Long COVID in hospitalized and non-hospitalized patients in a large cohort in Northwest Spain, a prospective cohort study

Pérez-González, Alexandre; Araújo-Ameijeiras, Alejandro; Fernández-Villar, Alberto; Crespo, Manuel; Poveda, Eva

doi:10.1101/2021.08.05.21261634

Cited by 12 publications

(15 citation statements)

References 21 publications

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“…Previous studies have reported lower prevalence rates of post-COVID-19 symptoms among nonhospitalized than hospitalized patients. 9,10,[13][14][15] Our results revealed similar proportions of hospitalized and nonhospitalized patients with post-COVID-19 symptoms 2 years after the acute infection, suggesting that, despite having not been hospitalized during the acute phase, the symptoms of long COVID are also found in the nonhospitalized cohort. This finding could be explained by the fact that COVID-19 severity is not a risk factor for the development of long COVID symptoms.…”

Section: Jama Network Open | Infectious Diseasessupporting

confidence: 64%

“…Data on nonhospitalized patients are based on follow-up periods no longer than 6 months 9,10,[13][14][15] ; accordingly, we cannot directly compare our results with previous data. Previous studies have reported lower prevalence rates of post-COVID-19 symptoms among nonhospitalized than hospitalized patients.…”

Section: Jama Network Open | Infectious Diseasesmentioning

confidence: 87%

“…Recent studies directly comparing hospitalized vs nonhospitalized patients have included follow-up periods up to 6 months after acute infection. [13][14][15] Data for follow-up periods longer than 1 year after SARS-CoV-2 infection are still lacking. Accordingly, the main objective of this study was to compare the presence of post-COVID-19 symptoms among hospitalized and nonhospitalized patients at a follow-up period of 2 years.…”

Section: Introductionmentioning

confidence: 99%

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Post–COVID-19 Symptoms 2 Years After SARS-CoV-2 Infection Among Hospitalized vs Nonhospitalized Patients

Fernández‐de‐las‐Peñas

Rodríguez‐Jiménez

Cancela-Cilleruelo

et al. 2022

JAMA Netw Open

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ImportanceIdentification of long-term post–COVID-19 symptoms among hospitalized and nonhospitalized patients is needed.ObjectiveTo compare the presence of post–COVID-19 symptoms 2 years after acute SARS-CoV-2 infection between hospitalized and nonhospitalized patients.Design, Setting, and ParticipantsA cross-sectional cohort study was conducted at 2 urban hospitals and general practitioner centers from March 20 to April 30, 2020, among 360 hospitalized patients and 308 nonhospitalized patients with acute SARS-CoV-2 infection during the first wave of the pandemic. Follow-up was conducted 2 years later.Main Outcomes and MeasuresParticipants were scheduled for a telephone interview 2 years after acute infection. The presence of post–COVID-19 symptoms was systematically assessed, with particular attention to symptoms starting after infection. Hospitalization and clinical data were collected from medical records. Between-group comparisons and multivariate logistic regressions were conducted.ResultsA total of 360 hospitalized patients (162 women [45.0%]; mean [SD] age, 60.7 [16.1] years) and 308 nonhospitalized patients (183 women [59.4%]; mean [SD] age, 56.7 [14.7] years) were included. Dyspnea was more prevalent at the onset of illness among hospitalized than among nonhospitalized patients (112 [31.1%] vs 36 [11.7%]; P &lt; .001), whereas anosmia was more prevalent among nonhospitalized than among hospitalized patients (66 [21.4%] vs 36 [10.0%]; P = .003). Hospitalized patients were assessed at a mean (SD) of 23.8 (0.6) months after hospital discharge, and nonhospitalized patients were assessed at a mean (SD) of 23.4 (0.7) months after the onset of symptoms. The number of patients who exhibited at least 1 post–COVID-19 symptom 2 years after infection was 215 (59.7%) among hospitalized patients and 208 (67.5%) among nonhospitalized patients (P = .01). Among hospitalized and nonhospitalized patients, fatigue (161 [44.7%] vs 147 [47.7%]), pain (129 [35.8%] vs 92 [29.9%]), and memory loss (72 [20.0%] vs 49 [15.9%]) were the most prevalent post–COVID-19 symptoms 2 years after SARS-CoV-2 infection. No significant differences in post–COVID-19 symptoms were observed between hospitalized and nonhospitalized patients. The number of preexisting medical comorbidities was associated with post–COVID-19 fatigue (odds ratio [OR], 1.93; 95% CI, 1.09-3.42; P = .02) and dyspnea (OR, 1.91; 95% CI, 1.04-3.48; P = .03) among hospitalized patients. The number of preexisting medical comorbidities (OR, 3.75; 95% CI, 1.67-8.42; P = .001) and the number of symptoms at the onset of illness (OR, 3.84; 95% CI, 1.33-11.05; P = .01) were associated with post–COVID-19 fatigue among nonhospitalized patients.Conclusions and RelevanceThis cross-sectional study suggested the presence of at least 1 post–COVID-19 symptom in 59.7% of hospitalized patients and 67.5% of nonhospitalized patients 2 years after infection. Small differences in symptoms at onset of COVID-19 were identified between hospitalized and nonhospitalized patients. Post–COVID-19 symptoms were similar between hospitalized and nonhospitalized patients; however, lack of inclusion of uninfected controls limits the ability to assess the association of SARS-CoV-2 infection with overall and specific post–COVID-19 symptoms 2 years after acute infection. Future studies should include uninfected control populations.

