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. 2023 Jun:60:102000.
doi: 10.1016/j.eclinm.2023.102000. Epub 2023 May 11.

Long-term post-acute sequelae of COVID-19 infection: a retrospective, multi-database cohort study in Hong Kong and the UK

Ivan Chun Hang Lam  1 , Carlos King Ho Wong  1   2   3 , Ran Zhang  2 , Celine Sze Ling Chui  3   4   5 , Francisco Tsz Tsun Lai  1   3 , Xue Li  1   3   6 , Esther Wai Yin Chan  1   3   7   8 , Hao Luo  9   10   11 , Qingpeng Zhang  12 , Kenneth Keng Cheung Man  1   3   13   14 , Bernard Man Yung Cheung  6   15 , Sydney Chi Wai Tang  16 , Chak Sing Lau  17 , Eric Yuk Fai Wan  1   2   3 , Ian Chi Kei Wong  1   3   18
Affiliations

Long-term post-acute sequelae of COVID-19 infection: a retrospective, multi-database cohort study in Hong Kong and the UK

Ivan Chun Hang Lam et al. EClinicalMedicine. 2023 Jun.

Abstract

Background: Evidence on post-acute sequelae of SARS-CoV-2 (PASC) has shown inconsistent findings. This study aimed to generate coherent evidence on the post-acute sequelae of COVID-19 infection using electronic healthcare records across two regions.

Methods: In this retrospective, multi-database cohort study, patients with COVID-19 aged 18 or above between April 1st 2020 and May 31st 2022 from the Hong Kong Hospital Authority (HKHA) and March 16th 2020 and May 31st 2021 from the UK Biobank (UKB) databases and their matched controls were followed for up to 28 and 17 months, respectively. Covariates between patients with COVID-19 and non-COVID-19 controls were adjusted using propensity score-based inverse probability treatment weighting. Cox proportional regression was used to estimate the hazard ratio (HR) of clinical sequelae, cardiovascular, and all-cause mortality 21 days after COVID-19 infection.

Findings: A total of 535,186 and 16,400 patients were diagnosed with COVID-19 from HKHA and UKB, of whom 253,872 (47.4%) and 7613 (46.4%) were male, with a mean age (±SD) of 53.6 (17.8) years and 65.0 (8.5) years, respectively. Patients with COVID-19 incurred greater risk of heart failure (HR 1.82; 95% CI 1.65, 2.01), atrial fibrillation (1.31; 1.16, 1.48), coronary artery disease (1.32; 1.07, 1.63), deep vein thrombosis (1.74; 1.27, 2.37), chronic pulmonary disease (1.61; 1.40, 1.85), acute respiratory distress syndrome (1.89; 1.04, 3.43), interstitial lung disease (3.91; 2.36, 6.50), seizure (2.32; 1.12, 4.79), anxiety disorder (1.65; 1.29, 2.09), post-traumatic stress disorder (1.52; 1.23, 1.87), end-stage renal disease (1.76; 1.31, 2.38), acute kidney injury (2.14; 1.69, 2.71), pancreatitis (1.42; 1.10, 1.83), cardiovascular (2.86; 1.25, 6.51) and all-cause mortality (4.16; 2.11, 8.21) mortality during their post-acute phase of infection.

Interpretation: The consistent greater risk of PASC highlighted the need for sustained multi-disciplinary care for COVID-19 survivors.

Funding: Health Bureau, The Government of the Hong Kong Special Administrative Region, Collaborative Research Fund, The Government of the Hong Kong Special Administrative Region and AIR@InnoHK, administered by the Innovation and Technology Commission, The Government of the Hong Kong Special Administrative Region.

Keywords: COVID-19; PASC; Post-acute sequelae of SARS-CoV-2; SARS-CoV-2.

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Conflict of interest statement

CKHW reports receipt of research funding from the EuroQoL Group Research Foundation, the Hong Kong Research Grants Council, and the Hong Kong Health and Medical Research Fund; CSLC has received grants from the Health Bureau of the Hong Kong Government, Hong Kong Research Grant Council, Hong Kong Innovation and Technology Commission, Pfizer, IQVIA, MSD, and Amgen, personal fee from Primevigilance Ltd., outside the submitted work; FTTL has been supported by the RGC Postdoctoral Fellowship under the Hong Kong Research Grants Council; XL has received research grants from the Health Bureau of the Government of the Hong Kong SAR, research and educational grants from Janssen and Pfizer, internal funding from University of Hong Kong, consultancy fee from Merck Sharp & Dohme, speaker fee from Pfizer, unrelated to this work; KKCM reports grants from the CW Maplethorpe Fellowship, National Institute of Health Research, UK, Hong Kong Research Grant Council and the European Commission Horizon 2020 Framework, personal fees from IQVIA, and grants from Amgen and GlaxoSmithKline, outside this work. EWYC has received grants from Research Grants Council of the Hong Kong SAR, Research Fund Secretariat of the Health Bureau of the Hong Kong SAR, National Natural Science Fund of China, Bayer, Bristol-Myers Squibb, Pfizer, Janssen, Novartis, Amgen, AstraZeneca, Takeda, the RGA Reinsurance Company, Narcotics Division of the Security Bureau of the Hong Kong SAR, and the National Health and Medical Research Council Australia; consulting fees from AstraZeneca, Pfizer and Novartis; and honorarium from the Hospital Authority of the Hong Kong SAR and serve as the president of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), Hong Kong Regional Chapter, outside the submitted work.; BMYC reports research funding outside the submitted work from Guangdong-Hong Kong Technology Cooperation Funding Scheme; SCWT reports research funding outside the submitted work from the Hong Kong RGC, and the Hong Kong Health and Medical Research Fund, and National Natural Science Fund of China; ICKW reports research funding from Amgen, Bristol Myers Squibb, Pfizer, Janssen, Bayer, GSK, Novartis, the Hong Kong Research Grants Council, the Hong Kong Health and Medical Research Fund, the National Institute for Health Research in England, the European Commission, and the National Health and Medical Research Council in Australia, outside the submitted work; and is a non-executive director of Jacobson Medical in Hong Kong and a consultant to IQVIA and World Health Organization; and serve as a member of the Pharmacy and Poisons Board, Hong Kong SAR, Expert Committee on Clinical Events Assessment Following COVID-19 Immunization and Advisory Panel on COVID-19 Vaccines of the Hong Kong Government; EYFW received research grants from the Health Bureau of the Government of the Hong Kong SAR, and the Hong Kong Research Grants Council, outside the submitted work. All other authors report no disclosures relevant to the manuscript.

Figures

Fig. 1
Fig. 1
Hazard ratio of post-acute sequelae of SARS-CoV-2 in the general population. aData from Hong Kong and the United Kingdom (UK) were obtained from the Hong Kong Hospital Authority and UK Biobank, respectively. bMeta-analysis was performed using a random effects model. cHazard Ratio (HR) and 95% Confidence Interval (95% CI) were estimated by Cox regression, HR > 1 (or <1) indicates patients with COVID-19 had higher (lower) risk of sequelae compared to the non-COVID-19 control cohort. The error bars denote the 95% CI of the respective HR. Note: Major CVD: Major Cardiovascular Disease; Composite outcome of stroke, heart failure and coronary artery disease; ARDS: Acute respiratory distress syndrome; NA: Not available due to insufficient number of events.
See this image and copyright information in PMC

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