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: 1 approved, 1 approved with reservations]

John Tazare, Alex J Walker, Laurie A Tomlinson, George Hickman, Christopher T Rentsch, Elizabeth Williamson, Krishnan Bhaskaran, David Evans, Kevin Wing, Rohini Mathur, Angel Y S Wong, Anna Schultze, Sebastian C J Bacon, Chris Bates, Caroline E Morton, Helen J Curtis, Emily Nightingale, Helen McDonald, Amir Mehrkar, Peter InglesbySimon Davy, Brian MacKenna, Jonathan Cockburn, William J Hulme, Charlotte Warren-Gash, Ketaki Bhate, Dorothea Nitsch, Emma Powell, Amy Mulick, Harriet J Forbes, Caroline Minassian, Richard Croker, John Parry, Frank Hester, Sam Harper, Rosalind M. Eggo, Stephen J W Evans, Liam Smeeth, Ian J Douglas, Ben Goldacre

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6 Citations (SciVal)

Abstract

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.
Original languageEnglish
Number of pages18
JournalWellcome Open Research
Volume7
Issue number142
DOIs
Publication statusPublished - 29 Apr 2022
Externally publishedYes

Bibliographical note

This work was supported by the Medical Research Council MR/V015737/1 and the National Core studies, an initiative funded by UKRI, NIHR and the Health and Safety Executive. This work uses data provided by patients and collected as part of their care and support. TPP provided technical expertise and infrastructure within their data centre pro bono in the context of a national emergency. The OpenSAFELY software platform is supported by a Wellcome Discretionary Award. BG’s work on clinical informatics is supported by the NIHR Oxford Biomedical Research Centre, the NIHR Applied Research Collaboration Oxford and Thames Valley, the Mohn-Westlake Foundation, and NHS England; all DataLab staff are supported by BG’s grants on this work. LS reports grants from Wellcome, MRC, NIHR, UKRI, British Council, GSK, British Heart Foundation, and Diabetes UK outside this work. AS is employed by LSHTM on a fellowship sponsored by GSK. KB holds a Sir Henry Dale fellowship jointly funded by Wellcome and the Royal Society (107731/Z/15/Z). HIM is funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation, a partnership between Public Health England and LSHTM. AYSW holds a fellowship from BHF. RM holds a Sir Henry Wellcome fellowship. EW holds grants from MRC. ID holds grants from NIHR and GSK. RM holds a Sir Henry Wellcome Fellowship funded by the Wellcome Trust (201375/Z/16/Z). HF holds a UKRI fellowship. CWG is supported by a Wellcome Intermediate Clinical Fellowship (201440/Z/16/Z). JT is funded by a MRC PhD Studentship (MR/N013638/1). KB holds a Doctoral Research Fellowship from NIHR. The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, Public Health England or the Department of Health and Social Care.

All data were linked, stored and analysed securely within the OpenSAFELY platform (https://opensafely.org/).

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