Risk of Medical Conditions Post-Hospitalization for COVID-19 vs Flu, Sepsis

Kieran Quinn, MD, PhD
Credit: IC/ES Central

The overall burden of post-acute conditions among COVID-19 survivors appeared to be comparable to that of other acute infectious illnesses like influenza and sepsis, with the exception of an elevated risk of venous thromboembolism.¹

Individuals who have been hospitalized for severe cases of COVID-19 are known to be at risk of developing various medical and mental health conditions.²

It remains unclear how these risks compare to those associated with other serious infectious illnesses, which prompted Kieran L. Quinn, MD, PhD, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, and investigators to assess further.

The study’s aim was to examine the risks of incident cardiovascular, neurological, mental health conditions, and rheumatoid arthritis within 1 year following hospitalization for COVID-19.

Patients included in the investigation were evaluated in 3 comparator groups: individuals hospitalized for influenza before the pandemic; individuals hospitalized for sepsis before and during the COVID-19 pandemic; and individuals concurrently hospitalized with sepsis.

The study population consisted of 26,499 patients who survived hospitalization for COVID-19, and the controls included 17,516 historical cases of influenza; 282,473 historical cases with sepsis; and 52,878 contemporary controls hospitalized with sepsis between April 2020 and October 2021.

The study’s main outcome measures were the occurrence of 13 prespecified conditions, including cardiovascular, neurological, and mental health conditions, as well as rheumatoid arthritis, within 1 year of hospitalization.

While COVID-19 survivors exhibited an increased risk of venous thromboembolism as compared with influenza, the general profile of post-acute conditions was similar to other acute infectious illnesses. Results showed patients hospitalized for COVID-19 had an increased 1-year risk of venous thromboembolic disease compared with those hospitalized for influenza (HR, 1.77; 95% CI, 1.36-2.31).

However, no increased risks were observed for developing selected ischemic and nonischemic cerebrovascular and cardiovascular disorders, neurological disorders, rheumatoid arthritis, or mental health conditions when compared to the influenza or sepsis cohorts.

Apart from this elevated risk, the results suggested post-acute medical and mental health conditions among individuals who survived hospitalization for COVID-19 may be comparable with other acute infectious illnesses.

It was acknowledged that post-acute consequences of COVID-19 could potentially be associated with the severity of the infectious illness that necessitates hospitalization, rather than being direct consequences of infection with the SARS-CoV-2 virus.

Regardless, these findings provide valuable insights into the long-term health outcomes of individuals who have experienced severe COVID-19 and highlight the need for continued monitoring and support for this population, investigators stated.

The team further stressed for vigilance among healthcare professionals in assessing and managing the risk of venous thromboembolism among COVID-19 survivors, and the need for expanded research evaluating how to mitigate the impact of severe infectious illnesses and prevent the progression of the disease to the point of hospitalization.

Some limitations expressed in the research were included the basis of data from a single region may not be representative of broader populations, and the fact the study only assessed specific medical and mental health conditions without considering other potential long-term consequences of COVID-19.

“To place the magnitude of these findings in context, we compared the crude annual incidence of acute myocardial infarction, stroke, and dementia in this study of hospitalized adults with the general population of adults in Canada,” investigators wrote. “The crude annual incidence of acute myocardial infarction following hospitalization for COVID-19 was lower (80 vs 212 per 100 000), and the annual crude incidence of stroke (2300 vs 303 per 100 000) and dementia (1580 vs 1317 per 100 000) was higher than those of adults in the general population.”

References:

1. Quinn KL, Stukel TA, Huang A, et al. Comparison of Medical and Mental Health Sequelae Following Hospitalization for COVID-19, Influenza, and Sepsis. JAMA Intern Med. Published online June 20, 2023. doi:10.1001/jamainternmed.2023.2228
2. Cosdon N. The Hidden Impact of COVID-19: Deterioration of Mental Health After Hospitalization. ContagionLive. Jun 2, 2023. https://www.contagionlive.com/view/the-hidden-impact-of-covid-19-deterioration-of-mental-health-after-hospitalization