■到2022年底,COVID-19后的急性后遗症仍然与知识空白和不确定性有关,例如,患病率,发病机制,治疗,和长期结果,并给医疗服务提供者在医疗管理方面带来挑战。这项研究的目的是帮助理解长期/后COVID的多方面状况。它旨在评估在德国首次COVID-19波中先前的SARS-CoV-2感染是否会增加疾病发生率,通过诊断方面的保险数据记录来衡量,症状,和治疗,在随后的12个月中,与未记录SARS-CoV-2感染的匹配对照组进行比较。
■50个疾病结局变量,根据健康保险数据定义了症状和治疗水平(14个主类别和36个亚类;新诊断).对2020年3月/4月SARS-CoV-2PCR检测阳性的两组患者进行了Logistic回归,与各自的风险调整后(年龄,行政区,1:5倾向得分匹配),同期对照组没有事先记录的SARS-CoV-2感染(CG):首先,门诊治疗急性COVID-19的个体,表明病程不严重(COV-OUT),第二,将住院接受急性COVID-19治疗的个体与各自的对照组进行比较,这些个体表明严重病程(COV-IN)。
■COV-OUT(n=32,378)和COV-IN(n=5,998)组的死亡率高于对照组,比值比(OR)分别为1.5[95CI(1.3,1.6)]和1.7[95CI(1.5,1.8)]。与他们的CG相比,两组更有可能经历至少一个结果[OR=1.4,95CI(1.4,1.4)];OR=2.5,95CI[2.4,2.6])。42/37(COV-IN/COV-OUT)结果变量显示OR增加。COV-OUT:味觉和嗅觉丧失[OR=5.8,95CI(5.1,6.6)],间质性呼吸系统疾病[OR=2.8,95CI(2.0,4.1)]和呼吸障碍[OR=3.2,95CI(2.2,4.7)]显示最高的OR。COV-IN:间质性呼吸系统疾病[OR=12.2,95CI(8.5,17.5)],氧疗[OR=8.1,95CI(6.4,10.2)]和肺栓塞/抗凝治疗[OR=5.9,95CI(4.4,7.9)]最为显著.
在德国第一波COVID-19大流行期间,SARS-CoV-2感染后,8.4[COV-OUT,95CI(7.7,9.1)]分别为25.5[COV-IN,95CI(23.6,27.4)]与匹配的CG相比,更多的受试者显示至少一种新的诊断/症状/治疗(COV-OUT:44.9%,CG:36.5%;COV-IN:72.0%,CG:46.5%)。因为症状和诊断是如此多样,提供管理的人员之间的跨学科和跨专业合作是必要的。
UNASSIGNED: Post-acute sequelae after COVID-19 are still associated with knowledge gaps and uncertainties at the end of 2022, e.g., prevalence, pathogenesis, treatment, and long-term outcomes, and pose challenges for health providers in medical management. The aim of this study was to contribute to the understanding of the multi-faceted condition of long-/ post-COVID. It was designed to evaluate whether a prior SARS-CoV-2 infection during the first COVID-19 wave in Germany increases the rate of disease, as measured via a record of insurance data on diagnoses, symptoms, and treatment, in the subsequent 12 months compared with matched control groups without recorded SARS-CoV-2 infection.
UNASSIGNED: 50 outcome variables at disease, symptom and treatment levels (14 main categories and 36 sub-categories; new diagnoses) were defined from health insurance data. Logistic regression was carried out for two groups of patients tested positive in a PCR test in March/April 2020 for SARS-CoV-2, compared to the respective risk-adjusted (age, administrative region, 1:5 propensity-score matching), contemporaneous control group without prior documented SARS-CoV-2 infection (CG): First, individuals with outpatient treatment of acute COVID-19, indicating a not severe course (COV-OUT), and second, individuals with inpatient treatment of acute COVID-19, indicating a severe course (COV-IN) were compared with their respective control group.
UNASSIGNED: The mortality rate in COV-OUT (n = 32,378) and COV-IN (n = 5,998) groups is higher compared to their control groups with odds ratio (OR) 1.5 [95%CI (1.3, 1.6)] and 1.7 [95%CI (1.5, 1.8)] respectively. Both groups were more likely to have experienced at least one outcome compared to their CG [OR = 1.4, 95%CI (1.4, 1.4)]; OR = 2.5, 95%CI [2.4, 2.6]). 42/37 (COV-IN/COV-OUT) outcome variables showed increased ORs. COV-OUT: Loss of taste and smell [OR = 5.8, 95%CI (5.1, 6.6)], interstitial respiratory diseases [OR = 2.8, 95%CI (2.0, 4.1)] and breathing disorders [OR = 3.2, 95%CI (2.2, 4.7)] showed the highest ORs. COV-IN: Interstitial respiratory diseases [OR = 12.2, 95%CI (8.5, 17.5)], oxygen therapy [OR = 8.1, 95%CI (6.4, 10.2)] and pulmonary embolism/anticoagulation [OR = 5.9, 95%CI (4.4, 7.9)] were the most pronounced.
UNASSIGNED: Following a SARS-CoV-2 infection during the first wave of the COVID-19 pandemic in Germany, 8.4 [COV-OUT, 95%CI (7.7, 9.1)] respectively 25.5 [COV-IN, 95%CI (23.6, 27.4)] percentage points more subjects showed at least one new diagnosis/symptom/treatment compared to their matched CG (COV-OUT: 44.9%, CG: 36.5%; COV-IN: 72.0%, CG: 46.5%). Because the symptoms and diagnoses are so varied, interdisciplinary and interprofessional cooperation among those providing management is necessary.