Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19 in England: a descriptive cohort study within the OpenSAFELY platform [version 1; peer review: 2 approved, 1 approved with reservations]
Background: Patients surviving hospitalisation for COVID-19 are thought to be at high risk of cardiometabolic and pulmonary complications, but quantification of that risk is limited. We aimed to describe the overall burden of these complications in people after discharge from hospital with COVID-19....
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wellcome
2022-04-01
|
| Series: | Wellcome Open Research |
| Subjects: | |
| Online Access: | https://wellcomeopenresearch.org/articles/7-142/v1 |
| _version_ | 1797798146436235264 |
|---|---|
| author | Richard Croker Anna Schultze Simon Davy David Evans John Parry Angel YS. Wong Alex J. Walker Kevin Wing Sam Harper Liam Smeeth Helen J. Curtis Caroline E. Morton Caroline Minassian Helen I. McDonald Emily Nightingale Ian J Douglas Ketaki Bhate William J. Hulme Emma Powell Dorothea Nitsch Frank Hester Amy Mulick Stephen JW. Evans Charlotte Warren-Gash Rosalind M. Eggo Elizabeth J. Williamson Krishnan Bhaskaran John Tazare Laurie A. Tomlinson Chris Bates Harriet Forbes Peter Inglesby Ben Goldacre Brian MacKenna Jonathan Cockburn Rohini Mathur Seb Bacon George Hickman Christopher T. Rentsch Amir Mehrkar |
| author_facet | Richard Croker Anna Schultze Simon Davy David Evans John Parry Angel YS. Wong Alex J. Walker Kevin Wing Sam Harper Liam Smeeth Helen J. Curtis Caroline E. Morton Caroline Minassian Helen I. McDonald Emily Nightingale Ian J Douglas Ketaki Bhate William J. Hulme Emma Powell Dorothea Nitsch Frank Hester Amy Mulick Stephen JW. Evans Charlotte Warren-Gash Rosalind M. Eggo Elizabeth J. Williamson Krishnan Bhaskaran John Tazare Laurie A. Tomlinson Chris Bates Harriet Forbes Peter Inglesby Ben Goldacre Brian MacKenna Jonathan Cockburn Rohini Mathur Seb Bacon George Hickman Christopher T. Rentsch Amir Mehrkar |
| author_sort | Richard Croker |
| collection | DOAJ |
| description | Background: Patients surviving hospitalisation for COVID-19 are thought to be at high risk of cardiometabolic and pulmonary complications, but quantification of that risk is limited. We aimed to describe the overall burden of these complications in people after discharge from hospital with COVID-19. Methods: Working on behalf of NHS England, we used linked primary care records, death certificate and hospital data from the OpenSAFELY platform. We constructed three cohorts: patients discharged following hospitalisation with COVID-19, patients discharged following pre-pandemic hospitalisation with pneumonia, and a frequency-matched cohort from the general population in 2019. We studied seven outcomes: deep vein thrombosis (DVT), pulmonary embolism (PE), ischaemic stroke, myocardial infarction (MI), heart failure, AKI and new type 2 diabetes mellitus (T2DM) diagnosis. Absolute rates were measured in each cohort and Fine and Gray models were used to estimate age/sex adjusted subdistribution hazard ratios comparing outcome risk between discharged COVID-19 patients and the two comparator cohorts. Results: Amongst the population of 77,347 patients discharged following hospitalisation with COVID-19, rates for the majority of outcomes peaked in the first month post-discharge, then declined over the following four months. Patients in the COVID-19 population had markedly higher risk of all outcomes compared to matched controls from the 2019 general population. Across the whole study period, the risk of outcomes was more similar when comparing patients discharged with COVID-19 to those discharged with pneumonia in 2019, although COVID-19 patients had higher risk of T2DM (15.2 versus 37.2 [rate per 1,000-person-years for COVID-19 versus pneumonia, respectively]; SHR, 1.46 [95% CI: 1.31 - 1.63]). Conclusions: Risk of cardiometabolic and pulmonary adverse outcomes is markedly raised following discharge from hospitalisation with COVID-19 compared to the general population. However, excess risks were similar to those seen following discharge post-pneumonia. Overall, this suggests a large additional burden on healthcare resources. |
| first_indexed | 2024-03-13T03:59:08Z |
| format | Article |
| id | doaj.art-8c0b0d16ce2246b5bbeb12f399c5c149 |
| institution | Directory Open Access Journal |
| issn | 2398-502X |
| language | English |
| last_indexed | 2024-03-13T03:59:08Z |
| publishDate | 2022-04-01 |
| publisher | Wellcome |
| record_format | Article |
| series | Wellcome Open Research |
