Zhang Bingyu, Thacker Deepika, Zhou Ting, Zhang Dazheng, Lei Yuqing, Chen Jiajie, Chrischilles Elizabeth, Christakis Dimitri A, Fernandez Soledad, Garg Vidu, Kim Susan, Mosa Abu S M, Sills Marion R, Taylor Bradley W, Williams David A, Wu Qiong, Forrest Christopher B, Chen Yong
The Center for Health AI and Synthesis of Evidence (CHASE), University of Pennsylvania, Philadelphia, PA, USA.
The Graduate Group in Applied Mathematics and Computational Science, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA.
medRxiv. 2024 May 15:2024.05.14.24307380. doi: 10.1101/2024.05.14.24307380.
The risk of cardiovascular outcomes in the post-acute phase of SARS-CoV-2 infection has been quantified among adults and children. This paper aimed to assess a multitude of cardiac signs, symptoms, and conditions, as well as focused on patients with and without congenital heart defects (CHDs), to provide a more comprehensive assessment of the post-acute cardiovascular outcomes among children and adolescents after COVID-19.
This retrospective cohort study used data from the RECOVER consortium comprising 19 US children's hospitals and health institutions between March 2020 and September 2023. Every participant had at least a six-month follow-up after cohort entry. Absolute risks of incident post-acute COVID-19 sequelae were reported. Relative risks (RRs) were calculated by contrasting COVID-19-positive with COVID-19-negative groups using a Poisson regression model, adjusting for demographic, clinical, and healthcare utilization factors through propensity scoring stratification.
A total of 1,213,322 individuals under 21 years old (mean[SD] age, 7.75[6.11] years; 623,806 male [51.4%]) were included. The absolute rate of any post-acute cardiovascular outcome in this study was 2.32% in COVID-19 positive and 1.38% in negative groups. Patients with CHD post-SARS-CoV-2 infection showed increased risks of any cardiovascular outcome (RR, 1.63; 95% confidence interval (CI), 1.47-1.80), including increased risks of 11 of 18 post-acute sequelae in hypertension, arrhythmias (atrial fibrillation and ventricular arrhythmias), myocarditis, other cardiac disorders (heart failure, cardiomyopathy, and cardiac arrest), thrombotic disorders (thrombophlebitis and thromboembolism), and cardiovascular-related symptoms (chest pain and palpitations). Those without CHDs also experienced heightened cardiovascular risks after SARS-CoV-2 infection (RR, 1.63; 95% CI, 1.57-1.69), covering 14 of 18 conditions in hypertension, arrhythmias (ventricular arrhythmias and premature atrial or ventricular contractions), inflammatory heart disease (pericarditis and myocarditis), other cardiac disorders (heart failure, cardiomyopathy, cardiac arrest, and cardiogenic shock), thrombotic disorders (pulmonary embolism and thromboembolism), and cardiovascular-related symptoms (chest pain, palpitations, and syncope).
Both children with and without CHDs showed increased risks for a variety of cardiovascular outcomes after SARS-CoV-2 infection, underscoring the need for targeted monitoring and management in the post-acute phase.
已对成人和儿童中新型冠状病毒2（SARS-CoV-2）感染急性期后心血管疾病发生风险进行了量化。本文旨在评估多种心脏体征、症状和疾病情况，尤其关注有和无先天性心脏病（CHD）的患者，以更全面地评估新冠病毒病（COVID-19）后儿童和青少年急性期后心血管疾病的转归情况。
这项回顾性队列研究使用了2020年3月至2023年9月期间来自美国19家儿童医院和卫生机构的康复协作组（RECOVER consortium）的数据。每位参与者在进入队列后至少有6个月的随访。报告了急性期后COVID-19后遗症的绝对风险。通过使用泊松回归模型对比COVID-19阳性组和COVID-19阴性组计算相对风险（RR），通过倾向评分分层对人口统计学、临床和医疗保健利用因素进行调整。
共纳入1,213,322名21岁以下个体（平均[标准差]年龄，7.75[6.11]岁；623,806名男性[51.4%]）。本研究中COVID-19阳性组急性期后任何心血管疾病转归的绝对发生率为2.32%，阴性组为1.38%。SARS-CoV-2感染后患有CHD的患者出现任何心血管疾病转归的风险增加（RR，1.63；95%置信区间[CI]，1.47 - 1.80），包括18种急性期后后遗症中的11种风险增加，这些后遗症包括高血压、心律失常（心房颤动和室性心律失常）、心肌炎、其他心脏疾病（心力衰竭、心肌病和心脏骤停）、血栓形成性疾病（血栓性静脉炎和血栓栓塞）以及心血管相关症状（胸痛和心悸）。无CHD的患者在SARS-CoV-2感染后也经历了心血管疾病风险增加（RR，1.63；95% CI，1.57 - 1.69），涵盖18种情况中的14种，包括高血压、心律失常（室性心律失常和房性或室性早搏）、炎症性心脏病（心包炎和心肌炎）、其他心脏疾病（心力衰竭、心肌病、心脏骤停和心源性休克）、血栓形成性疾病（肺栓塞和血栓栓塞）以及心血管相关症状（胸痛、心悸和晕厥）。
患有和未患有CHD的儿童在SARS-CoV-2感染后出现多种心血管疾病转归的风险均增加，这凸显了在急性期后进行针对性监测和管理的必要性。
