High-dimensional characterization of post-acute sequelae of COVID-19
High-dimensional characterization of post-acute sequelae of COVID-19
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DOI：
10.1038/s41586-021-03553-9
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发表时间：
2021-04-22
期刊：
影响因子：
64.8
通讯作者：
Bowe, Benjamin
中科院分区：
文献类型：
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作者：
Al-Aly, Ziyad;Xie, Yan;Bowe, Benjamin
COVID-19的急性临床表现已被很好地描述（1,2），但该疾病的急性后后遗症尚未得到全面描述。在这里，我们使用美国退伍军人事务部的国家医疗保健数据库，系统地、全面地识别诊断后存活至少30天的COVID-19患者6个月的事件后遗症，包括诊断、药物使用和实验室异常。我们表明，在患病的头30天之后，COVID-19患者的死亡风险和卫生资源的使用风险更高。我们的高维方法可以识别呼吸系统的意外后遗症，以及其他一些后遗症，包括神经系统和神经认知障碍、精神健康障碍、代谢障碍、心血管疾病、胃肠疾病、不适、疲劳、肌肉骨骼疼痛和贫血。我们显示了几种治疗药物的使用增加，包括止痛药（阿片类药物和非阿片类药物）以及抗抑郁药、抗焦虑药、降压药和口服降糖药，以及一些器官系统实验室异常的证据。我们对一系列预先指定结果的分析显示，风险梯度根据COVID-19急性感染的严重程度（即患者是否住院、住院或接受重症监护）而增加。我们的研究结果表明，在COVID-19急性期后存活的患者经历了跨越肺部和几个肺外器官系统的重大健康损失负担。这些结果将有助于为卫生系统规划和制定多学科护理战略提供信息，以减少COVID-19患者的慢性健康损失。
The acute clinical manifestations of COVID-19 have been well characterized(1,2), but the post-acute sequelae of this disease have not been comprehensively described. Here we use the national healthcare databases of the US Department of Veterans Affairs to systematically and comprehensively identify 6-month incident sequelae-including diagnoses, medication use and laboratory abnormalities-in patients with COVID-19 who survived for at least 30 days after diagnosis. We show that beyond the first 30 days of illness, people with COVID-19 exhibit a higher risk of death and use of health resources. Our high-dimensional approach identifies incident sequelae in the respiratory system, as well as several other sequelae that include nervous system and neurocognitive disorders, mental health disorders, metabolic disorders, cardiovascular disorders, gastrointestinal disorders, malaise, fatigue, musculoskeletal pain and anaemia. We show increased incident use of several therapeutic agents-including pain medications (opioids and non-opioids) as well as antidepressant, anxiolytic, antihypertensive and oral hypoglycaemic agents-as well as evidence of laboratory abnormalities in several organ systems. Our analysis of an array of prespecified outcomes reveals a risk gradient that increases according to the severity of the acute COVID-19 infection (that is, whether patients were not hospitalized, hospitalized or admitted to intensive care). Our findings show that a substantial burden of health loss that spans pulmonary and several extrapulmonary organ systems is experienced by patients who survive after the acute phase of COVID-19. These results will help to inform health system planning and the development of multidisciplinary care strategies to reduce chronic health loss among individuals with COVID-19.