Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study

BMJ, The - Trang n693
Daniel Ayoubkhani1, Kamlesh Khunti2, Vahé Nafilyan1, Thomas W. Maddox1, Ben Humberstone1, Ian Diamond1, Amitava Banerjee3,4,5
1Office for National Statistics, Government Buildings, Newport, UK
2Diabetes Research Centre, University of Leicester, Leicester, UK
3Barts Health NHS Trust, Royal London Hospital, London, UK
4Institute of Health Informatics, University College London, London NW1 2DA, UK
5University College London Hospitals NHS Trust, London, UK

Tóm tắt

AbstractObjectiveTo 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.DesignRetrospective cohort study.SettingNHS hospitals in England.Participants47 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 measuresRates 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.ResultsOver 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 yearsv4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-whitev5.2 (5.0 to 5.5) for white individuals).ConclusionsIndividuals 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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Tài liệu tham khảo

Ward H Atchison C Whitaker M . Antibody prevalence for SARS-CoV-2 in England following first peak of the pandemic: REACT2 study in 100 000 adults. medRxiv [Preprint] 2020. https://www.medrxiv.org/content/10.1101/2020.08.12.20173690v2

10.1016/S0140-6736(20)30854-0

10.1136/bmj.m3731

10.1038/s41586-020-2521-4

World Health Organization. Clinical management of severe acute respiratory infection (‎‎‎SARI)‎‎‎ when COVID-19 disease is suspected: interim guidance, 13 March 2020. 2020. https://apps.who.int/iris/handle/10665/331446

10.1001/jamacardio.2020.3557

10.1016/j.prp.2020.153097

10.1177/2050640620924157

10.1210/jendso/bvaa082

10.1007/s40620-020-00789-y

10.1136/heartjnl-2020-317870

10.1136/bmjopen-2020-043828

Katsoulis M, Gomes M, Lai A, et al. Estimating the effect of reduced attendance at emergency departments for suspected cardiac conditions on cardiac mortality during the COVID-19 pandemic. 2020. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.007085

National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing the long-term effects of COVID-19. 2020. https://www.nice.org.uk/guidance/ng188

10.1136/bmj.m3026

National Institute for Health Research. Themed review: living with covid19. 2020. https://evidence.nihr.ac.uk/themedreview/living-with-covid19

10.1093/ije/dyx015

NHS Digital. General Practice Extraction Service (GPES) data for pandemic planning and research: a guide for analysts and users of the data. 2020. https://digital.nhs.uk/coronavirus/gpes-data-for-pandemic-planning-and-research/guide-for-analysts-and-users-of-the-data

10.1002/sim.3697

10.1093/pan/mpr013

10.1136/bmj.m3001

10.1007/s11239-020-02266-6

10.1056/NEJMc2018688

Michelen M Manoharan L Elkheir N . Characterising long-term covid-19: a rapid living systematic review. medRxiv [Preprint] 2020. https://www.medrxiv.org/content/10.1101/2020.12.08.20246025v1

10.1001/jama.2020.21465

10.1101/2020.10.14.20212555

10.1016/j.eclinm.2020.100504

10.1136/bmj.m4677

10.1186/s12931-020-01385-1

10.1001/jamacardio.2020.4916

UK Government. Coronavirus (COVID-19) in the UK: daily update. https://coronavirus.data.gov.uk

10.1136/bmj.316.7125.133

10.1503/cmaj.110977

10.1097/MD.0000000000023327

10.1002/jmv.25757

Tazare J Walker AJ Tomlinson L . Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19: a descriptive cohort study within the OpenSAFELY platform. medRxiv [Preprint] 2021. https://www.medrxiv.org/content/10.1101/2021.01.22.21250304v2

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