Long-Term Metabolic Sequelae of COVID-19, By Severity Levels

OBJECTIVES: To estimate the long-term metabolic sequelae after COVID diagnosis and assess relationship with COVID severity using real-world data.

METHODS: This retrospective cohort study was conducted using Optum Research Database between 01July2019 to 30Sep2022. Patients included were ≥18 years with COVID diagnosis (index date) between 01Jan2020 and 31Oct2020, with continuous enrollment 6 months before and ≥12 months after index date, known demographics, not pregnant, and with no baseline metabolic conditions. Patients were stratified into COVID severity cohorts as mild (index diagnosis), moderate (inpatient visit within 15 days of index), or severe (evidence of acute respiratory distress) and followed for a minimum of 12-months post-index. Metabolic sequelae outcomes examined: acute myocardial infarction/stroke (MI), cardiomyopathy, heart failure (HF), myocarditis, pericardial disease (PCD), conduction disorders, coronary artery disease, thrombolytic/hemolytic disorders (TH), hypotension (HYP), diabetes, pulmonary heart disease (PHD), hemolytic-uremic syndrome, other heart diseases, and bowel-ischemia. Descriptive statistics and incidence rate ratios (IRR) were calculated to assess outcomes.

RESULTS: Of 534,843 patients, 146,718 (Mild 134,134; Moderate 4,119; Severe 8,465) met the study inclusion criteria. Median follow up time was 750, 771 and 767 days in the mild, moderate and severe cohorts, respectively.

Many patients experienced ≥3 sequelae during follow-up (12% mild, 26% moderate, 33% severe). Patients in moderate and severe cohorts had 5.1 and 7.5 times increased risk of any metabolic sequelae compared to the mild cohort during follow-up (p<0.001). Severe patients had 1.5 times higher risk of any metabolic sequelae versus moderate cohort (p<0.001). PHD, HYP, MI, HF, PCD and TH disorders were the most common metabolic manifestations in both moderate and severe cohorts (all IRR>5 vs. mild cohort; p<0.001).

CONCLUSIONS: The study provides early insights into long-term metabolic sequelae among COVID patients using large claims database highlighting the need for continuous monitoring and evaluation of moderate-to-severe COVID patients to prevent newer metabolic conditions.