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Postacute COVID-19 Multisystem Sequelae Are Substantial

Updated: Jul 10, 2021

Anthony L. Komaroff, MD, reviewing Al-Aly Z et al. Nature 2021 Jun

New disease diagnoses were common after COVID-19 recovery.

Some patients have lingering symptoms after recovery from acute COVID-19. To assess post–COVID-19 illness more comprehensively, investigators from the U.S. Department of Veterans Affairs (VA) compared 73,000 people who survived ≥30 days after diagnosis of COVID-19 and nearly 5 million nonhospitalized people without COVID-19. Average follow-up was 4 months.

In analyses adjusted for potential confounding variables — including sociodemographic factors and past use of healthcare in the VA system — risk for new diseases was much higher post-COVID-19: These new diagnoses included hypertension, sleep–wake disorders, and lipid disorders (all with hazard ratios in the range of 10–15); dysrhythmias, diabetes, esophageal disorders, anxiety disorders, anemia, and coronary artery disease (HRs in the 4–8 range); and heart failure, respiratory failure, cognitive disorders, and pulmonary embolism (HRs in the 2–4 range). Correspondingly, new symptoms (e.g., chest pain), laboratory abnormalities (e.g., elevated glycosylated hemoglobin), and drug prescriptions (e.g., bronchodilators) were much more common in COVID-19 patients. Risk for death also was higher (HR, 1.6; ≈8 extra deaths per 1000 individuals). These excess risks were seen even in nonhospitalized patients with COVID-19, although risk for postacute complications was highest in those who were sickest. When the postacute COVID-19 patients were compared with hospitalized postacute influenza patients, risk for multisystem complications was far greater with COVID-19.

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