Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: A cohort study using linked primary care, secondary care, and death registration data in the OpenSAFELY platform.
Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: A cohort study using linked primary care, secondary care, and death registration data in the OpenSAFELY platform.
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DOI：
10.1371/journal.pmed.1003871
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发表时间：
2022-01
期刊：
影响因子：
15.8
通讯作者：
Goldacre B
中科院分区：
文献类型：
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作者：
Bhaskaran K;Rentsch CT;Hickman G;Hulme WJ;Schultze A;Curtis HJ;Wing K;Warren-Gash C;Tomlinson L;Bates CJ;Mathur R;MacKenna B;Mahalingasivam V;Wong A;Walker AJ;Morton CE;Grint D;Mehrkar A;Eggo RM;Inglesby P;Douglas IJ;McDonald HI;Cockburn J;Williamson EJ;Evans D;Parry J;Hester F;Harper S;Evans SJ;Bacon S;Smeeth L;Goldacre B
人们担心2019年急性冠状病毒病（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。在英国NHS的批准下，我们进行了一项队列研究，使用OpenSAFELY中的相关初级保健和医院数据，比较COVID-19住院患者出院后的住院和死亡风险（总体和特定原因）（2020年2月至12月）并存活至少1周，以及（i）来自2019年一般人群的人口统计学匹配对照;及（ii）在2017至2019年因流感而出院的人士。我们使用了考克斯回归，对年龄、性别、种族、肥胖、吸烟状况、剥夺和合并症进行了调整，这些因素被认为是严重COVID-19结局的潜在风险因素。我们纳入了24，673名出院后COVID-19患者，123，362名普通人群对照和16，058名流感对照，随访≤315天。COVID-19患者的中位年龄为66岁，13，733名（56%）为男性，19，061名（77%）为白色种族。COVID-19组住院或死亡的总体风险（30，968起事件）高于一般人群对照（完全校正的风险比[aHR] 2.22，2.14至2.30，p < 0.001），但略低于流感组（aHR 0.95，0.91至0.98，p = 0.004）。COVID-19组的全因死亡率（7，439起事件）最高（aHR 4.82，4.48至5.19 vs一般人群对照[p < 0.001]，1.74，1.61至1.88 vs流感对照[p < 0.001]）。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与流感患者相比基本相似或更低。然而，COVID-19患者比流感患者更有可能因初次感染或其他下呼吸道感染而再次入院或死亡（aHR 1.37，1.22至1.54，p < 0.001），并经历精神健康或认知相关入院或死亡（aHR 1.37，1.02至1.84，p = 0.039）;特别是，患有既存痴呆症的COVID-19幸存者痴呆住院或死亡的风险更高（年龄和性别调整的HR 2.47，1.37至4.44，p = 0.002）。我们研究的局限性在于，在某些情况下，由于代码使用不一致，住院或死亡的原因可能被错误分类，并且我们没有数据来区分COVID-19变体。在这项研究中，我们观察到，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、因初始感染而再次入院或死亡以及痴呆死亡的风险更高，这突出了出院后监测的重要性。Krishnan Bhaskaran及其同事研究了因COVID-19入院和随后出院后的健康状况。- 早期的研究表明，一些感染SARS-CoV-2的人在初次感染后的几个月内可能有出现健康问题的风险。鉴于许多国家的感染率很高，这是一个重大的公共卫生问题，但目前为政策提供信息的证据有限。- 这项研究的目的是系统地量化与普通人群和因流感住院的人相比，因COVID-19住院的人死亡或再次入院的风险可能更高的程度，无论是整体还是特定疾病。- 我们采用队列研究设计，比较了因COVID-19住院治疗的人群之间的住院和死亡风险，包括总体和一系列特定原因（n = 24，673），2019年一般人群中具有相似人口统计学特征的人群（n = 123，362），以及2017年至2019年因流感住院的人（n = 16，058）。- 与普通人群相比，曾因COVID-19住院的人再次住院或出院后一周以上死亡的可能性是普通人群的两倍多，总体风险和一系列特定原因的风险更高。- 与流感患者相比，COVID-19患者的几种结局的风险大致相似或较低，但COVID-19患者的总体死亡风险、因初始感染而再次入院或死亡的风险以及痴呆死亡的风险较高。- 于疫情期间，大量人士因COVID-19而住院，而我们在该等人士中观察到的死亡及再入院风险上升，可能会对公共卫生及资源造成重大影响。- 通过在出院后的几个月内增加对患者的监测，以及提高患者和临床医生对潜在问题的认识，可以最大限度地减少或减轻风险。
There is concern about medium to long-term adverse outcomes following acute Coronavirus Disease 2019 (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. With the approval of NHS-England, we conducted a cohort study, using 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 to December 2020) and surviving at least 1 week, and (i) demographically matched controls from the 2019 general population; and (ii) people discharged from influenza hospitalisation in 2017 to 2019. We used Cox regression adjusted for age, sex, ethnicity, obesity, smoking status, deprivation, and comorbidities considered potential risk factors for severe COVID-19 outcomes. We included 24,673 postdischarge COVID-19 patients, 123,362 general population controls, and 16,058 influenza controls, followed for ≤315 days. COVID-19 patients had median age of 66 years, 13,733 (56%) were male, and 19,061 (77%) were of white ethnicity. Overall risk of hospitalisation or death (30,968 events) was higher in the COVID-19 group than general population controls (fully adjusted hazard ratio [aHR] 2.22, 2.14 to 2.30, p < 0.001) but slightly lower than the influenza group (aHR 0.95, 0.91 to 0.98, p = 0.004). All-cause mortality (7,439 events) was highest in the COVID-19 group (aHR 4.82, 4.48 to 5.19 versus general population controls [p < 0.001] and 1.74, 1.61 to 1.88 versus influenza controls [p < 0.001]). Risks for cause-specific outcomes were higher in COVID-19 survivors than in general population controls and largely similar or lower in COVID-19 compared with influenza patients. However, COVID-19 patients were more likely than influenza patients to be readmitted or die due to their initial infection or other lower respiratory tract infection (aHR 1.37, 1.22 to 1.54, p < 0.001) and to experience mental health or cognitive-related admission or death (aHR 1.37, 1.02 to 1.84, p = 0.039); in particular, COVID-19 survivors with preexisting dementia had higher risk of dementia hospitalisation or death (age- and sex-adjusted HR 2.47, 1.37 to 4.44, p = 0.002). Limitations of our study were that reasons for hospitalisation or death may have been misclassified in some cases due to inconsistent use of codes, and we did not have data to distinguish COVID-19 variants. In this study, we observed that 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, readmission or death due to the initial infection, and dementia death, highlighting the importance of postdischarge monitoring. Krishnan Bhaskaran and co-workers study health outcomes after admission with COVID-19 and subsequent discharge. - Early studies have suggested that some people infected with SARS-CoV-2 may be at risk of developing health problems in the months after their initial infection. Given high rates of infection in many countries, this is a significant public health concern, but there is currently limited evidence to inform policy. - The aim of this study was to systematically quantify the extent to which people who have been in hospital with COVID-19 may be at higher risk of dying or being readmitted to hospital, either overall or for specific illnesses, compared with people in the general population, and people who have been hospitalised with influenza. - We used a cohort study design to compare risks of hospitalisation and death, overall and for a range of specific causes, between people who had hospitalised with COVID-19 (n = 24,673), people with similar demographic characteristics in the 2019 general population (n = 123,362), and people who had been hospitalised with influenza in 2017 to 2019 (n = 16,058). - Compared with people in the general population, people who had had a COVID-19 hospitalisation were more than twice as likely to be rehospitalised or die more than a week after discharge, with higher risks overall and for a range of specific causes. - COVID-19 patients had broadly similar or lower risk of several outcomes compared with influenza patients, but risk of death overall, readmissions or death due to the initial infection, and dementia death were higher in COVID-19 patients. - Large numbers of people have been hospitalised with COVID-19 during the pandemic, and the raised risks of death and readmission to hospital that we observed in these individuals could significantly impact public health and resources. - Risks might be minimised or mitigated by increasing monitoring of patients in the months following hospital discharge, and greater awareness among patients and clinicians of potential problems.
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影响因子：
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作者：
Schultze A;Bates C;Cockburn J;MacKenna B;Nightingale E;Curtis HJ;Hulme WJ;Morton CE;Croker R;Bacon S;McDonald HI;Rentsch CT;Bhaskaran K;Mathur R;Tomlinson LA;Williamson EJ;Forbes H;Tazare J;Grint DJ;Walker AJ;Inglesby P;DeVito NJ;Mehrkar A;Hickman G;Davy S;Ward T;Fisher L;Evans D;Wing K;Wong AY;McManus R;Parry J;Hester F;Harper S;Evans SJ;Douglas IJ;Smeeth L;Eggo RM;Goldacre B
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影响因子：
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