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Section: Jama Network Open | Infectious Diseasessupporting

confidence: 64%

Section: Jama Network Open | Infectious Diseasesmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Post–COVID-19 Symptoms 2 Years After SARS-CoV-2 Infection Among Hospitalized vs Nonhospitalized Patients

Fernández‐de‐las‐Peñas

Rodríguez‐Jiménez

Cancela-Cilleruelo

et al. 2022

JAMA Netw Open

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“…There are similarities between our study, Living Risk Prediction Algorithm (QCOVID) study [ 21 ], and other reports [ 3 , 24 ] regarding sociodemographic and comorbidity variables associated with mortality. These include cardiometabolic conditions (eg, CKD, type 2 diabetes, ischemic heart disease, and atrial fibrillation), chronic obstructive pulmonary disease, and asthma.…”

Section: Discussionsupporting

confidence: 67%

Differences in Clinical Presentation With Long COVID After Community and Hospital Infection and Associations With All-Cause Mortality: English Sentinel Network Database Study

Meza-Torres¹,

Delanerolle²,

Okusi³

et al. 2022

JMIR Public Health Surveill

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Background Most studies of long COVID (symptoms of COVID-19 infection beyond 4 weeks) have focused on people hospitalized in their initial illness. Long COVID is thought to be underrecorded in UK primary care electronic records. Objective We sought to determine which symptoms people present to primary care after COVID-19 infection and whether presentation differs in people who were not hospitalized, as well as post–long COVID mortality rates. Methods We used routine data from the nationally representative primary care sentinel cohort of the Oxford–Royal College of General Practitioners Research and Surveillance Centre (N=7,396,702), applying a predefined long COVID phenotype and grouped by whether the index infection occurred in hospital or in the community. We included COVID-19 infection cases from March 1, 2020, to April 1, 2021. We conducted a before-and-after analysis of long COVID symptoms prespecified by the Office of National Statistics, comparing symptoms presented between 1 and 6 months after the index infection matched with the same months 1 year previously. We conducted logistic regression analysis, quoting odds ratios (ORs) with 95% CIs. Results In total, 5.63% (416,505/7,396,702) and 1.83% (7623/416,505) of the patients had received a coded diagnosis of COVID-19 infection and diagnosis of, or referral for, long COVID, respectively. People with diagnosis or referral of long COVID had higher odds of presenting the prespecified symptoms after versus before COVID-19 infection (OR 2.66, 95% CI 2.46-2.88, for those with index community infection and OR 2.42, 95% CI 2.03-2.89, for those hospitalized). After an index community infection, patients were more likely to present with nonspecific symptoms (OR 3.44, 95% CI 3.00-3.95; P<.001) compared with after a hospital admission (OR 2.09, 95% CI 1.56-2.80; P<.001). Mental health sequelae were more strongly associated with index hospital infections (OR 2.21, 95% CI 1.64-2.96) than with index community infections (OR 1.36, 95% CI 1.21-1.53; P<.001). People presenting to primary care after hospital infection were more likely to be men (OR 1.43, 95% CI 1.25-1.64; P<.001), more socioeconomically deprived (OR 1.42, 95% CI 1.24-1.63; P<.001), and with higher multimorbidity scores (OR 1.41, 95% CI 1.26-1.57; P<.001) than those presenting after an index community infection. All-cause mortality in people with long COVID was associated with increasing age, male sex (OR 3.32, 95% CI 1.34-9.24; P=.01), and higher multimorbidity score (OR 2.11, 95% CI 1.34-3.29; P<.001). Vaccination was associated with reduced odds of mortality (OR 0.10, 95% CI 0.03-0.35; P<.001). Conclusions The low percentage of people recorded as having long COVID after COVID-19 infection reflects either low prevalence or underrecording. The characteristics and comorbidities of those presenting with long COVID after a community infection are different from those hospitalized. This study provides insights into the presentation of long COVID in primary care and implications for workload.

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“…2 Though PASC is more common in hospitalized patients, epidemiological studies suggest that over a third of non-hospitalized patients without clinically severe infection, may also get PASC. 3,4 Rough first estimates suggest that as much as 30% of the SARS-CoV-2 health burden could be due to infection-induced disability and PASC, not death, with the overall economic cost of PASC reaching half the cost of COVID-related deaths in the UK. 5 The UK COVIDsortium recruited a cohort of 731 HCW at three London hospitals early in the pandemic starting 23 rd March 2020 6 before the availability of vaccines.…”

Section: Introductionmentioning

confidence: 99%

Plasma proteomic signature predicts who will get persistent symptoms following SARS-CoV-2 infection

et al. 2022

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Long COVID in hospitalized and non-hospitalized patients in a large cohort in Northwest Spain, a prospective cohort study

Cited by 12 publications

References 21 publications

Post–COVID-19 Symptoms 2 Years After SARS-CoV-2 Infection Among Hospitalized vs Nonhospitalized Patients

Post–COVID-19 Symptoms 2 Years After SARS-CoV-2 Infection Among Hospitalized vs Nonhospitalized Patients

Differences in Clinical Presentation With Long COVID After Community and Hospital Infection and Associations With All-Cause Mortality: English Sentinel Network Database Study

Plasma proteomic signature predicts who will get persistent symptoms following SARS-CoV-2 infection

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