Share on PinterestNew research finds that last year, 50% of people hospitalized with COVID-19 developed at least one complication. Steve Parsons/Pool/AFP via Getty imagesIn a study of patients hospitalized in the UK with SARS-CoV-2 infection, approximately one-half of patients developed at least one complication.The complication rate was high among all age groups with and without preexisting health conditions.Kidney, complex respiratory, and systemic complications were most frequent. Neurological, gastrointestinal or liver, and cardiovascular complications also occurred, with neurological complications associated with the poorest functional outcomes.About 27% of the survivors had a decreased ability to take care of themselves following hospitalization, which may impact long-term healthcare and societal burden.
COVID-19 is a disease that usually causes mild respiratory symptoms in most people. However, some individuals with certain underlying medical conditions and older adults may be at greater risk for severe illness.
In severe cases of COVID-19, an overactive immune response to the presence of the SARS-Co-V2 virus may occur, which may also cause damage to other organs of the body.
Complications related to damage of the blood vessels, kidneys, eyes, brain, skin, heart, and gastrointestinal organs may result from severe SARS-CoV-2 infection.
Current data focusing on mortality outcomes from COVI-19 in the United Kingdom demonstrate that 26% of patients admitted to the hospital with SARS-Co-V2 infection die from their illness.
However, there is a lack of data regarding morbidity related to in-hospital complications and the long-term physical and mental health burdens of patients who survive COVID-19.
Need for morbidity data
A collaboration of researchers from the Department of Health and Social Care, Imperial College London, Public Health England, University of Edinburgh, University of Glasgow, University of Liverpool, University of Nottingham, University of Oxford, and the University of Sheffield — all based in the U.K. — studied the incidence of short-term complications and association with sex, ethnicity, age, and patient outcomes.
Their findings now appear in The Lancet.
The study took place in 302 U.K. healthcare facilities between January 17 and August 4, 2020. It enrolled 80,388 patients 19 years or older hospitalized with highly suspected or confirmed SARS-CoV-2 infection. Of these, the researchers included 73,197 patients in the analysis.
The average age of patients included in the study was 71 years, with the majority being male (56%) and white (74%). Eighty-one percent of the patients had underlying conditions at baseline.
The study measured the incidence of in-hospital neurological, cardiovascular, gastrointestinal, complex respiratory, acute kidney injury, and other systemic complications. The trial also examined the patient’s ability for self-care.
Nurses and medical students collected data at specified intervals: on admission, on days 1, 3, 9 of the hospital stay, and at discharge (or at 28 days if not discharged).
Unexpected findings
Of the patients included in the final analysis, the study reported that about 32% died during the trial and 50% experienced at least one complication. Approximately 44% of those that survived had at least one complication.
The rate of having at least one complication ranged from 27% in patients aged 19–29 years with no comorbidities up to 58% in patients 60–69 years with two or more underlying conditions. The complication rates tended to increase with age and be higher in patients with preexisting medical conditions and in patients designated male at birth.
Dr. Thomas Drake, a co-author of the study from the University of Edinburgh, U.K., commented for MNT on the findings: “Complications from COVID-19 affect nearly all groups admitted to hospital with severe disease. Although people over 50 years were at the highest risk of developing complications, people under the age of 50 years were also very likely to develop complications, which was a real surprise.”
The incidence of complications was similar amongst white, East-Asian, and South-Asian racial and ethnic groups. However, complication rates were highest in Black (58%) versus white patients (49%).
Kidney, complex respiratory, systemic complications occurred most frequently. However, patients also developed cardiovascular, liver or gastrointestinal, and neurological complications.
Patients with complications were 2.4 times as likely to have an increased risk for poorer self-care after discharge, with neurological complications most strongly linked to the worst functional outcomes. In survivors with a complication, about 27% had a decreased ability to care for themselves.
Shahyar Yadegar, M.D., critical care medicine specialist, pulmonologist, and medical director of the ICU at Providence Cedars-Sinai Tarzana Medical Center in Tarzana, CA, an expert not involved in the study, commented to MNT on the strengths and weaknesses of the study.
He said, “Over 80,000 patients were included in this study, which aids in giving a more representative view of what truly happens within the population.”
“However, data were collected during the early days of the pandemic, which does not reflect the spread of variants that have since emerged. Ongoing data reports that variants are even more severe than the original strain studied in this article, which suggests that complications from a variant are even more severe than detailed.”
Dr. Drake elaborated on the study implications and the need for further research:
“Large numbers of patients with COVID-19 will develop complications. Therefore we need to make sure healthcare systems have enough resources to care for patients and monitor their complications in the long-term.”
“We don’t know whether these complications get better or whether they lead to long-term problems,” he added. “We are currently following these people up to try and work out what this means for these patients and society going forwards in the longer term.”
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