Mazzali Cristina, Magnoni Pietro, Zucchi Alberto, Maifredi Giovanni, Cavalieri d'Oro Luca, Gambino Maria Letizia, Fanetti Anna Clara, Perotti Pietro Giovanni, Villa Marco, Valsecchi Maria Grazia, Vigani Daria, Lucifora Claudio, Russo Antonio Giampiero
Epidemiology Unit, Agency for Health Protection Milan, Milan, Italy.
Epidemiology Unit, Agency for Health Protection Bergamo, Bergamo, Italy.
Front Public Health. 2025 Aug 20;13:1637112. doi: 10.3389/fpubh.2025.1637112. eCollection 2025.
Post-acute sequelae of COVID-19 (PASC) encompass several clinical outcomes, from new-onset symptoms to both acute and chronic diagnoses, including pulmonary and extrapulmonary manifestations. Health administrative data (HAD) from health information systems allow population-level analyses of such outcomes. Our primary aim was to identify clinical conditions potentially attributable to SARS-CoV-2 infection, and the types of HAD and "diagnostic criteria" used for their detection.
We performed a literature review to identify HAD-based cohort studies assessing the association between SARS-CoV-2 infection and medium-/long-term outcomes in the general population. From each included study, we extracted data on design, algorithms used for outcome identification (sources, coding systems, codes, time criteria/thresholds), and whether significant associations with SARS-CoV-2 infection were reported.
We identified six studies investigating acute and chronic conditions grouped by clinical domain (cardiovascular, respiratory, neurologic, mental health, endocrine/metabolic, pediatric, miscellaneous). Two studies also addressed the onset of specific symptoms. Cardio/cerebrovascular conditions were most studied, with significant associations reported for deep vein thrombosis, heart failure, atrial fibrillation, and coronary artery disease. Conditions in other domains were less investigated, with inconsistent findings. Only three studies were designed as test-positive vs. test-negative comparisons.
Heterogeneity in data sources, study design, and outcome definitions hinder the comparability of studies and explain the inconsistencies in findings about associations with SARS-CoV-2 infection. Rigorously designed studies on large populations with wide availability of data from health information systems are needed for population-level analyses on PASC, and especially on its impact on chronic diseases and their future burden on healthcare systems.
新冠病毒病的急性后遗症（PASC）包括多种临床结果，从新发症状到急性和慢性诊断，包括肺部和肺外表现。卫生信息系统中的卫生行政数据（HAD）可用于对此类结果进行人群水平的分析。我们的主要目的是确定可能归因于SARS-CoV-2感染的临床病症，以及用于检测这些病症的HAD类型和“诊断标准”。
我们进行了一项文献综述，以确定基于HAD的队列研究，评估SARS-CoV-2感染与普通人群中长期结果之间的关联。从每项纳入研究中，我们提取了关于设计、用于结果识别的算法（来源、编码系统、代码、时间标准/阈值）以及是否报告了与SARS-CoV-2感染存在显著关联的数据。
我们确定了六项研究，这些研究调查了按临床领域（心血管、呼吸、神经、心理健康、内分泌/代谢、儿科、其他）分组的急性和慢性病症。两项研究还探讨了特定症状的发作情况。心血管/脑血管病症研究最多，深静脉血栓形成、心力衰竭、心房颤动和冠状动脉疾病报告有显著关联。其他领域的病症研究较少，结果不一致。只有三项研究设计为检测阳性与检测阴性对照。
数据源、研究设计和结果定义的异质性阻碍了研究的可比性，并解释了关于与SARS-CoV-2感染关联的研究结果不一致的原因。需要对大量人群进行严格设计的研究，并广泛获取卫生信息系统的数据，以便对PASC进行人群水平的分析，尤其是对其对慢性病的影响及其未来对医疗保健系统的负担进行分析。
