PDF(Pubmed)
Abstract：
BACKGROUND: There have been over 772 million confirmed cases of COVID-19 worldwide. A significant portion of these infections will lead to long COVID (post-COVID-19 condition) and its attendant morbidities and costs. Numerous life-altering complications have already been associated with the development of long COVID, including chronic fatigue, brain fog, and dangerous heart rhythms.
OBJECTIVE: We aim to derive an actionable long COVID case definition consisting of significantly increased signs, symptoms, and diagnoses to support pandemic-related clinical, public health, research, and policy initiatives.
METHODS: This research employs a case-crossover population-based study using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) data generated at Veterans Affairs medical centers nationwide between January 1, 2020, and August 18, 2022. In total, 367,148 individuals with ICD-10-CM data both before and after a positive COVID-19 test were selected for analysis. We compared ICD-10-CM codes assigned 1 to 7 months following each patient\'s positive test with those assigned up to 6 months prior. Further, 350,315 patients had novel codes assigned during this window of time. We defined signs, symptoms, and diagnoses as being associated with long COVID if they had a novel case frequency of ≥1:1000, and they significantly increased in our entire cohort after a positive test. We present odds ratios with CIs for long COVID signs, symptoms, and diagnoses, organized by ICD-10-CM functional groups and medical specialty. We used our definition to assess long COVID risk based on a patient\'s demographics, Elixhauser score, vaccination status, and COVID-19 disease severity.
RESULTS: We developed a long COVID definition consisting of 323 ICD-10-CM diagnosis codes grouped into 143 ICD-10-CM functional groups that were significantly increased in our 367,148 patient post-COVID-19 population. We defined 17 medical-specialty long COVID subtypes such as cardiology long COVID. Patients who were COVID-19-positive developed signs, symptoms, or diagnoses included in our long COVID definition at a proportion of at least 59.7% (268,320/449,450, based on a denominator of all patients who were COVID-19-positive). The long COVID cohort was 8 years older with more comorbidities (2-year Elixhauser score 7.97 in the patients with long COVID vs 4.21 in the patients with non-long COVID). Patients who had a more severe bout of COVID-19, as judged by their minimum oxygen saturation level, were also more likely to develop long COVID.
CONCLUSIONS: An actionable, data-driven definition of long COVID can help clinicians screen for and diagnose long COVID, allowing identified patients to be admitted into appropriate monitoring and treatment programs. This long COVID definition can also support public health, research, and policy initiatives. Patients with COVID-19 who are older or have low oxygen saturation levels during their bout of COVID-19, or those who have multiple comorbidities should be preferentially watched for the development of long COVID.
OBJECTIVE: We aim to derive an actionable long COVID case definition consisting of significantly increased signs, symptoms, and diagnoses to support pandemic-related clinical, public health, research, and policy initiatives.
METHODS: This research employs a case-crossover population-based study using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) data generated at Veterans Affairs medical centers nationwide between January 1, 2020, and August 18, 2022. In total, 367,148 individuals with ICD-10-CM data both before and after a positive COVID-19 test were selected for analysis. We compared ICD-10-CM codes assigned 1 to 7 months following each patient\'s positive test with those assigned up to 6 months prior. Further, 350,315 patients had novel codes assigned during this window of time. We defined signs, symptoms, and diagnoses as being associated with long COVID if they had a novel case frequency of ≥1:1000, and they significantly increased in our entire cohort after a positive test. We present odds ratios with CIs for long COVID signs, symptoms, and diagnoses, organized by ICD-10-CM functional groups and medical specialty. We used our definition to assess long COVID risk based on a patient\'s demographics, Elixhauser score, vaccination status, and COVID-19 disease severity.
RESULTS: We developed a long COVID definition consisting of 323 ICD-10-CM diagnosis codes grouped into 143 ICD-10-CM functional groups that were significantly increased in our 367,148 patient post-COVID-19 population. We defined 17 medical-specialty long COVID subtypes such as cardiology long COVID. Patients who were COVID-19-positive developed signs, symptoms, or diagnoses included in our long COVID definition at a proportion of at least 59.7% (268,320/449,450, based on a denominator of all patients who were COVID-19-positive). The long COVID cohort was 8 years older with more comorbidities (2-year Elixhauser score 7.97 in the patients with long COVID vs 4.21 in the patients with non-long COVID). Patients who had a more severe bout of COVID-19, as judged by their minimum oxygen saturation level, were also more likely to develop long COVID.
CONCLUSIONS: An actionable, data-driven definition of long COVID can help clinicians screen for and diagnose long COVID, allowing identified patients to be admitted into appropriate monitoring and treatment programs. This long COVID definition can also support public health, research, and policy initiatives. Patients with COVID-19 who are older or have low oxygen saturation levels during their bout of COVID-19, or those who have multiple comorbidities should be preferentially watched for the development of long COVID.
