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Observational Study
. 2021 Mar 31:372:n693.
doi: 10.1136/bmj.n693.

Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study

Daniel Ayoubkhani  1 , Kamlesh Khunti  2 , Vahé Nafilyan  1 , Thomas Maddox  1 , Ben Humberstone  1 , Ian Diamond  1 , Amitava Banerjee  3   4   5
Affiliations
Observational Study

Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study

Daniel Ayoubkhani et al. BMJ. .

Abstract

Objective: To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population.

Design: Retrospective cohort study.

Setting: NHS hospitals in England.

Participants: 47 780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records.

Main outcome measures: Rates of hospital readmission (or any admission for controls), all cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity.

Results: Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals).

Conclusions: Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; KK is chair of the ethnicity subgroup of the Independent Scientific Advisory Group for Emergencies (SAGE), a member of Independent SAGE, a trustee of the South Asian Health Foundation (SAHF), and director of the University of Leicester Centre for Black Minority Ethnic Health; and AB is a trustee of SAHF and has received a research grant unrelated to the current work from AstraZeneca.

Figures

Fig 1
Fig 1
Study population flow diagram. Patient counts have been rounded to the nearest five for disclosure control reasons, and components may therefore not sum to totals
Fig 2
Fig 2
Rates of multiorgan dysfunction comparing individuals with covid-19 in England discharged from hospital by 31 August 2020 with matched controls. Outcomes calculated from hospital admissions to 31 August 2020, and primary care records and deaths registrations to 30 September 2020. Patients with covid-19 were matched to controls for baseline personal characteristics (age, sex, ethnicity, region, Index of Multiple Deprivation category, and smoking status) and clinical histories (hypertension, major adverse cardiovascular event, respiratory disease, chronic kidney disease, chronic liver disease, diabetes, and cancer). MACE=major adverse cardiovascular event
Fig 3
Fig 3
Rate ratios of death, readmission, and multiorgan dysfunction comparing individuals with covid-19 in England discharged from hospital by 31 August 2020 with matched controls, stratified by personal factors. Outcomes calculated from hospital admissions to 31 August 2020, and primary care records and deaths registrations to 30 September 2020. Readmission to hospital is any admission after discharge for patients with covid-19 and any admission after the index date for controls. Individuals with missing ethnicity information were omitted from the analysis stratified by ethnic group. Patients with covid-19 were matched to controls for baseline personal characteristics (age, sex, ethnicity, region, Index of Multiple Deprivation category, and smoking status) and clinical histories (hypertension, major adverse cardiovascular event, respiratory disease, chronic kidney disease, chronic liver disease, diabetes, and cancer). Rate ratios for chronic kidney disease could not be stratified by ethnic group because of insufficient event counts in the control group
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References

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