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Post COVID-19 hospitalizations in patients with chronic inflammatory diseases - A nationwide cohort study
Bente Mertz Nørgård1, Floor Dijkstra Zegers1, Jan Nielsen1
1Center for Clinical Epidemiology, Odense University Hospital, 5000, Odense C, Denmark; Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark.
Insights
Patients with chronic inflammatory diseases, such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA), spondyloarthropathy (SpA), or psoriatic arthritis (PsA), face an increased risk of hospitalization after COVID-19. This heightened risk is particularly noted for respiratory diseases and infections, underscoring the need for vigilant post-COVID-19 care.
Area of Science:
- Immunology
- Infectious Diseases
- Rheumatology
Background:
- Hospitalization for COVID-19 can lead to long-term health consequences.
- Patients with chronic inflammatory diseases may experience unique post-COVID-19 complications.
Purpose of the Study:
- To investigate the long-term risks of subsequent hospitalizations in patients with chronic inflammatory diseases following COVID-19 hospitalization.
- To compare these risks against individuals hospitalized for COVID-19 without these pre-existing conditions.
Main Methods:
- A population-based cohort study utilizing Danish nationwide health registers.
- Inclusion criteria: adult patients discharged alive after COVID-19 hospitalization (March 2020 - July 2021).
- Exposed cohort: patients with IBD, RA, SpA, or PsA prior to COVID-19 hospitalization; unexposed cohort: patients without these conditions.
Main Results:
- Patients with IBD/RA/SpA/PsA showed a significantly increased risk of hospitalization for respiratory diseases (aHR 1.27) and infections (aHR 1.55).
- Sensitivity analyses indicated a non-significant trend towards increased overall hospitalization (aHR 1.15) and cardiovascular diagnoses (aHR 1.14).
- No increased risk of nervous system diagnoses or death was observed in the exposed cohort during follow-up.
Conclusions:
- Patients with IBD/RA/SpA/PsA face elevated risks of re-hospitalization for specific conditions after COVID-19.
- These findings highlight the importance of heightened clinical awareness for post-COVID-19 sequelae in this patient group.
- Further research is warranted to understand and manage these long-term consequences.
Objective:
To study long term consequences of hospitalization for COVID-19 in patients with chronic inflammatory diseases. We studied the risk of subsequent hospitalizations in patients with chronic inflammatory diseases, who survived a hospitalization for COVID-19, compared to other patients who had been hospitalized for COVID-19.
Design And Setting:
Population based cohort study based on Danish nationwide health registers. The study population included all adult patients in Denmark who had been discharged alive after a hospitalization with COVID-19 from March 1, 2020 to July 31, 2021.
Population:
From the study population, the exposed cohort constituted patients who had inflammatory bowel diseases (IBD), rheumatoid arthritis (RA), spondyloarthropathy (SpA), or psoriatic arthritis (PsA) prior to hospitalization for COVID-19, and the unexposed cohort constituted those without these diseases.
Main Outcome Measures:
We estimated the adjusted Hazard Rate (aHR) for the following outcomes: overall risk of hospitalization, cardiovascular diseases, respiratory diseases, blood and blood-forming organs, nervous system diseases, infections, sequelae of COVID-19, and death.
Results:
A total of 417 patients with IBD/RA/SpA/PsA were discharged alive after COVID-19, and 9,248 patients without these diseases. Across the different outcomes examined, the median length of follow up was 6.50 months in the exposed cohort (25-75% percentiles: 4.38-8.12), and among the unexposed the median time of follow up was 6.59 months (25-75% percentiles: 4.17-8.49). Across different analyses, we consistently found a significantly increased risk of hospitalizations due to respiratory diseases (aHR 1.27 (95% CI 1.02-1.58)) and infections (aHR 1.55 (95% CI 1.26-1.92)). In sensitivity analyses, the overall risk of hospitalization was aHR 1.15 (95% CI 0.96-1.38) and the risk of hospitalization due to cardiovascular diagnoses was aHR 1.14 (95% CI 0.91-1.42). During the time of follow up, the risk of nervous system diagnoses or death was not increased in patients with IBD/RA/SpA/PsA.
Conclusions:
After hospitalization with COVID-19, patients with IBD/RA/SpA/PsA had an increased risk of subsequent hospitalizations for a number of categories of diseases, compared to other patients who have been hospitalized with COVID-19. These results are disturbing and need to be examined further. The implication of our results is that clinicians should be particularly alert for post COVID-19 symptoms from several organ systems in patients with IBD/RA/SpA/PsA.
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