Post-acute effects of SARS-CoV-2 infection in individuals not requiring hospital admission: a Danish population-based cohort study.
Post-acute effects of SARS-CoV-2 infection in individuals not requiring hospital admission: a Danish population-based cohort study.
复制标题
DOI：
10.1016/s1473-3099(21)00211-5
复制
发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Pottegård A
中科院分区：
文献类型：
--
作者：
Lund LC;Hallas J;Nielsen H;Koch A;Mogensen SH;Brun NC;Christiansen CF;Thomsen RW;Pottegård A
因 COVID-19 入院的个人出院后可能会出现持续症状（所谓的长期 COVID）和迟发性并发症。然而，对于那些未入院的人的风险知之甚少。因此，我们检查了 SARS-CoV-2 感染后无需住院的处方药和医疗保健使用情况。这是一项基于人群的队列研究，使用丹麦处方、患者和健康保险登记处。 2020 年 2 月 27 日至 5 月 31 日期间在丹麦进行 SARS-CoV-2 RT-PCR 检测呈阳性或阴性的所有个体均有资格纳入。感兴趣的结果包括延迟性急性并发症、慢性疾病、因持续症状而去医院就诊以及处方药的使用。我们使用了 SARS-CoV-2 测试后 2 周至 6 个月内非住院 SARS-CoV-2 阳性个体和匹配的 SARS-CoV-2 阴性个体的数据，以获得 14 个药物组和 27 个医院诊断的倾向得分加权风险差异 (RD) 和风险比 (RR)，表明潜在的急性后效应。我们还计算了整体医疗保健使用的先前事件发生率调整后的比率。这项研究已在欧盟授权后研究电子登记册 (EUPAS37658) 中注册。 2020 年 2 月 27 日至 5 月 31 日，丹麦有 10 498 名符合条件的个人检测出 SARS-CoV-2 呈阳性，其中 8983 人 (85·6%) 在检测呈阳性后 2 周仍活着且未入院。匹配的未入院的 SARS-CoV-2 阴性参考人群由 80 894 人组成。与 SARS-CoV-2 阴性个体相比，SARS-CoV-2 阳性个体启动新药的风险并未增加（RD <0·1%），但支气管扩张剂，特别是短效 β2 激动剂除外（6935 名阳性个体中的 117 名 [1·7%] 与 57 206 名阴性个体中的 743 名 [1·3%]；RD +0·4% [95% CI 0·1–0·7]；RR 1·32 [1·09–1·60]）和曲坦类（8292 中的 33 [0·4%] vs 72 828 中的 198 [0·3%]；RD +0·1% [0·0–0·3]；RR 1·55 [1·07–2·25]）。接受医院诊断呼吸困难（8676 中的 103 [1·2%] vs 76 728 中的 499 [0·7%]；RD +0·6% [0·4–0·8]；RR 2·00 [1·62–2·48]）和静脉血栓栓塞（8785 中的 20 [0·2%] vs 110）的风险增加78 872 中的 [0·1%]；与阴性个体相比，SARS-CoV-2 阳性个体的 RD +0·1% [0·0–0·2]；RR 1·77 [1·09–2·86]），但其他诊断的风险没有增加。与 SARS-CoV-2 阴性个体相比，全科医生就诊总数 (1·18 [95% CI 1·15–1·22]) 和门诊医院就诊 (1·10 [1·05–1·16])（但不包括入院）的既往事件发生率调整率比显示，SARS-CoV-2 阳性个体比 SARS-CoV-2 阴性个体有所增加。 SARS-CoV-2 感染后无需住院的严重急性后并发症的绝对风险较低。然而，全科医生就诊和门诊就诊的增加可能表明存在 COVID-19 后遗症。没有任何。
Individuals admitted to hospital for COVID-19 might have persisting symptoms (so-called long COVID) and delayed complications after discharge. However, little is known regarding the risk for those not admitted to hospital. We therefore examined prescription drug and health-care use after SARS-CoV-2 infection not requiring hospital admission. This was a population-based cohort study using the Danish prescription, patient, and health insurance registries. All individuals with a positive or negative RT-PCR test for SARS-CoV-2 in Denmark between Feb 27 and May 31, 2020, were eligible for inclusion. Outcomes of interest were delayed acute complications, chronic disease, hospital visits due to persisting symptoms, and prescription drug use. We used data from non-hospitalised SARS-CoV-2-positive and matched SARS-CoV-2-negative individuals from 2 weeks to 6 months after a SARS-CoV-2 test to obtain propensity score-weighted risk differences (RDs) and risk ratios (RRs) for initiation of 14 drug groups and 27 hospital diagnoses indicative of potential post-acute effects. We also calculated prior event rate ratio-adjusted rate ratios of overall health-care use. This study is registered in the EU Electronic Register of Post-Authorisation Studies (EUPAS37658). 10 498 eligible individuals tested positive for SARS-CoV-2 in Denmark from Feb 27 to May 31, 2020, of whom 8983 (85·6%) were alive and not admitted to hospital 2 weeks after their positive test. The matched SARS-CoV-2-negative reference population not admitted to hospital consisted of 80 894 individuals. Compared with SARS-CoV-2-negative individuals, SARS-CoV-2-positive individuals were not at an increased risk of initiating new drugs (RD <0·1%) except bronchodilating agents, specifically short-acting β2-agonists (117 [1·7%] of 6935 positive individuals vs 743 [1·3%] of 57 206 negative individuals; RD +0·4% [95% CI 0·1–0·7]; RR 1·32 [1·09–1·60]) and triptans (33 [0·4%] of 8292 vs 198 [0·3%] of 72 828; RD +0·1% [0·0–0·3]; RR 1·55 [1·07–2·25]). There was an increased risk of receiving hospital diagnoses of dyspnoea (103 [1·2%] of 8676 vs 499 [0·7%] of 76 728; RD +0·6% [0·4–0·8]; RR 2·00 [1·62–2·48]) and venous thromboembolism (20 [0·2%] of 8785 vs 110 [0·1%] of 78 872; RD +0·1% [0·0–0·2]; RR 1·77 [1·09–2·86]) for SARS-CoV-2-positive individuals compared with negative individuals, but no increased risk of other diagnoses. Prior event rate ratio-adjusted rate ratios of overall general practitioner visits (1·18 [95% CI 1·15–1·22]) and outpatient hospital visits (1·10 [1·05–1·16]), but not hospital admission, showed increases among SARS-CoV-2-positive individuals compared with SARS-CoV-2-negative individuals. The absolute risk of severe post-acute complications after SARS-CoV-2 infection not requiring hospital admission is low. However, increases in visits to general practitioners and outpatient hospital visits could indicate COVID-19 sequelae. None.