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. 2023 Aug 1;183(8):806-817.
doi: 10.1001/jamainternmed.2023.2228.

Comparison of Medical and Mental Health Sequelae Following Hospitalization for COVID-19, Influenza, and Sepsis

Kieran L Quinn  1   2   3   4   5 , Thérèse A Stukel  2   3 , Anjie Huang  2 , Husam Abdel-Qadir  1   2   3   6   7 , Azmina Altaf  2 , Chaim M Bell  1   2   3   4 , Angela M Cheung  1   2 , Allan S Detsky  1   3   4 , Susie Goulding  8 , Margaret Herridge  1   2 , Noah Ivers  6 , Lauren Lapointe-Shaw  1   2   3   4 , John Lapp  4 , Candace D McNaughton  1   2   9 , Afsaneh Raissi  10   11 , Laura C Rosella  2   3 , Nahrain Warda  4 , Fahad Razak  1   3   10   11 , Amol A Verma  1   3   10   11   12
Affiliations

Comparison of Medical and Mental Health Sequelae Following Hospitalization for COVID-19, Influenza, and Sepsis

Kieran L Quinn et al. JAMA Intern Med. .

Abstract

Importance: People who survive hospitalization for COVID-19 are at risk for developing new cardiovascular, neurological, mental health, and inflammatory autoimmune conditions. It is unclear how posthospitalization risks for COVID-19 compare with those for other serious infectious illnesses.

Objective: To compare risks of incident cardiovascular, neurological, and mental health conditions and rheumatoid arthritis in 1 year following COVID-19 hospitalization against 3 comparator groups: prepandemic hospitalization for influenza and hospitalization for sepsis before and during the COVID-19 pandemic.

Design, setting, and participants: This population-based cohort study included all adults hospitalized for COVID-19 between April 1, 2020, and October 31, 2021, historical comparator groups of people hospitalized for influenza or sepsis, and a contemporary comparator group of people hospitalized for sepsis in Ontario, Canada.

Exposure: Hospitalization for COVID-19, influenza, or sepsis.

Main outcome and measures: New occurrence of 13 prespecified conditions, including cardiovascular, neurological, and mental health conditions and rheumatoid arthritis, within 1 year of hospitalization.

Results: Of 379 366 included adults (median [IQR] age, 75 [63-85] years; 54% female), there were 26 499 people who survived hospitalization for COVID-19, 299 989 historical controls (17 516 for influenza and 282 473 for sepsis), and 52 878 contemporary controls hospitalized for sepsis. Hospitalization for COVID-19 was associated with an increased 1-year risk of venous thromboembolic disease compared with influenza (adjusted hazard ratio, 1.77; 95% CI, 1.36-2.31) but with no increased risks of developing selected ischemic and nonischemic cerebrovascular and cardiovascular disorders, neurological disorders, rheumatoid arthritis, or mental health conditions compared with influenza or sepsis cohorts.

Conclusions and relevance: In this cohort study, apart from an elevated risk of venous thromboembolism within 1 year, the burden of postacute medical and mental health conditions among those who survived hospitalization for COVID-19 was comparable with other acute infectious illnesses. This suggests that many of the postacute consequences of COVID-19 may be related to the severity of infectious illness necessitating hospitalization rather than being direct consequences of infection with SARS-CoV-2.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Quinn reported personal fees through part-time employment at Public Health Ontario and stock in Pfizer and BioNTech outside the submitted work. Dr Abdel-Qadir reported support through a National New Investigator Award from the Heart and Stroke Foundation of Canada outside the submitted work. Dr Detsky reported owning stock in Pfizer and Johnson and Johnson, serving as a member of the TELUS Medical Advisory Committee, and serving on the scientific advisory body for Bindle Systems outside the submitted work. Dr McNaughton reported grants from the National Heart, Lung, and Blood Institute (R01HL127215) and the US Department of Veterans Affairs (ORH-10808, IIR-19-134); salary support from Sunnybrook Research Institute, the Department of Medicine at the University of Toronto, and the Department of Emergency Services at Sunnybrook Health Sciences Centre; and other support from Pfizer outside the submitted work. Dr Ivers reported support through a Canada Research Chair (Tier 2) in Implementation of Evidence-Based Practice at Women’s College Hospital and as a clinician scholar from the Department of Family and Community Medicine at the University of Toronto outside the submitted work. Dr Razak reported being a salaried employee through Public Health Ontario as the scientific director of the COVID-19 advisory group outside the submitted work. Dr Verma reported personal fees from Ontario Health and through the University of Toronto Temerty Professorship in AI Research and Education in Medicine outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Creation of the Study Cohorts
OHIP indicates the Ontario Health Insurance Plan.
Figure 2.
Figure 2.. Primary Analysis of Outcomes
Forest plot of the adjusted risk of incident cardiovascular, neurologic, and mental health conditions and rheumatoid arthritis within 1 year among adults who survived hospitalization for COVID-19 compared with those who survived hospitalization for influenza and sepsis in Ontario, Canada, between January 1, 2014, and October 31, 2021. PCI/CABG indicates percutaneous coronary intervention/coronary artery bypass grafting.
Figure 3.
Figure 3.. Secondary Analysis of Outcomes After Hospital Discharge
Forest plot of the adjusted risk of incident cardiovascular, neurologic, and mental health conditions and rheumatoid arthritis among adults who survived hospitalization for COVID-19 compared with those who survived hospitalization for influenza and sepsis in Ontario, Canada, between January 1, 2014, and October 31, 2021. PCI/CABG indicates percutaneous coronary intervention/coronary artery bypass grafting.
See this image and copyright information in PMC

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