Preprint: Severe acute infection and chronic pulmonary disease are risk factors for developing post-COVID-19 conditions 2022 Ghosh et al

[Andy]

Abstract

Post-COVID-19 conditions, also known as “long COVID”, has significantly impacted the lives of many individuals, but the risk factors for this condition are poorly understood.

In this study, we performed a retrospective EHR analysis of 89,843 individuals at a multi-state health system in the United States with PCR-confirmed COVID-19, including 1,086 patients diagnosed with long COVID and 1,086 matched controls not diagnosed with long COVID. For these two cohorts, we evaluated a wide range of clinical covariates, including laboratory tests, medication orders, phenotypes recorded in the clinical notes, and outcomes.

We found that chronic pulmonary disease (CPD) was significantly more common as a pre-existing condition for the long COVID cohort than the control cohort (odds ratio: 1.9, 95% CI: [1.5, 2.6]). Additionally, long-COVID patients were more likely to have a history of migraine (odds ratio: 2.2, 95% CI: [1.6, 3.1]) and fibromyalgia (odds ratio: 2.3, 95% CI: [1.3, 3.8]). During the acute infection phase, the following lab measurements were abnormal in the long COVID cohort: high triglycerides (meanlongCOVID: 278.5 mg/dL vs. meancontrol: 141.4 mg/dL), low HDL cholesterol levels (meanlongCOVID: 38.4 mg/dL vs. meancontrol: 52.5 mg/dL), and high neutrophil-lymphocyte ratio (meanlongCOVID: 10.7 vs. meancontrol: 7.2). The hospitalization rate during the acute infection phase was also higher in the long COVID cohort compared to the control cohort (ratelongCOVID: 5% vs. ratecontrol: 1%).

Overall, this study suggests that the severity of acute infection and a history of CPD, migraine, CFS, or fibromyalgia may be risk factors for long COVID symptoms. Our findings motivate clinical studies to evaluate whether suppressing acute disease severity proactively, especially in patients at high risk, can reduce incidence of long COVID.

https://www.medrxiv.org/content/10.1101/2022.11.30.22282831v1

 

[rvallee]

evaluate whether suppressing acute disease severity proactively, especially in patients at high risk, can reduce incidence of long COVID

Since there is no high risk profile and healthcare services cannot do this realistically, this is in the same category as "if wishes had wings, you could fly them all the way up".

This would work if severity of illness was very significant, and even then. It clearly matters little. But very few even know that.

 

[Trish]

I think it's interesting that they picked out migraine, FM and CFS as predisposing factors for long covid.

 

[RedFox]

I'm having trouble parsing this paper. They're comparing around 1,000 people who got Covid but recovered, and 1,000 who got Covid and had lasting effects. They conclusion about ME seems to be in table S3. There were more pwME in the long Covid group (1%) than the control group (<1%). I guess, this is only accurate if the pwME have the same demographics as everyone else in the study and the same odds of getting Covid.

 

[Dolphin]

I'm having trouble parsing this paper. They're comparing around 1,000 people who got Covid but recovered, and 1,000 who got Covid and had lasting effects. They conclusion about ME seems to be in table S3. There were more pwME in the long Covid group (1%) than the control group (<1%). I guess, this is only accurate if the pwME have the same demographics as everyone else in the study and the same odds of getting Covid.

Not sure about the last point: everyone has PCR-confirmed Covid in the study. So we are looking at the subgroup of the population who got Covid. The former point could be relevant: the finding could be due to confounding from some other factor e.g. if gender really alone was the biggest risk factor for Long Covid, given CFS is more common in females, there could appear to be a risk from having CFS but the risk might really have been from gender. The numbers might be too small to use multivariate analysis well to see if the number of variables could be reduced.