摘要：
背景：全球已确诊病例超过7.72亿例。这些感染的很大一部分将导致长期的COVID(后COVID-19病症)及其伴随的发病率和成本。许多改变生活的并发症已经与长期COVID的发展有关，包括慢性疲劳,脑雾,和危险的心律。
目的：我们的目标是得出一个可操作的长期COVID病例定义，包括显著增加的迹象，症状,和诊断，以支持大流行相关的临床，公共卫生,研究,和政策倡议。
方法：本研究采用基于病例交叉人群的国际疾病分类研究，第十次修订,2020年1月1日至2022年8月18日在全国退伍军人事务医疗中心生成的临床修改（ICD-10-CM）数据。总的来说,选择COVID-19检测阳性前后具有ICD-10-CM数据的367,148名个体进行分析。我们将每位患者阳性检测后1至7个月分配的ICD-10-CM代码与前6个月分配的代码进行了比较。Further,350,315名患者在此时间窗内分配了新的代码。我们定义了标志，症状,如果他们的新病例频率≥1：1000，则诊断为与长COVID相关，并且在阳性测试后，他们在我们整个队列中显著增加。我们给出了长COVID体征与CI的比值比，症状,和诊断，由ICD-10-CM功能小组和医学专业组织。我们使用我们的定义根据患者的人口统计学来评估长期COVID风险，Elixhauser分数,疫苗接种状况,和COVID-19疾病严重程度。
结果：我们开发了一个长的COVID定义，由323个ICD-10-CM诊断代码组成，分为143个ICD-10-CM功能组，在我们的367,148名患者中，COVID-19后人群显著增加。我们定义了17种医学专业长COVID亚型，如心脏病学长COVID。COVID-19阳性的患者出现体征，症状,或诊断包括在我们的长期COVID定义中，比例至少为59.7%(268,320/449,450，基于所有COVID-19阳性患者的分母)。长COVID队列年龄大8岁，合并症更多(长COVID患者的2年Elixhauser评分为7.97，非长COVID患者的2年Elixhauser评分为4.21)。根据最低氧饱和度水平判断，新冠肺炎发作更严重的患者，也更有可能发展为长COVID。
结论：可操作的，数据驱动的长COVID定义可以帮助临床医生筛查和诊断长COVID，允许确定的患者进入适当的监测和治疗计划。这个长长的COVID定义也可以支持公共卫生，研究,和政策倡议。年龄较大或在COVID-19发作期间血氧饱和度水平较低的COVID-19患者，或有多种合并症的患者，应优先观察长期COVID的发展。
目的：我们的目标是得出一个可操作的长期COVID病例定义，包括显著增加的迹象，症状,和诊断，以支持大流行相关的临床，公共卫生,研究,和政策倡议。
方法：本研究采用基于病例交叉人群的国际疾病分类研究，第十次修订,2020年1月1日至2022年8月18日在全国退伍军人事务医疗中心生成的临床修改（ICD-10-CM）数据。总的来说,选择COVID-19检测阳性前后具有ICD-10-CM数据的367,148名个体进行分析。我们将每位患者阳性检测后1至7个月分配的ICD-10-CM代码与前6个月分配的代码进行了比较。Further,350,315名患者在此时间窗内分配了新的代码。我们定义了标志，症状,如果他们的新病例频率≥1：1000，则诊断为与长COVID相关，并且在阳性测试后，他们在我们整个队列中显著增加。我们给出了长COVID体征与CI的比值比，症状,和诊断，由ICD-10-CM功能小组和医学专业组织。我们使用我们的定义根据患者的人口统计学来评估长期COVID风险，Elixhauser分数,疫苗接种状况,和COVID-19疾病严重程度。
结果：我们开发了一个长的COVID定义，由323个ICD-10-CM诊断代码组成，分为143个ICD-10-CM功能组，在我们的367,148名患者中，COVID-19后人群显著增加。我们定义了17种医学专业长COVID亚型，如心脏病学长COVID。COVID-19阳性的患者出现体征，症状,或诊断包括在我们的长期COVID定义中，比例至少为59.7%(268,320/449,450，基于所有COVID-19阳性患者的分母)。长COVID队列年龄大8岁，合并症更多(长COVID患者的2年Elixhauser评分为7.97，非长COVID患者的2年Elixhauser评分为4.21)。根据最低氧饱和度水平判断，新冠肺炎发作更严重的患者，也更有可能发展为长COVID。
结论：可操作的，数据驱动的长COVID定义可以帮助临床医生筛查和诊断长COVID，允许确定的患者进入适当的监测和治疗计划。这个长长的COVID定义也可以支持公共卫生，研究,和政策倡议。年龄较大或在COVID-19发作期间血氧饱和度水平较低的COVID-19患者，或有多种合并症的患者，应优先观察长期COVID的发展。
