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Hospitalised COVID-19 patients face organ damage risk

Thursday April 1st 2021

People discharged from hospital after being treated for COVID-19 are more likely to suffer from multi-organ dysfunction.

A new study, published in the latest edition of The BMJ, warns the long-term burden of COVID-19-related illness on hospitals and broader healthcare systems could be substantial because the increase in risk was across different age groups and ethnic groups.

Researchers from the Office for National Statistics, University College London and University of Leicester compared rates of organ dysfunction in 47,780 individuals several months after they were discharged from hospital after being treated for COVID-19.

They were on average 65 years and 55% were men and had been in hospital in England and discharged by 31 August 2020.

These participants were matched with controls, based on personal characteristics and medical history, and health records were used to track rates of hospital readmission, death from any cause, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020.

Over an average follow-up of 140 days, nearly one third of patients (14,060) who were discharged from hospital after acute COVID-19 were readmitted and 5,875 died after discharge.

They calculated the rate at 766 readmissions and 320 deaths per 1,000 person years – four and eight times greater, respectively, than those in matched controls.

Rates of respiratory disease, cardiovascular disease, and diabetes were also significantly raised in COVID-19 patients, with 539, 66, and 29 new onset diagnoses per 1,000 person years, respectively, which is equivalent to 27, three, and 1.5 times greater than in matched controls.

Differences in rates of multi-organ dysfunction between patients with COVID-19 and matched controls were greater for those under 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.

The researchers call for urgent research “to understand the risk factors for post-COVID syndrome so that treatment can be targeted better to demographically and clinically at risk populations”.

The study is published as research from the University of East Anglia (UEA) and the Norfolk and Norwich University Hospital (NNUH) finds that comorbidities such as heart disease, respiratory disease, renal disease and cancer lead to an increased risk of death from COVID-19.

In the most comprehensive study of its kind to date, the team reviewed 52 studies involving more than 100,000 patients and studied the outcomes for patients taking antihypertensives – looking particularly at critical outcomes.

Their metanalysis, published in the latest edition of JAMA Network Open, shows a significantly lower risk of hospitalisation or death for people taking Angiotensin-Converting Enzyme inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB).

But they found that risks for hospitalisation and death were much higher for people with comorbidities.

Lead researcher Dr Vassilios Vassiliou, from UEA’s Norwich Medical School and honorary consultant cardiologist at NNUH, said: “With these increased numbers, what we can see very clearly now, is that it is the comorbidities such as cardiac disease or respiratory disease, cancer or obesity amongst others that lead to an increased mortality.

“And we can confirm that the blood pressure medications themselves are protective – not only for people who have high blood pressure, but for people with a range of other comorbidities as well.”

Ayoubkhani D, Khunti K, Nafilyan V et al. Post-COVID syndrome in individuals admitted to hospital with COVID-19: retrospective cohort study. BMJ 1 April 2021; doi: 10.1136/bmj.n693

[abstract]

Baral R, Tsampasian V, Debski M et al. Association Between Renin-Angiotensin-Aldosterone System Inhibitors and Clinical Outcomes in Patients With COVID-19: An Updated Systematic Review and Meta-analysis. JAMA Network Open 31 March 2021; doi:10.1001/jamanetworkopen.2021.3594

Tags: Flu & Viruses | NHS | UK News

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