectively.
- Significantly elevated rates of respiratory disease, diabetes, and cardiovascular disease were observed in COVID-19 patients.
- Increased risks were noted in individuals under 70 and ethnic minority groups compared to older individuals and the white population.
Conclusions:
- Individuals discharged after COVID-19 exhibit increased rates of multiorgan dysfunction compared to the general population.
- The heightened risk is not limited to the elderly and varies across ethnic groups.
- Integrated, rather than organ-specific, approaches are necessary for diagnosing, treating, and preventing post-COVID conditions, necessitating urgent research into risk factors.
Objective:
To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population.
Design:
Retrospective cohort study.
Setting:
NHS hospitals in England.
Participants:
47 780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records.
Main Outcome Measures:
Rates of hospital readmission (or any admission for controls), all cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity.
Results:
Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals).
Conclusions:
Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.
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