Almost half of patients hospitalized with COVID-19 develop at least one complication, regardless of age. This can have a significant impact on their ability to take care of themselves after discharge, suggesting a large UK prospective study.
With common complications and bad consequences, even among younger patients, researchers say the results emphasize the importance of vaccination and proper medical planning.
Research Release Along Lancet July 17th.
Contradictory current story
The team surveyed more than 73,000 UK patients admitted with COVID-19 between January and August 2020. Almost 50% of them developed at least one complication, from 39% aged 19-49 to 51% of older patients.
The most common complications are kidneys, complex respiratory tract, systemic, which have a continuous impact on patient health and the ability to take care of themselves after discharge, including 13% of ages 19-29. Decreased by 27%.
“This study contradicts the current explanation that COVID-19 is only dangerous to people with pre-existing comorbidities and the elderly,” said a co-principal professor of pediatric health and developmental medicine at the University of Liverpool. Calum Semple commented in the news release.
“It is becoming increasingly important to dispel and contribute to the scientific debate over such stories,” he continued. “Since the severity of the disease on admission is a predictor of complications even in young adults, prevention of complications requires a primary prevention strategy that means vaccination.”
Professor Ewen Harrison, co-senior author of the Center for Medical Informatics at the University of Edinburgh Asher Institute, agreed that their study emphasized the importance of COVID-19 vaccination.
“This result can also inform the public health message about the risks COVID-19 poses to young and healthy people at the population level, especially in terms of the importance of vaccination in this group.”
In addition, the results emphasize “some insightful patterns and trends that can inform the healthcare system and policymakers’ response to the effects of COVID-19.”
Dr. Thomas Drake, co-author of the Center for Medical Informatics at the University of Edinburgh Asher Institute, said the study also demonstrates the importance of considering “not only COVID-19 deaths but also other complications.” Emphasized.
He added: “To understand how COVID-19 has long-term effects on their health, we are still studying participants in our study.
“The results from these ongoing studies are particularly useful, as we have found that many people who survive COVID-19 and develop complications come from an economically active age group.”
Aya Riad, a medical student at the University of Edinburgh and co-author of the study, said it was important to understand this when “determining the best way to tackle a pandemic.”
“Focusing on COVID-19 death alone can underestimate the true impact, especially in young people who are more likely to survive severe COVID-19.”
Organ support
Previous studies of patients admitted with COVID-19 have shown a mortality rate of approximately 26%, with up to 17% requiring mechanical ventilation and critical care.
Researchers point out that “a significant proportion of COVID-19 patients develop serious illness and require organ support,” and “significant” additional physical and mental health morbidity. Lead to the state.
However, the widespread use of mortality as a result of epidemiological studies failed to capture “immediate short-term health problems faced by survivors, including in-hospital complications and functional consequences.”
To further investigate, the team conducted a prospective multicenter cohort study of patients aged 19 years and older with confirmed or highly suspected COVID-19 at 302 healthcare facilities in the United Kingdom.
Nurses and medical students collected baseline demographic and health-related data, including the presence of comorbidities such as chronic heart disease, blood disorders, kidney disease, neurological disorders, and lung disorders. asthma, HIV/ AIDS, cancer, liver disease, obesity, And rheumatic diseases.
They also collected data on the respiratory, neurological, cardiovascular, renal, gastrointestinal and systemic complications that participants experienced during hospitalization, and the ability of patients to take care of themselves when discharged.
Between January 17th and August 4th, 2020, 75,276 eligible patients aged 19 years and older were included. Among them, 73,197 (97.2%) had complication data available for analysis.
The average age of the patients was 71.1 years, 56.0% were male, and 81.0% had at least one comorbidity. Chronic heart disease is the most common (30.8%), diabetes (24.2%), chronic lung disease (16.7%), Chronic kidney disease (16.6%).
The overall mortality rate of the cohort was 31.5% and 49.7% of patients had at least one complication. Of the surviving patients, 43.5% had at least one complication.
Complications were found to be significantly associated with critical care hospitalization at an odds ratio of 7.25 (p <0.0001) and mortality at a hazard ratio of 1.74 (p <0.0001).
Risk factor
Like patients over the age of 60, men were more likely than women to have at least one complication.
The complication rate for patients over the age of 60 was 54.5% for men and 48.2% for women, while the complication rate for patients under the age of 60 was 48.8% for men and 36.6% for women.
Incidence increases with age, increasing from 27% of 19-29 years hospitalized with COVID-19 to 37% of 30-39 years, 43% of 40-49 years, and 51% of people over 50 years. Did.
Black patients were also more likely to experience complications than whites, 58% vs. 49%.
The most common complication was the kidney, which was found in 24.3% of patients, followed by complex respiratory (18.4%) and systemic (16.3%) complications.
Cardiovascular complications were recorded in 12.3% of patients, gastrointestinal and hepatic complications in 10.8%, and neurological complications in 4.3%.
The most common individual complications are Acute kidney injury, likely Acute respiratory distress syndrome, Liver disorder, anemia, And cardiac arrhythmia.
After admission, 27% of patients were less able to take care of themselves than they were before they were infected with COVID-19. This was a result related to older age, men, and critical care centers.
The team calculates that complications, with an odds ratio of 2.42 (p <0.0001), are associated with a significant reduction in self-care capacity after discharge.
“Inspirational idea”
In an accompanying comment, Dr. Xiaoying Gu and Professor Bin Cao of the National Center for Respiratory Diseases National Clinical Research Center, Beijing-Japan Friendship Hospital, said the study provides “exciting ideas” for further research.
“One of the most notable findings is that younger patients with complications have a much higher relative risk of death when compared to patients of the same age without complications, whereas older patients have a much higher relative risk of death. It’s the relative impact of complications on mortality. It seems low. “
It also states that “young patients who are unlikely to die in the acute phase but are likely to live longer with complications in the days following acute or subacute COVID-19 should also be noted. Shows, “they write.
They say the long-term effects of COVID-19 complications in hospitals, as well as the effects of ethnicity and socio-economic factors, need to be investigated.
This work is supported by grants from the National Institute for Health Research (NIHR), the British Medical Research Council, the NIHR Imperial Center for Biomedical Research, and HPRU. Respiratory tract infection Partnerships with Imperial College London, NIHR HPRU for Emerging and Zoological Infectious Diseases, University of Liverpool, Public Health England, Welcome Trust, International Development Agency, Bill & Melinda Gates Foundation, Liverpool Experimental Cancer Medical Center, NIHR Biomedical Research Center Imperial College London, EU platform for (re) Europe’s preparation for a new plague.
Professor Semple reports grants from DHSC, NIHR UK, MRC UK, HPRU for emerging and zoonotic diseases, and the University of Liverpool during the course of the study. Other than the submitted research, he is the chair of the Infectious Diseases Science Advisory Board and a minority shareholder in Integra Scientific in Greensboro, North Carolina.
No other relevant financial relationships have been declared.
Lancet 2021; 398: 223–37 doi: http: //www.thelancet.com/journals/lancet/article/PIIS0140-6736 (21) 00799-6 / fulltext
