Acute and postacute sequelae associated with SARS-CoV-2 reinfection.
Acute and postacute sequelae associated with SARS-CoV-2 reinfection.
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DOI：
10.1038/s41591-022-02051-3
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发表时间：
2022-11
期刊：
影响因子：
82.9
通讯作者：
Al-Aly, Ziyad
中科院分区：
文献类型：
--
作者：
Bowe, Benjamin;Xie, Yan;Al-Aly, Ziyad
首先，感染严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)会增加各种器官系统的急性和急性后死亡和后遗症的风险。目前尚不清楚再次感染是否会增加首次感染后产生的风险。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建立了一个队列，其中包括一次感染SARS-CoV-2(n = 443,588)、再次感染(两次或更多感染，n = 40,947)和未感染的对照组(n = 5,334,729)。我们使用逆概率加权生存模型来估计死亡、住院和事件后遗症的风险和6个月的负担。与不再感染相比，再感染增加了死亡(危险比(HR) = 2.17，95%可信区间(CI)1.93~2.45)、住院(HR = 3.32，95%CI 3.13~3.51)和后遗症(包括肺、心血管、血液、糖尿病、胃肠道、肾脏、精神健康、肌肉骨骼和神经疾病)的风险。无论接种状态如何，风险都是显而易见的。风险在急性期最为明显，但在6个月后的急性期持续存在。与未感染的对照组相比，重复感染的累积风险和负担随着感染次数的增加而增加。限制因素包括以白人男性为主的队列。证据表明，在急性期和急性期，再感染进一步增加了多个器官系统的死亡、住院和后遗症的风险。减少SARS-CoV-2造成的死亡和疾病的总体负担将需要预防再次感染的战略。一项使用美国退伍军人事务部数据库的新分析表明，与没有再感染的人相比，患有SARS-CoV-2的人再次感染与全原因死亡、住院和各种长期COVID并发症的风险增加有关。
First infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with increased risk of acute and postacute death and sequelae in various organ systems. Whether reinfection adds to risks incurred after first infection is unclear. Here we used the US Department of Veterans Affairs’ national healthcare database to build a cohort of individuals with one SARS-CoV-2 infection (n = 443,588), reinfection (two or more infections, n = 40,947) and a noninfected control (n = 5,334,729). We used inverse probability-weighted survival models to estimate risks and 6-month burdens of death, hospitalization and incident sequelae. Compared to no reinfection, reinfection contributed additional risks of death (hazard ratio (HR) = 2.17, 95% confidence intervals (CI) 1.93–2.45), hospitalization (HR = 3.32, 95% CI 3.13–3.51) and sequelae including pulmonary, cardiovascular, hematological, diabetes, gastrointestinal, kidney, mental health, musculoskeletal and neurological disorders. The risks were evident regardless of vaccination status. The risks were most pronounced in the acute phase but persisted in the postacute phase at 6 months. Compared to noninfected controls, cumulative risks and burdens of repeat infection increased according to the number of infections. Limitations included a cohort of mostly white males. The evidence shows that reinfection further increases risks of death, hospitalization and sequelae in multiple organ systems in the acute and postacute phase. Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention. A new analysis using US Department of Veterans Affairs databases showed that reinfection is associated with increased risk of all-cause mortality, hospitalization and a wide range of long COVID complications in individuals who have had SARS-CoV-2 compared to those with no reinfection.
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DOI：
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发表时间：
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期刊：
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影响因子：
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