High-dimensional characterization of post-acute sequelae of COVID-19

Nature. 2021 Jun;594(7862):259-264. doi: 10.1038/s41586-021-03553-9. Epub 2021 Apr 22.


The acute clinical manifestations of COVID-19 have been well characterized1,2, but the post-acute sequelae of this disease have not been comprehensively described. Here we use the national healthcare databases of the US Department of Veterans Affairs to systematically and comprehensively identify 6-month incident sequelae-including diagnoses, medication use and laboratory abnormalities-in patients with COVID-19 who survived for at least 30 days after diagnosis. We show that beyond the first 30 days of illness, people with COVID-19 exhibit a higher risk of death and use of health resources. Our high-dimensional approach identifies incident sequelae in the respiratory system, as well as several other sequelae that include nervous system and neurocognitive disorders, mental health disorders, metabolic disorders, cardiovascular disorders, gastrointestinal disorders, malaise, fatigue, musculoskeletal pain and anaemia. We show increased incident use of several therapeutic agents-including pain medications (opioids and non-opioids) as well as antidepressant, anxiolytic, antihypertensive and oral hypoglycaemic agents-as well as evidence of laboratory abnormalities in several organ systems. Our analysis of an array of prespecified outcomes reveals a risk gradient that increases according to the severity of the acute COVID-19 infection (that is, whether patients were not hospitalized, hospitalized or admitted to intensive care). Our findings show that a substantial burden of health loss that spans pulmonary and several extrapulmonary organ systems is experienced by patients who survive after the acute phase of COVID-19. These results will help to inform health system planning and the development of multidisciplinary care strategies to reduce chronic health loss among individuals with COVID-19.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • COVID-19 / complications*
  • COVID-19 / diagnosis
  • COVID-19 / physiopathology
  • COVID-19 / psychology
  • COVID-19 Drug Treatment
  • Cohort Studies
  • Databases, Factual
  • Datasets as Topic
  • Electronic Health Records
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Influenza, Human / diagnosis
  • Influenza, Human / drug therapy
  • Influenza, Human / physiopathology
  • Male
  • Outpatients / psychology
  • Outpatients / statistics & numerical data
  • Post-Acute COVID-19 Syndrome
  • Risk
  • SARS-CoV-2 / pathogenicity*
  • Time Factors
  • United States
  • United States Department of Veterans Affairs