Post-COVID sequelae conditions identified, could help establish definition

Patients diagnosed with COVID-19 could have an increased risk of certain conditions up to 120 days post-diagnosis, a finding which could help establish the definition of Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), according to a study presented at CROI 2022.

“PASC is a relatively novel condition,” said study author Dr Michael Horberg from the Kaiser Permanente Mid-Atlantic States (KPMAS) Mid-Atlantic Permanente Research Institute, Rockville, Maryland, US.

Characterized as new onset or persistence of SARS-CoV-2 symptoms beyond convalescence or first 30 days post-diagnosis, PASC has not been well defined by conditions or timeline manifestation, he added, highlighting the aim of the study.

Using electronic health records from the KPMAS health system, the researchers identified adults with SARS-CoV-2 RT-PCR test results between January and December 2020. PCR-positive and -negative individuals were classed as cases (n=28,118) and controls (n=70,293), respectively, and were matched according to month of test, age group, race, sex, and medical centre. About 57–58 percent were female, and 59–60 percent were aged <50 years,

The incidence of incident/late PASC-related conditions of focus (COF), ie, those occurring 30–120 days post-PCR test, was greater in cases compared with controls (13.6 percent vs 12.1 percent*; risk ratio [RR], 1.12, 95 percent confidence interval [CI], 1.08–1.16). [CROI 2022, abstract 98]

The incidence of acute/persistent PASC-related COF (occurring 0–30 days post-PCR and persisting at 30–120 days follow-up) was also elevated among cases vs controls (4.1 percent vs 2.5 percent; RR, 1.60, 95 percent CI, 1.48–1.72).

Both analyses excluded conditions and symptoms that were deemed prevalent (identified 4 years prior to PCR test and thus, potentially pre-existing), and the analysis of incident/late COF also excluded conditions and symptoms identified in the acute/persistent period.

Certain incident/late COF conditions occurred with greater frequency in cases vs controls. These were anosmia (0.3 percent vs 0.1 percent; RR, 3.88), cardiac dysrhythmias (0.9 percent vs 0.7 percent; RR, 1.25), diabetes (0.9 percent vs 0.8 percent; RR, 1.20), genitourinary symptoms and ill-defined conditions (1.5 percent vs 1.2 percent; RR, 1.21), malaise and fatigue (1.4 percent vs 0.9 percent; RR, 1.60), and non-specific chest pain (1.7 percent vs 1.2 percent; RR, 1.39).

Persistent COFs that were significantly more common in cases than controls were cardiac dysrhythmias (0.3 percent vs 0.2 percent; RR, 1.90), diabetes (0.3 percent vs 0.2 percent; 1.96), fluid and electrolyte disorders (0.2 percent vs 0.1 percent; RR, 1.96), malaise and fatigue (0.3 percent vs 0.1 percent; RR, 2.89), non-specific chest pain (0.4 percent vs 0.2 percent; RR, 2.39), other lower respiratory disease (1.2 percent vs 0.5 percent; RR, 2.51), and respiratory failure, insufficiency, or arrest (0.7 percent vs 0 percent; RR, 22.95).

When all conditions were taken into account (regardless of COF), the conditions were more common among cases than controls in the incident/late period (26.1 percent vs 25.2 percent; RR, 1.04), but were less common in cases than controls in the persistent period (20.4 percent vs 22.1 percent; RR, 0.92).

“Our findings contribute to the overall evaluation of PASC and provide supporting evidence for an accepted definition,” Horberg pointed out.

He noted several limitations including the retrospective study design, the possible exclusion of prevalent conditions should they have been diagnosed >4 years before the PCR test, and the non-inclusion of more novel diagnoses such as brain fog.

Further research is warranted to assess persistence and severity of symptoms beyond 120 days post-COVID diagnosis, he concluded.