Risk of persistent and new clinical sequelae among adults aged 65 years and older during the post-acute phase of SARS-CoV-2 infection: retrospective cohort study.
Risk of persistent and new clinical sequelae among adults aged 65 years and older during the post-acute phase of SARS-CoV-2 infection: retrospective cohort study.
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DOI：
10.1136/bmj-2021-068414
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发表时间：
2022-02-09
期刊：
影响因子：
--
通讯作者：
Daugherty SE
中科院分区：
文献类型：
--
作者：
Cohen K;Ren S;Heath K;Dasmariñas MC;Jubilo KG;Guo Y;Lipsitch M;Daugherty SE
旨在描述 65 岁以上成年人在 SARS-CoV-2 感染急性期后出现持续性和新的临床后遗症的风险。回顾性队列研究。联合健康集团临床研究数据库：去识别化的行政索赔和门诊实验室检测结果。从 2019 年 1 月到诊断 SARS-CoV-2 感染之日，连续加入 Medicare Advantage 计划（涵盖处方药）的年龄≥65 岁的个人，通过倾向评分与三个没有 covid-19 的比较组相匹配：2020 年对照组 (n=87 337)、2019 年历史对照组 (n=88 070) 和病毒性下呼吸道疾病历史对照组(n=73 490)。使用 ICD-10（国际疾病分类，第 10 次修订版）代码确定诊断 covid-19 后 21 天或以上是否存在持续性和新的后遗症。通过风险差和风险比，估计了疾病急性期后 120 天内因感染 SARS-CoV-2 引起的后遗症的超额风险，并使用 95% Bonferroni 校正置信区间计算。按年龄、种族、性别以及患者是否因covid-19入院分析急性感染后后遗症的发生率。在被诊断患有 SARS-CoV-2 的个体中，32%（87-337 人中的 27-698 人）在急性期后因一种或多种新的或持续的临床后遗症寻求医疗护理，比 2020 年对照组高出 11%。呼吸衰竭（风险差异 7.55，95% 置信区间 7.18 至 8.01）、疲劳（5.66、5.03 至 6.27）、高血压（4.43、2.27 至 6.37）、记忆困难（2.63、2.23 至 3.13）、肾损伤（2.59、2.03 至与 2020 年对照组相比，3.12）、心理健康诊断（2.50、2.04 至 3.04）、高凝状态 1.47（1.2 至 1.73）和心律失常（2.19、1.76 至 2.57）的风险差异最大，与 2019 年对照组的结果相似。然而，与病毒性下呼吸道疾病组相比，每 100 名患者中，只有呼吸衰竭、痴呆和病毒后疲劳的风险差异分别增加了 2.39（95% 置信区间 1.79 至 2.94）、0.71（0.3 至 1.08）和 0.18（0.11 至 0.26）。患有严重的 covid-19 疾病、需要入院的个体出现大多数（但不是全部）临床后遗症的风险显着增加。结果证实，≥65 岁的成年人在急性感染 SARS-CoV-2 后出现持续性和新后遗症的风险过高。除了呼吸衰竭、痴呆和病毒后疲劳之外，其后遗症与老年人病毒性下呼吸道疾病的后遗症类似。这些发现进一步凸显了 SARS-CoV-2 病毒急性感染后的广泛重要后遗症。
To characterize the risk of persistent and new clinical sequelae in adults aged ≥65 years after the acute phase of SARS-CoV-2 infection. Retrospective cohort study. UnitedHealth Group Clinical Research Database: deidentified administrative claims and outpatient laboratory test results. Individuals aged ≥65 years who were continuously enrolled in a Medicare Advantage plan with coverage of prescription drugs from January 2019 to the date of diagnosis of SARS-CoV-2 infection, matched by propensity score to three comparison groups that did not have covid-19: 2020 comparison group (n=87 337), historical 2019 comparison group (n=88 070), and historical comparison group with viral lower respiratory tract illness (n=73 490). The presence of persistent and new sequelae at 21 or more days after a diagnosis of covid-19 was determined with ICD-10 (international classification of diseases, 10th revision) codes. Excess risk for sequelae caused by infection with SARS-CoV-2 was estimated for the 120 days after the acute phase of the illness with risk difference and hazard ratios, calculated with 95% Bonferroni corrected confidence intervals. The incidence of sequelae after the acute infection was analyzed by age, race, sex, and whether patients were admitted to hospital for covid-19. Among individuals who were diagnosed with SARS-CoV-2, 32% (27 698 of 87 337) sought medical attention in the post-acute period for one or more new or persistent clinical sequelae, which was 11% higher than the 2020 comparison group. Respiratory failure (risk difference 7.55, 95% confidence interval 7.18 to 8.01), fatigue (5.66, 5.03 to 6.27), hypertension (4.43, 2.27 to 6.37), memory difficulties (2.63, 2.23 to 3.13), kidney injury (2.59, 2.03 to 3.12), mental health diagnoses (2.50, 2.04 to 3.04), hypercoagulability 1.47 (1.2 to 1.73), and cardiac rhythm disorders (2.19, 1.76 to 2.57) had the greatest risk differences compared with the 2020 comparison group, with similar findings to the 2019 comparison group. Compared with the group with viral lower respiratory tract illness, however, only respiratory failure, dementia, and post-viral fatigue had increased risk differences of 2.39 (95% confidence interval 1.79 to 2.94), 0.71 (0.3 to 1.08), and 0.18 (0.11 to 0.26) per 100 patients, respectively. Individuals with severe covid-19 disease requiring admission to hospital had a markedly increased risk for most but not all clinical sequelae. The results confirm an excess risk for persistent and new sequelae in adults aged ≥65 years after acute infection with SARS-CoV-2. Other than respiratory failure, dementia, and post-viral fatigue, the sequelae resembled those of viral lower respiratory tract illness in older adults. These findings further highlight the wide range of important sequelae after acute infection with the SARS-CoV-2 virus.
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影响因子：
13.8
作者：
Nasserie T;Hittle M;Goodman SN
通讯作者：
Goodman SN
DOI：
10.1097/ede.0b013e3181d61eeb
发表时间：
2010-05
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Lipsitch M;Tchetgen Tchetgen E;Cohen T
通讯作者：
Cohen T
影响因子：
64.8
作者：
Al-Aly, Ziyad;Xie, Yan;Bowe, Benjamin
通讯作者：
Bowe, Benjamin
影响因子：
--
作者：
Altman, DG;Andersen, PK
通讯作者：
Andersen, PK
影响因子：
13.8
作者：
Crabb, Brendan T.;Lyons, Ann;Shah, Rashmee U.
通讯作者：
Shah, Rashmee U.