May 11, 2021

Non-hospitalised patients with COVID-19 have low risk of delayed acute complications after infection: Study

The risk of delayed acute complications after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that did not require hospitalisation is low, but persistent symptoms could lead to increased visits to general practitioners or outpatient clinics in the 6 months following infection, according to a study published in The Lancet Infectious Diseases.

“Most of the literature regarding post-acute complications of SARS-CoV-2 infection is based on follow-up of individuals admitted to hospital for coronavirus disease 2019 (COVID-19), and is therefore not generalisable to all individuals infected with SARS-CoV-2. Because most SARS-CoV-2-infected individuals are managed in the community, it is of major public health importance to better understand the risk of delayed effects in non-hospitalised individuals,” wrote Lars Christian Lund, MD, University of Southern Denmark, Odense, Denmark, and colleagues. 

“Therefore, we aimed to examine the occurrence of post-acute effects 2 weeks to 6 months after SARS-CoV-2 infection not requiring hospital admission, by assessing initiation of specific drugs, hospital diagnoses, and overall frequency of health-care encounters in a population-based cohort of SARS-CoV-2-positive individuals who were not admitted to hospital compared with SARS-CoV-2-negative individuals,” the researchers noted. 

The researchers used data from the Danish health registries on all individuals who were tested for SARS-CoV-2 between February 27 and May 31, 2020. The study followed 8,983 non-hospitalised SARS-CoV-2-positive people and 80,894 matched SARS-CoV-2-negative people 2 weeks to 6 months after the test. The cohorts had a median age of 43 years and 64% were female.

Compared with SARS-CoV-2-negative individuals, the researchers found that SARS-CoV-2-positive individuals were not at an increased risk of initiating new drugs (risk difference [RD] <0.1%) except for bronchodilating agents (adjusted RD +0.3% [95% confidence interval {CI} 0.0–0.7]; adjusted risk ratio {RR} 1.23 [95% CI 1.01–1.48]), specifically short-acting β2-agonists (adjusted RD +0.4% [0.1–0.7]; adjusted RR 1.32 [1.09–1.60]), and triptans (adjusted RD +0.1% [0.0–0.3]; adjusted RR 1.55 [1.07–2.25]).

Meanwhile, the risks of receiving any new hospital diagnosis during follow-up were 26.3% among SARS-CoV-2-positive individuals and 28.8% among SARS-CoV-2-negative individuals. The researchers found that SARS-CoV-2-positive individuals were at an increased risk of receiving a first diagnosis of dyspnoea (adjusted RD +0.6% [95% CI 0.4–0.8]; adjusted RR 2.00 [1.62–2.48]) and venous thromboembolism (adjusted RD +0.1% [0.0–0.2]; adjusted RR 1.77 [1.09–2.86]) compared with SARS-CoV-2-negative individuals. No increased risk of suggested serious complications of SARS-CoV-2 infection, which included ischaemic stroke, encephalitis, psychoses, or diagnoses related to paediatric inflammatory multisystemic syndrome was observed among SARS-CoV-2-positive individuals compared with SARS-CoV-2-negative individuals.

The research also analysed the use of health services in the follow-up period and found that prior event rate ratio-adjusted rate ratios of overall general practitioner visits (1.18 [95% CI 1.15–1.22]) and outpatient hospital visits (1.10 [1.05–1.16]), but not hospital admission were increased among SARS-CoV-2-positive individuals compared with SARS-CoV-2-negative individuals.

“The absolute risk of delayed acute complications, new onset of chronic disease, and hospital encounters for persisting symptoms 2 weeks to 6 months after SARS-CoV-2 infection not requiring hospital admission is low. However, among those not admitted to hospital, SARS-CoV-2-positive individuals are at a slightly increased risk of venous thromboembolism, receiving a hospital diagnosis of dyspnoea, initiating bronchodilator therapy, and initiating triptans compared with individuals who tested negative for SARS-CoV-2,” the authors concluded. “Moreover, SARS-CoV-2-positive individuals visited their general practitioner and outpatient hospital clinics more often after the primary infection than those who tested negative, which could indicate persistent symptoms that do not lead to specific drug treatment or hospital admission.”

Nonetheless, the follow-up of the study which was limited to 6 months after the positive test, remarked the authors, meant that the data may not have captured the longer-term complications and symptoms of COVID-19 that could occur after this time. In addition, due to the limited resources during the pandemic, some individuals with complications may have been referred to hospitals but not actually attended clinics before the end of the follow-up. This may have affected the numbers of hospital diagnoses recorded.

The researchers called for large population-based studies of patient-reported symptoms and healthcare visits to fully evaluate the duration and range of any persisting symptoms after SARS-CoV-2 infection.

SOURCE: The Lancet Infectious Diseases
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