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

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 i...

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Autores principales:	Can Hou, Yihan Hu, Huazhen Yang, Wenwen Chen, Yu Zeng, Zhiye Ying, Yao Hu, Yajing Sun, Yuanyuan Qu, Magnús Gottfreðsson, Unnur A. Valdimarsdóttir, Huan Song
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	COVID-19 Life-threatening infections Severe secondary infections Sepsis Medicine R
Acceso en línea:	https://doaj.org/article/cc512ea3445e4d6abaab7c0b1d107b96
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spelling	oai:doaj.org-article:cc512ea3445e4d6abaab7c0b1d107b962021-11-21T12:16:08ZCOVID-19 and risk of subsequent life-threatening secondary infections: a matched cohort study in UK Biobank10.1186/s12916-021-02177-01741-7015https://doaj.org/article/cc512ea3445e4d6abaab7c0b1d107b962021-11-01T00:00:00Zhttps://doi.org/10.1186/s12916-021-02177-0https://doaj.org/toc/1741-7015Abstract 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.Can HouYihan HuHuazhen YangWenwen ChenYu ZengZhiye YingYao HuYajing SunYuanyuan QuMagnús GottfreðssonUnnur A. ValdimarsdóttirHuan SongBMCarticleCOVID-19Life-threatening infectionsSevere secondary infectionsSepsisMedicineRENBMC Medicine, Vol 19, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	COVID-19 Life-threatening infections Severe secondary infections Sepsis Medicine R
spellingShingle	COVID-19 Life-threatening infections Severe secondary infections Sepsis Medicine R Can Hou Yihan Hu Huazhen Yang Wenwen Chen Yu Zeng Zhiye Ying Yao Hu Yajing Sun Yuanyuan Qu Magnús Gottfreðsson Unnur A. Valdimarsdóttir Huan Song COVID-19 and risk of subsequent life-threatening secondary infections: a matched cohort study in UK Biobank
description	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.
format	article
author	Can Hou Yihan Hu Huazhen Yang Wenwen Chen Yu Zeng Zhiye Ying Yao Hu Yajing Sun Yuanyuan Qu Magnús Gottfreðsson Unnur A. Valdimarsdóttir Huan Song
author_facet	Can Hou Yihan Hu Huazhen Yang Wenwen Chen Yu Zeng Zhiye Ying Yao Hu Yajing Sun Yuanyuan Qu Magnús Gottfreðsson Unnur A. Valdimarsdóttir Huan Song
author_sort	Can Hou
title	COVID-19 and risk of subsequent life-threatening secondary infections: a matched cohort study in UK Biobank
title_short	COVID-19 and risk of subsequent life-threatening secondary infections: a matched cohort study in UK Biobank
title_full	COVID-19 and risk of subsequent life-threatening secondary infections: a matched cohort study in UK Biobank
title_fullStr	COVID-19 and risk of subsequent life-threatening secondary infections: a matched cohort study in UK Biobank
title_full_unstemmed	COVID-19 and risk of subsequent life-threatening secondary infections: a matched cohort study in UK Biobank
title_sort	covid-19 and risk of subsequent life-threatening secondary infections: a matched cohort study in uk biobank
publisher	BMC
publishDate	2021
url	https://doaj.org/article/cc512ea3445e4d6abaab7c0b1d107b96
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COVID-19 and risk of subsequent life-threatening secondary infections: a matched cohort study in UK Biobank

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