Tag: covid hospitalization

The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis

Abstract:

Background: The aim of this study was to systematically synthesise the global evidence on the prevalence of persistent symptoms in a general post COVID-19 population.

Methods: A systematic literature search was conducted using multiple electronic databases (MEDLINE and The Cochrane Library, Scopus, CINAHL, and medRxiv) until January 2022. Studies with at least 100 people with confirmed or self-reported COVID-19 symptoms at ≥28 days following infection onset were included. Patient-reported outcome measures and clinical investigations were both assessed. Results were analysed descriptively, and meta-analyses were conducted to derive prevalence estimates. This study was pre-registered (PROSPERO-ID: CRD42021238247).

Findings: 194 studies totalling 735,006 participants were included, with five studies conducted in those <18 years of age. Most studies were conducted in Europe (n = 106) or Asia (n = 49), and the time to follow-up ranged from ≥28 days to 387 days. 122 studies reported data on hospitalised patients, 18 on non-hospitalised, and 54 on hospitalised and non-hospitalised combined (mixed). On average, at least 45% of COVID-19 survivors, regardless of hospitalisation status, went on to experience at least one unresolved symptom (mean follow-up 126 days). Fatigue was frequently reported across hospitalised (28.4%; 95% CI 24.7%-32.5%), non-hospitalised (34.8%; 95% CI 17.6%-57.2%), and mixed (25.2%; 95% CI 17.7%-34.6%) cohorts. Amongst the hospitalised cohort, abnormal CT patterns/x-rays were frequently reported (45.3%; 95% CI 35.3%-55.7%), alongside ground glass opacification (41.1%; 95% CI 25.7%-58.5%), and impaired diffusion capacity for carbon monoxide (31.7%; 95% CI 25.8%-3.2%).

Interpretation: Our work shows that 45% of COVID-19 survivors, regardless of hospitalisation status, were experiencing a range of unresolved symptoms at ∼ 4 months. Current understanding is limited by heterogeneous study design, follow-up durations, and measurement methods. Definition of subtypes of Long Covid is unclear, subsequently hampering effective treatment/management strategies.

Source: O’Mahoney LL, Routen A, Gillies C, Ekezie W, Welford A, Zhang A, Karamchandani U, Simms-Williams N, Cassambai S, Ardavani A, Wilkinson TJ, Hawthorne G, Curtis F, Kingsnorth AP, Almaqhawi A, Ward T, Ayoubkhani D, Banerjee A, Calvert M, Shafran R, Stephenson T, Sterne J, Ward H, Evans RA, Zaccardi F, Wright S, Khunti K. The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis. EClinicalMedicine. 2022 Dec 1;55:101762. doi: 10.1016/j.eclinm.2022.101762. PMID: 36474804; PMCID: PMC9714474. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9714474/ (Full text)

Outcomes of SARS-CoV-2 Reinfection

Abstract:

First infection with SARS-CoV-2 is associated with increased risk of acute and post-acute death and sequelae in the pulmonary and extrapulmonary organ systems. However, whether reinfection adds to the risk incurred after the first infection is not clear. Here we use the national health care databases of the US Department of Veterans Affairs to build a cohort of people with first infection (n = 257,427), reinfection (2 or more infections, n = 38,926), and a non-infected control group (n = 5,396,855) to estimate risks and 6-month burdens of all-cause mortality, hospitalization, and a set of pre-specified incident outcomes.

We show that compared to people with first infection, reinfection contributes additional risks of all-cause mortality, hospitalization, and adverse health outcomes in the pulmonary and several extrapulmonary organ systems (cardiovascular disorders, coagulation and hematologic disorders, diabetes, fatigue, gastrointestinal disorders, kidney disorders, mental health disorders, musculoskeletal disorders, and neurologic disorders); the risks were evident in those who were unvaccinated, had 1 shot, or 2 or more shots prior to the second infection; the risks were most pronounced in the acute phase, but persisted in the post-acute phase of reinfection, and most were still evident at 6 months after reinfection.

