Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto and Ottawa, Ontario, Canada.
JAMA Intern Med. 2023 Aug 1;183(8):806-817. doi: 10.1001/jamainternmed.2023.2228.
People who survive hospitalization for COVID-19 are at risk for developing new cardiovascular, neurological, mental health, and inflammatory autoimmune conditions. It is unclear how posthospitalization risks for COVID-19 compare with those for other serious infectious illnesses.
To compare risks of incident cardiovascular, neurological, and mental health conditions and rheumatoid arthritis in 1 year following COVID-19 hospitalization against 3 comparator groups: prepandemic hospitalization for influenza and hospitalization for sepsis before and during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included all adults hospitalized for COVID-19 between April 1, 2020, and October 31, 2021, historical comparator groups of people hospitalized for influenza or sepsis, and a contemporary comparator group of people hospitalized for sepsis in Ontario, Canada.
Hospitalization for COVID-19, influenza, or sepsis.
New occurrence of 13 prespecified conditions, including cardiovascular, neurological, and mental health conditions and rheumatoid arthritis, within 1 year of hospitalization.
Of 379 366 included adults (median [IQR] age, 75 [63-85] years; 54% female), there were 26 499 people who survived hospitalization for COVID-19, 299 989 historical controls (17 516 for influenza and 282 473 for sepsis), and 52 878 contemporary controls hospitalized for sepsis. Hospitalization for COVID-19 was associated with an increased 1-year risk of venous thromboembolic disease compared with influenza (adjusted hazard ratio, 1.77; 95% CI, 1.36-2.31) but with no increased risks of developing selected ischemic and nonischemic cerebrovascular and cardiovascular disorders, neurological disorders, rheumatoid arthritis, or mental health conditions compared with influenza or sepsis cohorts.
In this cohort study, apart from an elevated risk of venous thromboembolism within 1 year, the burden of postacute medical and mental health conditions among those who survived hospitalization for COVID-19 was comparable with other acute infectious illnesses. This suggests that many of the postacute consequences of COVID-19 may be related to the severity of infectious illness necessitating hospitalization rather than being direct consequences of infection with SARS-CoV-2.
从 COVID-19 住院治疗中存活下来的患者面临新发心血管、神经、精神健康和炎症性自身免疫性疾病的风险。目前尚不清楚 COVID-19 患者的住院后风险与其他严重传染性疾病相比如何。
比较 COVID-19 住院后 1 年内发生心血管、神经和精神健康疾病及类风湿关节炎的风险，与以下 3 个对照组进行比较：大流行前季节性流感住院和 COVID-19 大流行期间和之前的脓毒症住院；以及加拿大安大略省脓毒症住院的当代对照组。
设计、地点和参与者：这项基于人群的队列研究纳入了 2020 年 4 月 1 日至 2021 年 10 月 31 日期间因 COVID-19 住院的所有成年人、季节性流感或脓毒症住院的历史对照组人群，以及加拿大安大略省脓毒症住院的当代对照组人群。
COVID-19、流感或脓毒症住院。
住院后 1 年内新发生 13 种预先确定的疾病，包括心血管、神经和精神健康疾病及类风湿关节炎。
共纳入 379366 例成年人（中位数[IQR]年龄，75[63-85]岁；54%为女性），其中 26499 例患者幸存 COVID-19 住院治疗，299989 例为历史对照组（17516 例流感和 282473 例脓毒症），52878 例为同期脓毒症住院对照组。与流感相比，COVID-19 住院治疗与静脉血栓栓塞疾病 1 年风险增加相关（校正后的危险比，1.77；95%CI，1.36-2.31），但与流感或脓毒症队列相比，发生特定的缺血性和非缺血性脑血管病及心血管疾病、神经疾病、类风湿关节炎或精神健康疾病的风险没有增加。
在这项队列研究中，与流感相比，除了在 1 年内发生静脉血栓栓塞的风险升高外，COVID-19 住院治疗后幸存者的急性后医疗和精神健康状况负担与其他急性传染病相当。这表明 COVID-19 的许多急性后后果可能与需要住院治疗的传染性疾病的严重程度有关，而不是与 SARS-CoV-2 感染直接相关。
