Nearly a 3rd of COVID-19 sufferers hospitalized within the UK have been readmitted
At the start of the UK's coronavirus disease (COVID-19) pandemic, it was believed that approximately 6% of the national population and 13% of the London population were infected with severe coronavirus 2 (SARS-CoV-2) with acute respiratory syndrome. . Most of the research and media responses to the pandemic have focused on short-term impacts and deaths directly and indirectly related to COVID-19. However, more attention needs to be paid to the long-term effects of the disease in order to improve health capacity and care.
Much academic and clinical work has focused on manifestations of SARS-CoV-2 infection in the respiratory tract, although there is increasing evidence of multi-organ effects and indirect effects on other organs and comorbidities such as cancer and cardiovascular disease due to limited access to health care . The epidemiology of the so-called post-COVID syndrome (PCS) is currently not clearly defined. Existing data show large differences in the estimates of PCS prevalence and incidence due to differences in study population, sample size, recruitment methods, and follow-up periods.
A retrospective study to determine organ impairment rates after recovery from COVID-19
In a recent medRxiv * preprint paper, researchers from the UK discussed how they measured post-hospital-related organ impairment rates for COVID-19 and compared the results with those of a control group. They also analyzed how the rate ratio (RR) changes across gender, age and ethnicity.
The observational, retrospective, concerted cohort study was conducted in NHS hospitals in England. Study participants included 47,780 people with an average age of 65 who were hospitalized with COVID-19 and discharged by August 31, 2020. Approximately 55% of the study cohort were male, and the cohort was matched to controls for demographic and clinical characteristics. The key outcomes measured were all-cause mortality, readmission to hospital, and diagnoses of cardiovascular, respiratory, metabolic, liver, and kidney diseases by September 30, 2020.
Study population flowchart
Individuals with PCS had higher rates of respiratory, cardiovascular, and diabetes-related events
The mean follow-up time for COVID-19 cases was 140 days and that for controls was 153 days. In COVID-19 cases, 766 (95% confidence interval: 753 to 779) readmissions and 320 (312 to 328) deaths per 1,000 person-years were reported, which is 3.5 (3.4 to 3.6) and 7.7 ( 7.2 to 8.3) times each corresponds to greater than controls.
The incidence of respiratory, cardiovascular, and diabetes-related events was also significantly increased in COVID-19 cases, with 770 (758 to 783), 126 (121 to 131), and 127 (122 to 132) events per 1,000 person-years. respectively.
Frequency of adverse events versus those with COVID-19 in England who were discharged from hospital with appropriate controls by August 31, 2020
The RRs were higher in people under 70 than in people over 70. RRs were also higher in minority ethnic groups than in the white population. The most significant differences were found in respiratory diseases: 10.5 (9.7 to 11.4) in people under the age of 70 versus 4.6 (4.3 to 4.8) in people aged 70 and over and 11.4 (9 8 to 13.3) for non-whites versus 5.2 (5.0 to 5.5) for the white population.
"Individuals discharged from hospital after acute COVID-19 face increased mortality, readmission, and multi-organ function rates compared to background levels for those individuals, and the relative increase in risk is neither limited to the elderly nor ethnically consistent Groups. "
The increased risk of multiple organ dysfunction was not uniform across different ethnicities
Based on the results of the study, the authors concluded that people discharged from hospital after COVID-19 infection had a higher rate of multi-organ dysfunction compared to control rates. Interestingly, the increase in risk was not limited to the elderly, nor was it uniform across different ethnic groups. Diagnosing, treating, and preventing long-term complications of COVID-19 requires integrated approaches rather than organ- or disease-specific approaches. According to the authors, there is an urgent need for research to identify the risk factors for PCS.
"Integrated pathways are structured, multidisciplinary care plans for specific conditions that have been effective in other conditions, such as chronic obstructive pulmonary disease, and may be useful in treating PCS."
* Important NOTE
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.