Compared to non-infected controls, assessment of the cumulative risks of repeated infection showed that the risk and burden increased in a graded fashion according to the number of infections. The constellation of findings show that reinfection adds non-trivial risks of all-cause mortality, hospitalization, and adverse health outcomes in the acute and post-acute phase of the reinfection. Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention.

Source: Ziyad Al-Aly, Benjamin Bowe, Yan Xie et al. Outcomes of SARS-CoV-2 Reinfection, 17 June 2022, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-1749502/v1] https://www.researchsquare.com/article/rs-1749502/v1 (Full text available as PDF file)

“Long COVID” results after hospitalization for SARS-CoV-2 infection

Abstract:

Long-term sequelae of symptomatic infection caused by SARS-CoV-2 are largely undiscovered. We performed a prospective cohort study on consecutively hospitalized Sars-CoV-2 patients (March-May 2020) for evaluating COVID-19 outcomes at 6 and 12 months. After hospital discharge, patients were addressed to two follow-up pathways based on respiratory support needed during hospitalization. Outcomes were assessed by telephone consultation or ambulatory visit.

Among 471 patients, 80.9% received no respiratory support during hospitalization; 19.1% received non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV). 58 patients died during hospitalization, therefore 413 were enrolled for follow-up. At 6 months, among 355 patients, the 30.3% had any symptoms, 18.0% dyspnea, 6.2% neurological symptoms. Fifty-two out of 105 had major damages in interstitial computed tomography images. NIV/IMV patients had higher probability to suffer of symptoms (aOR = 4.00, 95%CI:1.99-8.05), dyspnea (aOR = 2.80, 95%CI:1.28-6.16), neurological symptoms (aOR = 9.72, 95%CI:2.78-34.00). At 12 months, among 344, the 25.3% suffered on any symptoms, 12.2% dyspnea, 10.1% neurological symptoms. Severe interstitial lesions were present in 37 out of 47 investigated patients.

NIV/IMV patients in respect to no respiratory support, had higher probability of experiencing symptoms (aOR = 3.66, 95%CI:1.73-7.74), neurological symptoms (aOR = 8.96, 95%CI:3.22-24.90). COVID-19 patients showed prolonged sequelae up to 12 months, highlighting the need of follow-up pathways for post-COVID-19 syndrome.

Source: Rigoni M, Torri E, Nollo G, Donne LD, Rizzardo S, Lenzi L, Falzone A, Cozzio S. “Long COVID” results after hospitalization for SARS-CoV-2 infection. Sci Rep. 2022 Jun 10;12(1):9581. doi: 10.1038/s41598-022-13077-5. PMID: 35688830; PMCID: PMC9185134. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9185134/ (Full text)

Is the number of long-term post-COVID symptoms relevant in hospitalized COVID-19 survivors?

Dear editor,

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the coronavirus disease-2019 (COVID-19) is associated with heterogeneous symptoms at its acute phase but also at post-acute phase. Current evidence suggests that 50% of survivors experience post-COVID symptoms the following months after the acute infection [,]. The presence of post-COVID symptoms is associated with worse quality of life . In fact, up to 50 diffferent post-COVID symptoms have been described, and patients usually exhibit more than one symptom . Similarly, the number of symptoms at onset is also heterogeneous, and patients can exhibit several number of symptoms. It has been found that a higher number of onset symptoms at the acute phase (high viral load) is associated with a greater number of post-COVID symptoms . Previous studies focussing on post-COVID symptoms did not use machine learning analysis. Here we present the use of a network analysis for investigating the associations between COVID-19 onset symptoms at hospital admission and the presence of post-COVID symptoms at a long-term follow-up in previously hospitalised COVID-19 survivors recruited from different hospitals.

Read the rest of this article HERE.

Source: Fernández-de-Las-Peñas C, Varol U, Fuensalida-Novo S, Plaza-Canteli S, Valera-Calero JA. Is the number of long-term post-COVID symptoms relevant in hospitalized COVID-19 survivors? Eur J Intern Med. 2022 Jun;100:133-136. doi: 10.1016/j.ejim.2022.02.013. Epub 2022 Feb 14. PMID: 35181183; PMCID: PMC8841158. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8841158/ (Full text)