Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection

1. Among a large cohort from United States, infection with SARS-CoV-2 led to excess risk of developing new clinical sequelae, less commonly seen in other viral illnesses, after the acute phase of the infection.

Evidence Rating Level: 2 (Good)

In addition to the acute threat to life that the SARS-CoV-2 infection can pose to an infected individual, there is emerging literature suggesting that infection is additionally associated with significant long-term sequelae that can contribute to  increased morbidity and mortality worldwide. In this retrospective cohort study, researchers examined individuals aged 18 to 65, enrolled continuously in a health plan in 2019 – 2020, who were diagnosed with COVID-19 to further investigate the emergence of clinical sequalae following the acute phase of infection. The study utilized two control groups. The first comparator group were individuals aged 18 to 65, enrolled in a continuous health plan in 2019 or 2020, who were not diagnosed with COVID-19. There were 226 586 matched pairs made with this comparison group. The other comparator group included individuals aged 18 to 65, enrolled in a continuous health program in 2016, 2017 or 2018, who developed a viral-respiratory tract illness. The study matched 244 276 pairs with this comparison group. Examples of various sequelae included arrythmias, dermatitis, stroke, cardiomyopathy, hypercoagulability/deep vein thrombosis, kidney injury, seizures, and many more. All three comparator groups had lower rates of clinical sequelae develop, although the difference was smallest when compared to the viral lower respiratory tract group. The study found that 10.01% of individuals with COVID-19 developed new sequela after the acute phase of the infection and 4.01% had more than one type of sequelae. In the 2020 group, 7.08% of patients developed a clinical sequela (difference = 2.93%, p < 0.01) and 1.99% developed more than one type of sequelae (difference = 2.02%, p < 0.01). The 2019 group demonstrated that 7.36% of patients developed a clinical sequela (difference = 2.68%, p < 0.01) and 2.11% developed more than one sequela (difference = 1.91%, p < 0.01). In the viral lower respiratory tract matched groups, 10.38% of individuals with COVID-19 developed one sequela compared to 9.71% of those with another viral illness (difference = 0.68%, p < 0.01). 4.22% of individuals with COVID-19 developed more than one sequela compared to 3.25% of individuals with another viral illness (difference = 0.97%, p < 0.01). Finally, the study concluded that excess risk for developing clinical sequelae increased significantly with age. Several studies in the past have examined acute sequelae associated with COVID-19, however, this is one of the first large scale studies focusing on sequelae after the acute infection. The significant risk of sequelae development reported in the study provides valuable insight into the ongoing impact COVID-19 can have on a patient’s medical course, and is highly relevant for healthcare planning discussions.

Click to read the study in BMJ

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