Three-year outcomes of post-acute sequelae of COVID-19, 2024, Cai, Xie, Topol, Al-Aly

[SNT Gatchaman]

Three-year outcomes of post-acute sequelae of COVID-19
Cai, Miao; Xie, Yan; Topol, Eric J.; Al-Aly, Ziyad

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes post-acute sequelae of coronavirus disease 2019 (COVID-19) (PASC) in many organ systems. Risks of these sequelae have been characterized up to 2 years after infection, but longer-term follow-up is limited. Here we built a cohort of 135,161 people with SARS-CoV-2 infection and 5,206,835 controls from the US Department of Veterans Affairs who were followed for 3 years to estimate risks of death and PASC.

Among non-hospitalized individuals, the increased risk of death was no longer present after the first year of infection, and risk of incident PASC declined over the 3 years but still contributed 9.6 (95% confidence interval (CI): 0.4–18.7) disability-adjusted life years (DALYs) per 1,000 persons in the third year. Among hospitalized individuals, risk of death declined but remained significantly elevated in the third year after infection (incidence rate ratio: 1.29 (95% CI: 1.19–1.40)). Risk of incident PASC declined over the 3 years, but substantial residual risk remained in the third year, leading to 90.0 (95% CI: 55.2–124.8) DALYs per 1,000 persons.

Altogether, our findings show reduction of risks over time, but the burden of mortality and health loss remains in the third year among hospitalized individuals.

Link | PDF (Nature Medicine) [Open Access]

 

[Hutan]

In this work, we used the US Department of Veterans Affairs (VA) national health care databases to build a cohort of 135,161 US veterans who survived the first 30 d of COVID-19 and a control of 5,206,835 users of the VA healthcare system with no evidence of SARS-CoV-2 infection. To ensure 3-year follow-up, these cohorts were enrolled between March and December 2020, an era that pre-dated the availability of COVID-19 vaccines and antivirals and when the ancestral SARS-CoV-2 virus predominated. These cohorts were followed longitudinally for 3 years to estimate the risks of death and incident sequelae of SARS-CoV-2 throughout the 3-year follow-up and cumulatively at 3 years in mutually exclusive groups according to care setting of the acute phase of the disease (in non-hospitalized and hospitalized).

The data is surely going to be messy, with many people in the control group having Covid-19, and many people in both groups having multiple infections.

Compared to the control group without infection, people with COVID-19 who were not hospitalized during the acute phase of the disease were at an increased risk of death (incidence rate ratio (IRR): 1.58, 95% confidence interval (CI): 1.53–1.62; excess burden per 1,000 persons: 16.20, 95% CI: 14.90–17.51; Fig. 1a) during the first year after SARS-CoV-2 infection but not in the second year (IRR: 0.97, 95% CI: 0.94–1.00; excess burden per 1,000 persons: −0.91, 95% CI: −2.20 to 0.38) and third year (IRR: 1.01, 95% CI: 0.97–1.04; excess burden per 1,000 persons: 0.22, 95% CI: −1.14 to 1.58) after the infection.

Excess mortality relative to controls in the three years (years on x axis). Red is the hospitalised group, blue is the unhospitalised group.



Incidence of a range of symptom types relative to controls - for non-hospitalised group



Fig 2 has a very detailed break down of symptoms that is worth look, with incidence rate ratios.

Some of the "symptoms", such as 'Nicotine use disorder" which I assume is largely smoking, might actually be a contributor to the person ending up hospitalised with Covid-19. So they are more like a risk factor that is present at a higher rate than in the controls. So, far, while the symptoms are called 'post-acute sequelae' I haven't seen any analysis of symptoms that only arose after the infection.

Years are the three columns - 1,2,3
The top row is non-hospitalised
Bottom row is hospitalised

 

[Dakota15]

Fortune: 'COVID can cause new health problems to appear years after infection, according to a study of more than 130,000 patients’

'For these and other reasons, researchers have led the charge to accelerate the pace of trials for long COVID treatments..’

'Researchers hope that this latest study will again focus attention on a disease with a long tail and an unknowable future, and perhaps prod the National Institutes of Health to take a bigger swing at the issue.’

“We need to be much bolder and much more ambitious with our trials,” Al-Aly says. “At the glacial pace that they’re going, we’re unlikely to get any definitive answers for decades to come.”

 

[ME/CFS Skeptic]

They used a veterans database where only 10% of participants were women. Long Covid mostly affects women so probably not an ideal cohort to test long-term sequelae.

 

[Hutan]

Looking for Long Covid: A Clash of Definition and Study Design
An article commenting on this study