Post-COVID Syndrome is linked to higher mortality risk and multi-organ dysfunction

1. Hospital readmission and mortality rates were higher in post-COVID patients as compared to matched control groups.

2. More diagnoses of respiratory disease, diabetes, and cardiovascular events were observed in post COVID patients.

3. Older and non-white individuals were at the highest risk for post-COVID complications.

Evidence Rating Level: 2 (Good)

Study Rundown: Currently, the particular chronic sequelae of COVID infection are poorly understood. This study has attempted to assess the manifestations of disease after an acute COVID infection as a means of characterizing post-COVID syndrome. Indeed, most studies on COVID have focused on the acute infection phase, leaving the post-infection complications poorly characterized. It is vital that the potential complications of post-COVID syndrome are ascertained so that possible therapies may be appropriately initiated. This study observed higher rates of mortality and readmission in patients having been recently hospitalized with COVID; in particular, it was observed that post-COVID diagnoses of respiratory disease, diabetes, and cardiovascular events were prevalent at much higher rates. In addition, those aged 70 and older along with those from minority backgrounds were at a much higher risk of developing post-infection complications as compared to their white peers. This study is most strengthened by its large subject pool. Significant limitations exist; namely, this is a retrospective study with broad inclusion criteria. The overall clinical status of the patients followed in this study may not have been fully depicted as only major comorbidities were included as matching factors and primary outcomes. Further, the matched control group used was meant to represent the general population and not others with non-COVID hospitalizations; this can lead to the further influence of confounders in such an analysis. Moreover, environmental factors may have played a significant role in the subsequent medical progression of the patient in addition to the manifestation of post-COVID syndrome; this study is thus unable to meaningfully explore causality beyond correlation.

Click to read the study in BMJ

Relevant Reading: A Review of Persistent Post-COVID Syndrome (PPCS)

In-Depth [retrospective cohort]: This study applied a retrospective observational cohort design to data acquired from a national database in England. COVID patient populations were drawn from all those admitted with a COVID related hospitalized from January 1st, 2020 to August 31st, 2020. A matched control group was derived from all those living in the database that were not hospitalized, in other words, the general English population. A matching procedure was applied based on age, ethnicity, region, poverty, and comorbidities (i.e., respiratory disease, cardiovascular event, diabetes, chronic kidney disease, chronic liver disease, and hypertension). Overall, patients discharged after having COVID had a mean age of 64.5 years (SD 19.2) and were 54.9% male. Mortality rates (320 deaths per 1000 person years [95% CI 311.9-328.3] vs. 41.3 per 1000 [95% CI 38.6-44.3]), readmission rates (766 per 1000 [95% 753.4-778.8]) vs. 218.9 per 1000 [95% 212.4-225.4]), and incidence of multiorgan dysfunction (i.e. diabetes, cardiovascular events, chronic kidney disease, chronic liver disease) after discharge were significantly higher in those with recent COVID hospitalizations compared to matched controls. Among those with hospitalized with COVID, rates for all outcomes after discharge were greater among patients aged 70 years or more compared to those less than 70 years. However, compared to the control cohort, those aged less than 70 and belonging to ethnic minority groups showed greater relative risks than those aged 70 or more or of white ethnic groups. The greatest differences between risk rates were seen in respiratory disease (10.5 [95% CI 9.7-11.4] for age less than 70 years compared to 4.6 [95% CI 4.3-4.8] for those aged 70 or more; and 11.4 [95% 9.8 to 13.3] for minorities compared to 5.2 [95% 5.0 – 5.5] for white ethnic groups).

Image: PD

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