| spelling | doaj.art-8c0b0d16ce2246b5bbeb12f399c5c1492023-06-22T01:00:01ZengWellcomeWellcome Open Research2398-502X2022-04-01719626Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19 in England: a descriptive cohort study within the OpenSAFELY platform [version 1; peer review: 2 approved, 1 approved with reservations]Richard Croker0https://orcid.org/0000-0002-8114-9186Anna Schultze1https://orcid.org/0000-0002-1637-837XSimon Davy2David Evans3https://orcid.org/0000-0002-1100-079XJohn Parry4https://orcid.org/0000-0002-1207-9612Angel YS. Wong5https://orcid.org/0000-0002-8618-7333Alex J. Walker6https://orcid.org/0000-0003-4932-6135Kevin Wing7Sam Harper8Liam Smeeth9https://orcid.org/0000-0002-9168-6022Helen J. Curtis10https://orcid.org/0000-0003-3429-9576Caroline E. Morton11Caroline Minassian12Helen I. McDonald13https://orcid.org/0000-0003-0576-2015Emily Nightingale14Ian J Douglas15Ketaki Bhate16William J. Hulme17https://orcid.org/0000-0002-9162-4999Emma Powell18Dorothea Nitsch19Frank Hester20Amy Mulick21Stephen JW. Evans22https://orcid.org/0000-0002-1474-2596Charlotte Warren-Gash23https://orcid.org/0000-0003-4524-3180Rosalind M. Eggo24https://orcid.org/0000-0002-0362-6717Elizabeth J. Williamson25https://orcid.org/0000-0001-6905-876XKrishnan Bhaskaran26https://orcid.org/0000-0001-5364-8757John Tazare27https://orcid.org/0000-0002-7194-2615Laurie A. Tomlinson28https://orcid.org/0000-0001-8848-9493Chris Bates29Harriet Forbes30Peter Inglesby31Ben Goldacre32Brian MacKenna33Jonathan Cockburn34Rohini Mathur35https://orcid.org/0000-0002-3817-8790Seb Bacon36George Hickman37https://orcid.org/0000-0002-6691-4046Christopher T. Rentsch38https://orcid.org/0000-0002-1408-7907Amir Mehrkar39The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKThe DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UKThe DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UKTPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKThe DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKTPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKThe DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKThe DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKTPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKTPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKThe DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UKThe DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UKThe DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UKTPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKThe DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UKThe DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UKLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UKThe DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UKBackground: Patients surviving hospitalisation for COVID-19 are thought to be at high risk of cardiometabolic and pulmonary complications, but quantification of that risk is limited. We aimed to describe the overall burden of these complications in people after discharge from hospital with COVID-19. Methods: Working on behalf of NHS England, we used linked primary care records, death certificate and hospital data from the OpenSAFELY platform. We constructed three cohorts: patients discharged following hospitalisation with COVID-19, patients discharged following pre-pandemic hospitalisation with pneumonia, and a frequency-matched cohort from the general population in 2019. We studied seven outcomes: deep vein thrombosis (DVT), pulmonary embolism (PE), ischaemic stroke, myocardial infarction (MI), heart failure, AKI and new type 2 diabetes mellitus (T2DM) diagnosis. Absolute rates were measured in each cohort and Fine and Gray models were used to estimate age/sex adjusted subdistribution hazard ratios comparing outcome risk between discharged COVID-19 patients and the two comparator cohorts. Results: Amongst the population of 77,347 patients discharged following hospitalisation with COVID-19, rates for the majority of outcomes peaked in the first month post-discharge, then declined over the following four months. Patients in the COVID-19 population had markedly higher risk of all outcomes compared to matched controls from the 2019 general population. Across the whole study period, the risk of outcomes was more similar when comparing patients discharged with COVID-19 to those discharged with pneumonia in 2019, although COVID-19 patients had higher risk of T2DM (15.2 versus 37.2 [rate per 1,000-person-years for COVID-19 versus pneumonia, respectively]; SHR, 1.46 [95% CI: 1.31 - 1.63]). Conclusions: Risk of cardiometabolic and pulmonary adverse outcomes is markedly raised following discharge from hospitalisation with COVID-19 compared to the general population. However, excess risks were similar to those seen following discharge post-pneumonia. Overall, this suggests a large additional burden on healthcare resources.https://wellcomeopenresearch.org/articles/7-142/v1Electronic Health Records Covid-19 Pneumonia Cardiometabolic Post-hospitalisation eng |
