Risk Factors Associated With Post−COVID-19 Condition

Abstract

ImportancePost−COVID-19 condition (PCC) is a complex heterogeneous disorder that has affected the lives of millions of people globally. Identification of potential risk factors to better understand who is at risk of developing PCC is important because it would allow for early and appropriate clinical support.ObjectiveTo evaluate the demographic characteristics and comorbidities that have been found to be associated with an increased risk of developing PCC.Data sourcesMedline and Embase databases were systematically searched from inception to December 5, 2022.Study SelectionThe meta-analysis included all published studies that investigated the risk factors and/or predictors of PCC in adult (≥18 years) patients.Data Extraction and SynthesisOdds ratios (ORs) for each risk factor were pooled from the selected studies. For each potential risk factor, the random-effects model was used to compare the risk of developing PCC between individuals with and without the risk factor. Data analyses were performed from December 5, 2022, to February 10, 2023.Main Outcomes and MeasuresThe risk factors for PCC included patient age; sex; body mass index, calculated as weight in kilograms divided by height in meters squared; smoking status; comorbidities, including anxiety and/or depression, asthma, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, immunosuppression, and ischemic heart disease; previous hospitalization or ICU (intensive care unit) admission with COVID-19; and previous vaccination against COVID-19.ResultsThe initial search yielded 5334 records of which 255 articles underwent full-text evaluation, which identified 41 articles and a total of 860 783 patients that were included. The findings of the meta-analysis showed that female sex (OR, 1.56; 95% CI, 1.41-1.73), age (OR, 1.21; 95% CI, 1.11-1.33), high BMI (OR, 1.15; 95% CI, 1.08-1.23), and smoking (OR, 1.10; 95% CI, 1.07-1.13) were associated with an increased risk of developing PCC. In addition, the presence of comorbidities and previous hospitalization or ICU admission were found to be associated with high risk of PCC (OR, 2.48; 95% CI, 1.97-3.13 and OR, 2.37; 95% CI, 2.18-2.56, respectively). Patients who had been vaccinated against COVID-19 with 2 doses had a significantly lower risk of developing PCC compared with patients who were not vaccinated (OR, 0.57; 95% CI, 0.43-0.76).Conclusions and RelevanceThis systematic review and meta-analysis demonstrated that certain demographic characteristics (eg, age and sex), comorbidities, and severe COVID-19 were associated with an increased risk of PCC, whereas vaccination had a protective role against developing PCC sequelae. These findings may enable a better understanding of who may develop PCC and provide additional evidence for the benefits of vaccination.Trial RegistrationPROSPERO Identifier: CRD42022381002

Vaccination After SARS-CoV-2 Infection and Post−COVID-19 Condition

“…Therefore, the results of Dr Tsampasian and colleagues’ study regarding an association of COVID-19 vaccines with a reduced risk of developing PCC are inconsistent with the findings of other studies . Moreover, the researchers included only 4 studies to evaluate this risk and failed to adjust for combined vaccination before and after SARS-CoV-2 infection or after PCC diagnosis, potentially increasing the risk of bias and decreasing the certainty of the evidence. Importantly, the other studies enumerated previously also met the inclusion criteria but were excluded from the analysis.…”

Vaccination After SARS-CoV-2 Infection and Post−COVID-19 Condition—In Reply

“…In Reply We thank Dr Yang and colleagues for their interest in our study and for highlighting that post−COVID-19 condition (PCC) is of important public health interest. They mention specific studies and rightly ask why these were not included in our meta-analysis.…”

Exploring risk factors for persistent neurocognitive sequelae after hospitalization for COVID‐19

“…We also found that female sex was associated with greater than five times increased odds of persistent cognitive ability disturbance and greater than seven times increased odds of persistent cognitive function disturbance. Other studies have also found females to be significantly more likely to report persistent neurocognitive symptoms following SARS‐CoV2 infection 21,31–35 . One study suggests that discrepancies in sex hormones related to inflammatory processes may also contribute to this difference we see in COVID‐19 response 36 .…”