What are the risk factors associated with acute sequelae of SARS-CoV-2?

In a recent study posted on medrex sib*Preprint server, Researchers investigated risk factors correlated with acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PASC).

Background

Some coronavirus disease 2019 (COVID-19) patients have reported developing long-term complications, also known as PASC or long-COVID. Long-COVID is defined by the World Health Organization (WHO) as the disease that presents in individuals with a suspected or confirmed history of COVID-19, usually from the onset of SARS-CoV-2 infection and associated symptoms. Within a month, minimum two months.

Symptoms and complications associated with prolonged infection with COVID-1 include post-exercise malaise, fatigue, shortness of breath, cognitive impairment, and depression. Therefore, considerable research efforts have been made to identify risk factors for PASC.

About research

In this study, investigators investigated the association between demographic, clinical course, comorbidities, and patient-level social determinants of health (SDoH) factors with PASC risk.

The study cohort included 4,559,795 potentially eligible patients diagnosed with or tested positive for COVID-19. antigen (AG) Laboratory testing or polymerase chain reaction (PCR) for COVID-19. Of these, 3,884,477 were older than his 18 years. The team considered his COVID-19 index date as the earliest date on which a positive COVID-19 diagnosis or test was reported. Index days were employed to assess the relative timing of SARS-CoV-2 infection and diagnosis of prolonged COVID or prolonged COVID clinic visits.

In the primary analysis, cases of infection were defined as those documented with a diagnosis of U09.0 or those who visited a long-term COVID clinic in the National COVID Cohort Collaborative (N3C). In addition, control identification was performed and categorized as follows: (1) unrestricted controls – individuals not detected as cases, (2) restricted controls – individuals with strong long-term COVID experience. Suspected, attended a long-term COVID clinic, and (3) more limited controls included individuals who had not experienced long-term COVID and who were strongly suspected of not visiting a long-term COVID clinic.

The team used data prior to the date of COVID-19 diagnosis to detect patient age, gender, ethnicity, obesity, smoking status, comorbidities, and substance abuse status. The study included 17 common comorbidities included in the Charlson Comorbidity Index and additional treatments and comorbidities considered risk factors for severe acute COVID-19 infection. The team also identified data related to COVID-19 hospitalization, length of stay, invasive ventilator use, extracorporeal membrane oxygen therapy (ECMO), vasopressors, remdesivir, and diagnosis of acute kidney injury and sepsis. .

result

Findings showed that of the 8325 diagnosed PASC patients, 56.6% were 50 years or older, 62.8% were female, and 68.6% were non-Hispanic white. Of the complications reported, 56.4% were obesity, 40.4% hypertension, 28.9% chronic lung disease, and 20.5% uncomplicated diabetes. Moreover, compared with unrestricted controls, PASC patients were more likely to be older, male, and non-Hispanic white.

Notably, comorbidities were more common in PASC patients than controls, with hypertension in 40.4% and 26.2% of patients, chronic lung disease in 28.9% and 13.7%, and uncomplicated diabetes in 20.5% and 13.3% of patients. there were. Respectively. Furthermore, the number of hospitalizations related to COVID-19 was significantly higher in cases than in controls.

The team identified age as an important risk factor for PASC, with higher risk found in individuals aged 40 to 69 years. Women were also more likely to get PASC, and non-Hispanic blacks, Hispanics, and Asians were less likely than non-Hispanic whites to display PASC. Moreover, the most commonly observed comorbidities among PASC patients were tuberculosis, chronic lung disease, rheumatic disease, peptic ulcer, and obesity. Moreover, severe acute infection was the strongest predictor of PASC, along with prolonged hospitalization, prolonged hospitalization, COVID-related hospitalization, and mechanical ventilation.

Among the restricted controls, the magnitude and direction of the odds ratios were comparable to those of the primary analyses. However, obesity became less important as the limits adopted by the research team became progressively tighter. Moreover, ECMO correlated with PASC when more restrictive controls were used, but did not show statistical significance when restrictive controls were used.

Risk factors associated with hospitalization for COVID-19 were putative markers of severity of SARS-CoV-2 infection and obesity. Furthermore, living in a community with higher education improved the likelihood of long-term clinic diagnosis and care for COVID-1. Individuals who were not hospitalized on the index day had the following risk factors that differed from hospitalized patients: a diagnosis of coronary artery disease, peptic ulcer, systemic corticosteroid use, or depression.

Overall, the study results identified common risk factors associated with PASC, including middle age, comorbidities, and severe SARS-CoV-2 disease.

*Important Notices

medRxiv publishes non-peer-reviewed, preliminary scientific reports and should not be considered conclusive, to guide clinical practice/health-related actions, or to be treated as established information .