Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States of America.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, United States of America.
PLoS One. 2024 Mar 8;19(3):e0286371. doi: 10.1371/journal.pone.0286371. eCollection 2024.
Most patients with COVID-19 report experiencing one or more symptoms after acute infection subsides, known as post-acute sequelae of SARS-CoV-2 infection (PASC). Though research has examined PASC after acute COVID-19, few studies have examined PASC over a longer follow-up duration or accounted for rates of symptoms and diagnoses before COVID-19 infection, and included those not actively seeking treatment for PASC. To determine what symptoms and diagnoses are occurring at higher rates after acute COVID-19 infection from a more inclusive sample, we extracted electronic hospital records (EHR) data from 13,033 adults with previously known diagnoses and symptoms.
The sample was comprised of patients who had a positive PCR test for SARS-CoV-2 between March 1, 2020, and December 31, 2020, and follow-up was conducted through November 29, 2021. All patients in the sample had medical appointments ≥4 weeks before and ≥4 weeks after their positive PCR test. At these appointments, all ICD-10 codes recorded in the EHR were classified into 21 categories based on the literature and expert review. Conditional logistic regression models were used to quantify the odds of these symptoms and diagnostic categories following COVID-19 infection relative to visits occurring before infection. The sample was comprised of 28.0% adults over 65 and was 57.0% female. After the positive PCR test, the most recorded diagnoses and symptoms were dyspnea and respiratory failure, myositis, musculoskeletal pain/stiffness, anxiety, and depression.
Results from regression analyses showed increased odds of diagnosis for 15 of the 21 categories following positive PCR. Relative to pre-COVID, the diagnoses and symptoms with the greatest odds after a positive PCR test were loss of smell or taste [OR (95% CI) = 6.20 (3.18-12.09)], pulmonary fibrosis [3.50 (1.59-7.68)], and dyspnea/respiratory failure [2.14 (1.92-2.40)]. Stratification of these analyses by age, gender, race, and ethnicity showed similar results.
The increased symptoms and diagnoses detected in the current study match prior analyses of PASC diagnosis and treatment-seeking patients. The current research expands upon the literature by showing that these symptoms are more frequently detected following acute COVID-19 than before COVID-19. Further, our analyses provide a broad snapshot of the population as we were able to describe PASC among all patients who tested positive for COVID-19.
大多数 COVID-19 患者在急性感染消退后会出现一种或多种症状，称为 SARS-CoV-2 感染的急性后后遗症（PASC）。尽管有研究检查了急性 COVID-19 后的 PASC，但很少有研究在更长的随访时间内检查 PASC，或考虑 COVID-19 感染前的症状和诊断率，并且包括那些未积极寻求 PASC 治疗的患者。为了从更具包容性的样本中确定急性 COVID-19 感染后哪些症状和诊断更为常见，我们从之前有已知诊断和症状的 13033 名成年人的电子病历（EHR）数据中提取了数据。
该样本包括 2020 年 3 月 1 日至 2020 年 12 月 31 日期间 SARS-CoV-2 阳性 PCR 检测的患者，随访至 2021 年 11 月 29 日。样本中的所有患者在 PCR 检测呈阳性之前和之后至少有 4 周的医疗预约。在这些预约中，EHR 中记录的所有 ICD-10 代码都根据文献和专家审查分为 21 类。使用条件逻辑回归模型来量化 COVID-19 感染后与感染前就诊相比，这些症状和诊断类别的可能性。该样本由 28.0%的 65 岁以上成年人和 57.0%的女性组成。在阳性 PCR 检测后，记录最多的诊断和症状是呼吸困难和呼吸衰竭、肌炎、肌肉骨骼疼痛/僵硬、焦虑和抑郁。
回归分析的结果表明，在 21 个类别中有 15 个类别的诊断概率增加。与 COVID-19 前相比，PCR 检测呈阳性后诊断概率最大的诊断和症状是嗅觉或味觉丧失[比值比（95%CI）=6.20（3.18-12.09）]、肺纤维化[3.50（1.59-7.68）]和呼吸困难/呼吸衰竭[2.14（1.92-2.40）]。按年龄、性别、种族和民族对这些分析进行分层，结果相似。
当前研究中检测到的症状和诊断与之前对 PASC 诊断和治疗寻求患者的分析相匹配。本研究通过表明这些症状在急性 COVID-19 后比 COVID-19 前更频繁地被检测到，从而扩展了文献。此外，我们的分析提供了一个广泛的人群快照，因为我们能够描述所有 COVID-19 检测呈阳性的患者中的 PASC。
