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COVID-19 and risk of subsequent life-threatening secondary infections : a matched cohort study in UK Biobank

COVID-19 and risk of subsequent life-threatening secondary infections : a matched cohort study in UK Biobank


Title: COVID-19 and risk of subsequent life-threatening secondary infections : a matched cohort study in UK Biobank
Author: Hou, Can
Hu, Yihan
Yang, Huazhen
Chen, Wenwen
Zeng, Yu
Ying, Zhiye
Hu, Yao
Sun, Yajing
Qu, Yuanyuan
Gottfreðsson, Magnús
... 2 more authors Show all authors
Date: 2021-11-16
Language: English
Scope: 301
Department: Other departments
Faculty of Medicine
Series: BMC Medicine; 19(1)
ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-021-02177-0
Subject: COVID-19; Blóðeitrun; Sýkingar; COVID-19; Life-threatening infections; Sepsis; Severe secondary infections; SARS-CoV-2; Coinfection; COVID-19 Testing; Biological Specimen Banks; Humans; Male; United Kingdom/epidemiology; Cohort Studies; Medicine (all)
URI: https://hdl.handle.net/20.500.11815/2920

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Citation:

Hou , C , Hu , Y , Yang , H , Chen , W , Zeng , Y , Ying , Z , Hu , Y , Sun , Y , Qu , Y , Gottfreðsson , M , Valdimarsdóttir , U A & Song , H 2021 , ' COVID-19 and risk of subsequent life-threatening secondary infections : a matched cohort study in UK Biobank ' , BMC Medicine , vol. 19 , no. 1 , 301 , pp. 301 . https://doi.org/10.1186/s12916-021-02177-0

Abstract:

BACKGROUND: With the increasing number of people infected with and recovered from coronavirus disease 2019 (COVID-19), the extent of major health consequences of COVID-19 is unclear, including risks of severe secondary infections. METHODS: Based on 445,845 UK Biobank participants registered in England, we conducted a matched cohort study where 5151 individuals with a positive test result or hospitalized with a diagnosis of COVID-19 were included in the exposed group. We then randomly selected up to 10 matched individuals without COVID-19 diagnosis for each exposed individual (n = 51,402). The life-threatening secondary infections were defined as diagnoses of severe secondary infections with high mortality rates (i.e., sepsis, endocarditis, and central nervous system infections) from the UK Biobank inpatient hospital data, or deaths from these infections from mortality data. The follow-up period was limited to 3 months after the initial COVID-19 diagnosis. Using a similar study design, we additionally constructed a matched cohort where exposed individuals were diagnosed with seasonal influenza from either inpatient hospital or primary care data between 2010 and 2019 (6169 exposed and 61,555 unexposed individuals). After controlling for multiple confounders, Cox models were used to estimate hazard ratios (HRs) of life-threatening secondary infections after COVID-19 or seasonal influenza. RESULTS: In the matched cohort for COVID-19, 50.22% of participants were male, and the median age at the index date was 66 years. During a median follow-up of 12.71 weeks, the incidence rate of life-threatening secondary infections was 2.23 (123/55.15) and 0.25 (151/600.55) per 1000 person-weeks for all patients with COVID-19 and their matched individuals, respectively, which corresponded to a fully adjusted HR of 8.19 (95% confidence interval [CI] 6.33-10.59). The corresponding HR of life-threatening secondary infections among all patients with seasonal influenza diagnosis was 4.50, 95% CI 3.34-6.08 (p for difference < 0.01). Also, elevated HRs were observed among hospitalized individuals for life-threatening secondary infections following hospital discharge, both in the COVID-19 (HR = 6.28 [95% CI 4.05-9.75]) and seasonal influenza (6.01 [95% CI 3.53-10.26], p for difference = 0.902) cohorts. CONCLUSION: COVID-19 patients have increased subsequent risks of life-threatening secondary infections, to an equal extent or beyond risk elevations observed for patients with seasonal influenza.

Description:

This work is supported by the 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (grant no. ZYYC21005 to HS), the National Natural Science Foundation of China (81971262 to HS), and the NordForsk grant (105668 to UAV). The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2021, The Author(s).

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