Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: cohort study in OpenSAFELY using linked primary care, secondary care and death registration data-猫眼课题宝

DOI：

10.1101/2021.07.16.21260628

发表时间：

2021-07

期刊：

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其他

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作者：

K. Bhaskaran;C. Rentsch;G. Hickman;W. Hulme;Anna Schultze;H. Curtis;K. Wing;C. Warren-Gash;L. Tomlinson;C. Bates;R. Mathur;B. Mackenna;V. Mahalingasivam;A. Wong;A. Walker;C. Morton;D. Grint;A. Mehrkar;R. Eggo;P. Inglesby;I. Douglas;H. Mcdonald;J. Cockburn;E. Williamson;D. Evans;J. Parry;F. Hester;S. Harper;S. Evans;S. Bacon;L. Smeeth;B. Goldacre

背景：人们担心急性COVID-19后的中长期不良后果，但几乎没有相关证据。我们的目的是调查在COVID-19住院治疗出院后，住院和死亡的总体风险和特定原因的风险是否会增加。方法和发现：我们代表NHS-英格兰工作，使用OpenSAFELY中关联的初级保健和医院数据，比较了2020年2月至12月从COVID-19住院治疗出院的患者与（i）2019年一般人群的人口统计学匹配对照组;（ii）2017-19年从流感住院治疗出院的患者之间的住院和死亡风险（总体和特定原因）。我们使用考克斯回归调整个人和临床特征。对24，673名出院后COVID-19患者、123，362名一般人群对照和16，058名流感对照进行了[≤]315天的随访。COVID-19组住院或死亡的总体风险（30968起事件）高于一般人群对照（调整后HR 2.23，2.14-2.31），但与流感组相似（调整后HR 0.94，0.91-0.98）。COVID-19组的全因死亡率（7439起事件）最高（与普通人群对照组相比，调整后HR为4.97，4.58-5.40;与流感对照组相比，调整后HR为1.73，1.60-1.87）。COVID-19幸存者的病因特异性结局风险高于一般人群对照，COVID-19和流感患者之间基本相当。然而，COVID-19患者比流感患者更有可能因初次感染/其他下呼吸道感染而再次入院/死亡（调整后HR 1.37，1.22-1.54），并经历精神健康或认知相关入院/死亡（调整后-HR 1.36，1.01-2.83）;特别是，患有既存痴呆症的COVID-19幸存者痴呆症死亡风险较高。我们研究的一个局限性是，由于代码的使用不一致，在某些情况下，住院/死亡的原因可能被错误分类。结论：从COVID-19医院入院出院的人再次住院和死亡的风险明显高于一般人群，这表明医疗保健的额外负担相当大。大多数风险与流感住院后观察到的风险相似;但COVID-19患者的全因死亡率、首次感染导致的再入院/死亡和痴呆死亡的风险较高，突出了出院后监测的重要性。

Background: There is concern about medium to long-term adverse outcomes following acute COVID-19, but little relevant evidence exists. We aimed to investigate whether risks of hospital admission and death, overall and by specific cause, are raised following discharge from a COVID-19 hospitalisation. Methods and Findings: Working on behalf of NHS-England, we used linked primary care and hospital data in OpenSAFELY to compare risks of hospital admission and death, overall and by specific cause, between people discharged from COVID-19 hospitalisation (February-December 2020), and (i) demographically-matched controls from the 2019 general population; (ii) people discharged from influenza hospitalisation in 2017-19. We used Cox regression adjusted for personal and clinical characteristics. 24,673 post-discharge COVID-19 patients, 123,362 general population controls, and 16,058 influenza controls were followed for [≤]315 days. Overall risk of hospitalisation or death (30968 events) was higher in the COVID-19 group than general population controls (adjusted-HR 2.23, 2.14-2.31) but similar to the influenza group (adjusted-HR 0.94, 0.91-0.98). All-cause mortality (7439 events) was highest in the COVID-19 group (adjusted-HR 4.97, 4.58-5.40 vs general population controls and 1.73, 1.60-1.87 vs influenza controls). Risks for cause-specific outcomes were higher in COVID-19 survivors than general population controls, and largely comparable between COVID-19 and influenza patients. However, COVID-19 patients were more likely than influenza patients to be readmitted/die due to their initial infection/other lower respiratory tract infection (adjusted-HR 1.37, 1.22-1.54), and to experience mental health or cognitive-related admission/death (adjusted-HR 1.36, 1.01-2.83); in particular, COVID-19 survivors with pre-existing dementia had higher risk of dementia death. One limitation of our study is that reasons for hospitalisation/death may have been misclassified in some cases due to inconsistent use of codes. Conclusions: People discharged from a COVID-19 hospital admission had markedly higher risks for rehospitalisation and death than the general population, suggesting a substantial extra burden on healthcare. Most risks were similar to those observed after influenza hospitalisations; but COVID-19 patients had higher risks of all-cause mortality, readmissions/death due to the initial infection, and dementia death, highlighting the importance of post-discharge monitoring.

Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: cohort study in OpenSAFELY using linked primary care, secondary care and death registration data

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