Tazare John, Walker Alex J, Tomlinson Laurie A, Hickman George, Rentsch Christopher T, Williamson Elizabeth J, Bhaskaran Krishnan, Evans David, Wing Kevin, Mathur Rohini, Wong Angel Ys, Schultze Anna, Bacon Seb, Bates Chris, Morton Caroline E, Curtis Helen J, Nightingale Emily, McDonald Helen I, Mehrkar Amir, Inglesby Peter, Davy Simon, MacKenna Brian, Cockburn Jonathan, Hulme William J, Warren-Gash Charlotte, Bhate Ketaki, Nitsch Dorothea, Powell Emma, Mulick Amy, Forbes Harriet, Minassian Caroline, Croker Richard, Parry John, Hester Frank, Harper Sam, Eggo Rosalind M, Evans Stephen Jw, Smeeth Liam, Douglas Ian J, Goldacre Ben
London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK.
Wellcome Open Res. 2022 Apr 29;7:142. doi: 10.12688/wellcomeopenres.17735.1. eCollection 2022.
Patients surviving hospitalisation for COVID-19 are thought to be at high risk of cardiometabolic and pulmonary complications, but quantification of that risk is limited. We aimed to describe the overall burden of these complications in people after discharge from hospital with COVID-19. Working on behalf of NHS England, we used linked primary care records, death certificate and hospital data from the OpenSAFELY platform. We constructed three cohorts: patients discharged following hospitalisation with COVID-19, patients discharged following pre-pandemic hospitalisation with pneumonia, and a frequency-matched cohort from the general population in 2019. We studied seven outcomes: deep vein thrombosis (DVT), pulmonary embolism (PE), ischaemic stroke, myocardial infarction (MI), heart failure, AKI and new type 2 diabetes mellitus (T2DM) diagnosis. Absolute rates were measured in each cohort and Fine and Gray models were used to estimate age/sex adjusted subdistribution hazard ratios comparing outcome risk between discharged COVID-19 patients and the two comparator cohorts. Amongst the population of 77,347 patients discharged following hospitalisation with COVID-19, rates for the majority of outcomes peaked in the first month post-discharge, then declined over the following four months. Patients in the COVID-19 population had markedly higher risk of all outcomes compared to matched controls from the 2019 general population. Across the whole study period, the risk of outcomes was more similar when comparing patients discharged with COVID-19 to those discharged with pneumonia in 2019, although COVID-19 patients had higher risk of T2DM (15.2 versus 37.2 [rate per 1,000-person-years for COVID-19 versus pneumonia, respectively]; SHR, 1.46 [95% CI: 1.31 - 1.63]). Risk of cardiometabolic and pulmonary adverse outcomes is markedly raised following discharge from hospitalisation with COVID-19 compared to the general population. However, excess risks were similar to those seen following discharge post-pneumonia. Overall, this suggests a large additional burden on healthcare resources.
新冠病毒病（COVID-19）住院幸存者被认为有发生心脏代谢和肺部并发症的高风险，但对该风险的量化有限。我们旨在描述COVID-19患者出院后这些并发症的总体负担。
我们代表英国国民健康服务体系（NHS England），使用了来自OpenSAFELY平台的关联初级保健记录、死亡证明和医院数据。我们构建了三个队列：COVID-19住院后出院的患者、大流行前因肺炎住院后出院的患者，以及2019年普通人群中频率匹配的队列。我们研究了七个结局：深静脉血栓形成（DVT）、肺栓塞（PE）、缺血性中风、心肌梗死（MI）、心力衰竭、急性肾损伤（AKI）和新型2型糖尿病（T2DM）诊断。在每个队列中测量绝对发生率，并使用Fine和Gray模型估计年龄/性别调整后的亚分布风险比，以比较COVID-19出院患者与两个对照队列之间的结局风险。
在77347例COVID-19住院后出院的患者群体中，大多数结局的发生率在出院后的第一个月达到峰值，然后在接下来的四个月中下降。与2019年普通人群的匹配对照组相比，COVID-19患者群体发生所有结局的风险明显更高。在整个研究期间，将COVID-19出院患者与2019年肺炎出院患者进行比较时，结局风险更为相似，尽管COVID-19患者患T2DM的风险更高（分别为15.2对37.2[COVID-19与肺炎每1000人年的发生率]；标准化风险比，1.46[95%置信区间：1.31 - 1.63]）。
与普通人群相比，COVID-19住院出院后心脏代谢和肺部不良结局的风险明显增加。然而，额外风险与肺炎出院后所见的风险相似。总体而言，这表明医疗资源面临巨大的额外负担。