| spellingShingle | Richard Croker Anna Schultze Simon Davy David Evans John Parry Angel YS. Wong Alex J. Walker Kevin Wing Sam Harper Liam Smeeth Helen J. Curtis Caroline E. Morton Caroline Minassian Helen I. McDonald Emily Nightingale Ian J Douglas Ketaki Bhate William J. Hulme Emma Powell Dorothea Nitsch Frank Hester Amy Mulick Stephen JW. Evans Charlotte Warren-Gash Rosalind M. Eggo Elizabeth J. Williamson Krishnan Bhaskaran John Tazare Laurie A. Tomlinson Chris Bates Harriet Forbes Peter Inglesby Ben Goldacre Brian MacKenna Jonathan Cockburn Rohini Mathur Seb Bacon George Hickman Christopher T. Rentsch Amir Mehrkar Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19 in England: a descriptive cohort study within the OpenSAFELY platform [version 1; peer review: 2 approved, 1 approved with reservations] Wellcome Open Research Electronic Health Records Covid-19 Pneumonia Cardiometabolic Post-hospitalisation eng |
| title | Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19 in England: a descriptive cohort study within the OpenSAFELY platform [version 1; peer review: 2 approved, 1 approved with reservations] |
| title_full | Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19 in England: a descriptive cohort study within the OpenSAFELY platform [version 1; peer review: 2 approved, 1 approved with reservations] |
| title_fullStr | Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19 in England: a descriptive cohort study within the OpenSAFELY platform [version 1; peer review: 2 approved, 1 approved with reservations] |
| title_full_unstemmed | Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19 in England: a descriptive cohort study within the OpenSAFELY platform [version 1; peer review: 2 approved, 1 approved with reservations] |
| title_short | Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19 in England: a descriptive cohort study within the OpenSAFELY platform [version 1; peer review: 2 approved, 1 approved with reservations] |
| title_sort | rates of serious clinical outcomes in survivors of hospitalisation with covid 19 in england a descriptive cohort study within the opensafely platform version 1 peer review 2 approved 1 approved with reservations |
| topic | Electronic Health Records Covid-19 Pneumonia Cardiometabolic Post-hospitalisation eng |
| url | https://wellcomeopenresearch.org/articles/7-142/v1 |
| work_keys_str_mv | AT richardcroker ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT annaschultze ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT simondavy ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT davidevans ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT johnparry ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT angelyswong ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT alexjwalker ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT kevinwing ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT samharper ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT liamsmeeth ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT helenjcurtis ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT carolineemorton ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT carolineminassian ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT helenimcdonald ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT emilynightingale ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT ianjdouglas ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT ketakibhate ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT williamjhulme ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT emmapowell ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT dorotheanitsch ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT frankhester ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT amymulick ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT stephenjwevans ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT charlottewarrengash ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT rosalindmeggo ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT elizabethjwilliamson ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT krishnanbhaskaran ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT johntazare ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT laurieatomlinson ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT chrisbates ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT harrietforbes ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT peteringlesby ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT bengoldacre ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT brianmackenna ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT jonathancockburn ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT rohinimathur ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT sebbacon ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT georgehickman ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT christophertrentsch ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations AT amirmehrkar ratesofseriousclinicaloutcomesinsurvivorsofhospitalisationwithcovid19inenglandadescriptivecohortstudywithintheopensafelyplatformversion1peerreview2approved1approvedwithreservations |