Ioannou George N, Berry Kristin, Rajeevan Nallakkandi, Li Yuli, Yan Lei, Huang Yuan, Bui David, Hynes Denise M, Rowneki Mazhgan, Hickok Alex, Niederhausen Meike, Shahoumian Troy A, Bohnert Amy, Boyko Edward J, Korpak Anna, Fox Alexandra, Baraff Aaron, Iwashyna Theodore J, Maciejewski Matthew L, Smith Valerie A, Berkowitz Theodore S Z, Pura John A, Hebert Paul, Wong Edwin S, O'Hare Ann M, Osborne Thomas F, Viglianti Elizabeth M, Aslan Mihaela, Bajema Kristina L
Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.
Divisions of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, USA.
Clin Infect Dis. 2025 Apr 10. doi: 10.1093/cid/ciaf087.
Coronavirus disease 2019 (COVID-19) has been linked to the development of post-COVID-19 conditions (PCCs). We investigated whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases the risk of selected PCCs or death up to 1 year after infection, separately in the wild-type (WT), Alpha-transition, Delta, and Omicron eras and by vaccination status.
We used health records of the Veterans Health Administration to emulate a hypothetical target trial of SARS-CoV-2 infection versus no infection. Veterans who tested positive for SARS-CoV-2 between March 2020 and April 2022 (n = 430 160) were matched 1:1 to veterans who had not tested positive for SARS-CoV-2. All-cause mortality and cumulative incidence of 32 potential PCCs were ascertained at 31-180 and 181-365 days after infection or matched index date.
From 31 to 180 days, the cumulative incidence of death and all organ-level PCCs was greater in infected versus uninfected participants, with cumulative incidence differences lower in the Omicron than in the WT era and lower in vaccinated than in unvaccinated persons. In the Omicron era, the cumulative incidence of death and most PCCs from day 181-365 were higher in infected than in uninfected participants only among unvaccinated but not among vaccinated persons.
Excess burden of PCCs and mortality persisted 31-180 days after infection in the Omicron era, albeit at a lower level than in the WT and Delta eras. Excess burden of mortality and most PCCs was much lower 181-365 days after infection and was observed in the Omicron era only among unvaccinated persons, suggesting a protective effect of vaccination.
2019冠状病毒病（COVID-19）与感染后状况（PCCs）的发生有关。我们调查了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染是否会增加感染后长达1年的特定PCCs风险或死亡风险，分别在野生型（WT）、阿尔法变异株流行期、德尔塔变异株流行期和奥密克戎变异株流行期以及按疫苗接种状态进行调查。
我们利用退伍军人健康管理局的健康记录来模拟一项关于SARS-CoV-2感染与未感染的假设性目标试验。2020年3月至2022年4月期间SARS-CoV-2检测呈阳性的退伍军人（n = 430160）与SARS-CoV-2检测未呈阳性的退伍军人进行1:1匹配。在感染或匹配的索引日期后的31 - 180天和181 - 365天确定全因死亡率和32种潜在PCCs的累积发病率。
在31至180天，感染组的死亡和所有器官水平PCCs的累积发病率高于未感染组，奥密克戎变异株流行期的累积发病率差异低于野生型流行期，接种疫苗者低于未接种疫苗者。在奥密克戎变异株流行期，仅在未接种疫苗者中，感染组在第181 - 365天的死亡和大多数PCCs的累积发病率高于未感染组，而接种疫苗者中并非如此。
在奥密克戎变异株流行期，感染后31 - 180天PCCs和死亡率的额外负担持续存在，尽管低于野生型和德尔塔变异株流行期。感染后181 - 365天死亡率和大多数PCCs的额外负担要低得多，并且仅在奥密克戎变异株流行期的未接种疫苗者中观察到，表明疫苗接种具有保护作用。
