Those hospitalized with COVID-19 later at risk for several key symptoms

exhausted woman


A study of about 3 million US adults and 675,000 US children reveals that hospitalized adults and children with a positive COVID-19 test had 17% and 18% increased odds, respectively, of being diagnosed as having one or more long-COVID symptoms 31 to 150 days after their positive test.

The study, published in BMC Infectious Diseases, also showed that adults and kids have a 50% and 40% higher risk of having shortness of breath after recovery from COVID-19, respectively.

With so many symptoms and conditions linked to long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), the authors of the study used electronic health record (EHR) data to track which specific symptoms were more likely to appear among adult and pediatric COVID patients compared to other hospitalized patients or patients with negative COVID tests.

Data were collected from 43 sites across the United States from patients who had a SARS-CoV-2 laboratory test from March 1, 2020, through May 31, 2021. Hospitalization within 16 days of a positive test for SARS-CoV-2 infection acted as a proxy for COVID-19 severity.

The authors identified 3,091,580 adults aged 20 years or older, including 316,249 with a positive viral test and 2,775,331 with only negative viral tests. They also identified 675,643 children 19 years or younger meeting the inclusion criteria, including 62,131 with a positive viral test and 613,512 with only negative tests.

Diabetes linked to COVID hospitalization

The authors assessed a number of possible conditions from 1 to 6 months after COVID testing, including, in adults, mental health conditions, chronic kidney disorders, diabetes mellitus type 1 or 2, hematologic disorders such as venous thromboembolism, major cardiovascular events, neurologic disorders, and respiratory diseases.

Both adult and children were assessed for common PASC symptoms, including fatigue or muscle weakness, shortness of breath or difficulty breathing, cough, change in bowel habits, abdominal pain, headache, cognitive disorders, disorders of taste and smell, non-cardiac chest pain, heart rate abnormalities, sleep disorders, and muscle pain, the authors said.

Hospitalized adults with a positive test had increased odds of being diagnosed as having three or more symptoms or fatigue compared with those testing negative, the authors found.

Hospitalized adults with positive COVID tests were also at increased risk for being newly diagnosed as having type 1 or type 2 diabetes (adjusted hazard ratio [aHR], 1.25; 95% confidence interval, 1.17 to 1.33), hematologic disorders (aHR, 1.19), or respiratory disease (aHR, 1.44).

Hospitalized patients more likely to have long COVID

"The condition with the highest incidence among hospitalized adults with a positive test was respiratory diseases (14%), compared to 7% incidence among patients testing negative," the authors wrote. "Hospitalized children with a positive SARS-CoV-2 test also were at increased odds of being diagnosed with symptoms, including shortness of breath, compared to those hospitalized children testing negative."

The condition with the highest incidence among hospitalized adults with a positive test was respiratory diseases.

Overall, COVID-positive adults and children who were hospitalized were more likely to have EHRs showing PASC. Among COVID-positive and -negative patients who were not hospitalized, there was little difference in PASC outcomes.

"Clinicians and public health agencies should monitor for the development and persistence of symptoms and conditions after COVID-19, especially among those who are hospitalized," the authors concluded.

"The higher burden of PASC symptoms and conditions post-COVID, especially among those with severe disease, also should encourage investment in clinical and public health resources needed to deliver care to treat and prevent PASC, including ongoing support for trials underway to evaluate effectiveness of treatments for specific post-COVID conditions."

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