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New Research : Epidemiology of Post-Covid Syndrome following hospitalisation with Covid-19



The National Institute for Clinical Excellence (NICE) have described Post Covid Syndrome, or Long Covid, as:

“Signs and symptoms that develop during or following an infection consistent with Covid-19 which continue for more than 12 weeks are are not explained by an alternative diagnosis”.

Their guidelines currently recommend that a referral is made to a Long Covid Clinic if symptoms persist at 6-12 weeks.

Today I wanted to update you on some recent research, the pre-paper

“Epidemiology of post-COVID syndrome following hospitalisation with coronavirus: a retrospective cohort study”.

This was an observational, retrospective, matched cohort study undertaken by University College, London and the Office of National Statistics (ONS).

Their objective was to understand the epidemiology of post-COVID syndrome (PCS). It is the largest study to date looking at this.

*Epidemiology is the study of how often diseases occur in different groups of people and why*


They wanted to quantify rates of organ-specific impairment following recovery from COVID-19 hospitalisation compared with those in a matched control group. They also wanted to determine how the rate ratio varied by age, sex, and ethnicity.

*The rate ratio tells you how more (or less) common a particular event happened in an exposed group*


Dr Banerjee and his co-authors worked with the ONS and NHS records from hospitals in England.

They identified 86,955 patients who had been in hospital with Covid-19. Of these 53,795 were discharged alive. That is 61.9%.

After exclusions due to unknown age, sex or those who couldn’t be matched to a control they identified 47,780 individuals to remain in the study.


These participants, with an average age of 65 years and 55% male, were in hospital with COVID-19 and discharged alive by 31 August 2020. The participants were matched to controls on demographic and clinical characteristics.


The study's outcome measures were:

  1. Rates of hospital readmission

  2. All-cause mortality (death)

  3. Subsequent diagnoses of respiratory, cardiovascular, metabolic, kidney and liver diseases

The participants were followed up for an average of 140 days for COVID-19 cases and 153 days for controls.


Results:

Individuals in hospital with Covid-19 were more likely to be > 50 years old, male, living in a deprived area, a former smoker and overweight/obese.

They were also more likely to have existing co-morbidity (disease) such as hypertension, major adverse cardiovascular events (MACE), diabetes and/or respiratory disease.

  • 1 in 3 were readmitted after discharge from hospital

  • 12 % died following discharge from hospital

  • 1 in 3 had a respiratory disease diagnosed following discharge

  • 5 % developed new onset type 1 or 2 diabetes

  • 5 % had a MACE - heart attack, arrhythmia, stroke

  • 1.5% developed Chronic Kidney Disease

  • 0.3% developed Chronic Liver Disease

The absolute risk of post discharge adverse events was greater for those >70 years of age and from a White Ethnic background.

However when contrasted against the background rates of adverse events that might have been expected to occur in these groups in the general population the relative ratios were:


  • greater for individuals aged LESS THAN 70 years,

  • greater in individuals from an ethnic minority group. This was especially true for respiratory disease

With currently more than 4 million people in the UK having tested positive for Covid-19 it suggests that there will be a long term burden of Covid related morbidity.

The research demonstrates an:


1. Increase in the mortality rates in those discharged from hospital following a Covid-19 admission

2. Increase in the readmission rates in those discharged from hospital following a Covid-19 admission

3. Increase in multi-organ dysfunction in those discharged from hospital following a Covid-19 admission

They summarised that the individuals discharged from hospital following COVID-19 face elevated rates of multi-organ dysfunction compared with background levels, and the increase in risk is neither confined to the elderly nor uniform across ethnicities.

With poor high quality healthcare for long term conditions/ chronic illness, inequalities in access and provision of healthcare, incomplete post-covid pathways in the community and in hospitals, it is of the utmost importance that we urgently establish integrated care pathways with a multidisciplinary approach in the management of PCS

Urgent research is also required to establish risk factors for PCS and to extend this research to non-hospitalised patients also suffering from PCS.


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