922 – Long COVID Is a Multisystem Disorder: Assessment of the National Academies Definition, 2025, Huang et al

922 – Long COVID Is a Multisystem Disorder: Assessment of the National Academies Definition

Lawrence Huang, Amitabh Gunjan, Anudeep S. Appe, Paul A. Mckelvey, Heather A. Algren, Mark Berry, Essy Mozaffari, Bill J. Wright, Jennifer J. Hadlock, Jason D. Goldman

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Background
Long COVID is an infection-associated chronic condition occurring after SARS-CoV-2 infection that can manifest as one or multiple symptoms or diagnosable conditions, as newly defined by the National Academies. We evaluated this new Long COVID definition.

Methods
We reviewed hospital admissions from 5/1/20 – 9/30/22 in electronic health records (EHR) from a multistate healthcare system. The COVID+ group had first SARS-CoV-2 lab test or encounter diagnosis between 30 days before to 5 days after admission, and the non-COVID group was admitted with no prior or current SARS-CoV-2 test or diagnosis. The populations were balanced with overlap weights based on a high-dimensional propensity score of pre-specified variables and the top 100 comorbidities differing between the groups.

Hazard ratios (HR) were calculated for the combined primary outcome including any of the individual secondary outcomes or U09.9 (Post-Covid Conditions). Secondary outcomes included 29 individual incident diagnoses 90 to 360 days after admission. To account for multiplicity on the secondary outcomes, a Bonferroni-corrected p-value < 0.0017 was considered significant.

Results
Admissions included 45,065 persons with and 417,268 persons without COVID-19 during the study period. Mean age was 58 years, 62% were female, 25.4% were non-white, and 13% were Hispanic. After weighting, standardized difference was < 0.01 for age, sex, race, ethnicity, insurance, vaccination, variant era, WHO ordinal scale, steroid use, immunocompromised status and 100 clinical features.

In the COVID+ and non-COVID groups 16,945 (37.6%) and 122,201 (29.3%) met the combined primary outcome, respectively. The HR for the primary outcome after weighting was 1.29 (95%CI 1.27, 1.32), p < 0.00001.

Of the individual secondary outcomes, all but one outcome (post-exertional malaise) had significantly elevated HR in the COVID+ vs. non-COVID groups, after adjustment for multiplicity (Figure).

Incident diagnoses with strong associations (HR > 2) included thromboembolism, hair loss, diabetes mellitus, obesity, and hypoxia. Anosmia/dysgeusia was associated with prior COVID admission, but wide confidence intervals reflected few charted diagnoses.

Conclusions
Manifestations of Long COVID at population scale as defined by the National Academies are detectable as part of routine symptoms and clinical diagnoses in the EHR after admissions for COVID-19, compared with all other hospital admissions. Some features of Long COVID are not well coded in the EHR.
Conference Dates and Location

Link (Conference on Retroviruses and Opportunistic Infections) [Abstract Only]

 

I wonder how they defined PEM.

 

Well, this could have been an email, sent to them on day 1. Or on day -1000. Or -10000. Seems like we've been stuck at the "Long Covid is Long Covid" stage forever, even before it happened.