Clinical Epidemiology Center, Research and Development Service, VA Saint Louis Health Care System, Saint Louis, MO, USA.
Veterans Research and Education Foundation of Saint Louis, Saint Louis, MO, USA.
Nat Med. 2023 Sep;29(9):2347-2357. doi: 10.1038/s41591-023-02521-2. Epub 2023 Aug 21.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to postacute sequelae in multiple organ systems, but evidence is mostly limited to the first year postinfection. We built a cohort of 138,818 individuals with SARS-CoV-2 infection and 5,985,227 noninfected control group from the US Department of Veterans Affairs and followed them for 2 years to estimate the risks of death and 80 prespecified postacute sequelae of COVID-19 (PASC) according to care setting during the acute phase of infection. The increased risk of death was not significant beyond 6 months after infection among nonhospitalized but remained significantly elevated through the 2 years in hospitalized individuals. Within the 80 prespecified sequelae, 69% and 35% of them became not significant at 2 years after infection among nonhospitalized and hospitalized individuals, respectively. Cumulatively at 2 years, PASC contributed 80.4 (95% confidence interval (CI): 71.6-89.6) and 642.8 (95% CI: 596.9-689.3) disability-adjusted life years (DALYs) per 1,000 persons among nonhospitalized and hospitalized individuals; 25.3% (18.9-31.0%) and 21.3% (18.2-24.5%) of the cumulative 2-year DALYs in nonhospitalized and hospitalized were from the second year. In sum, while risks of many sequelae declined 2 years after infection, the substantial cumulative burden of health loss due to PASC calls for attention to the care needs of people with long-term health effects due to SARS-CoV-2 infection.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染可导致多个器官系统的急性后期后遗症，但证据主要局限于感染后 1 年。我们从美国退伍军人事务部建立了一个由 138818 名 SARS-CoV-2 感染患者和 5985227 名未感染对照组组成的队列，并对他们进行了 2 年的随访，以根据感染急性期的治疗环境来估计 COVID-19 急性后期后遗症（PASC）的 80 种预设风险。非住院患者感染后 6 个月后死亡风险无显著增加，但住院患者在 2 年内仍显著升高。在 80 种预设后遗症中，分别有 69%和 35%在非住院和住院患者感染后 2 年变得无显著意义。在 2 年内累积，PASC 导致非住院和住院患者每 1000 人分别损失 80.4（95%置信区间：71.6-89.6）和 642.8（95%置信区间：596.9-689.3）个伤残调整生命年（DALY）；非住院和住院患者累积 2 年 DALY 中分别有 25.3%（18.9-31.0%）和 21.3%（18.2-24.5%）来自第 2 年。总之，尽管许多后遗症的风险在感染后 2 年下降，但由于 PASC 导致的健康损失的大量累积负担需要关注因 SARS-CoV-2 感染而长期存在健康影响的人群的护理需求。
