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Min Seo Kim, MD
Credit: X.com
According to a study published in Annals of internal medicine.1 The risk of AIRD was higher in patients with higher COVID-19 severity.
“Emerging data suggest an increased risk of AIRD among patients with a history of COVID-19,” wrote a team of researchers led by Min Seo Kim, MD, associated with the Medical and Population Genetics and Cardiovascular Diseases Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts. “However, these findings are based entirely on comparisons between groups infected with SARS-CoV-2 and those not, which could be biased by differences in health care-seeking behavior and inherent risk factors within the groups. Additionally, studies have not explored the effect of vaccination and other modifiable factors on preventing long-term complications of COVID-19.”
Although the clinical definition of long COVID, the term commonly used for patients experiencing long-term sequelae, is still evolving, it is generally defined as new or persistent symptoms that last more than 4 weeks after diagnosis and that cannot be attributed to another cause. . Common symptoms can range from fatigue, depression and dyspnea to diabetes, neurological diseases and cardiovascular diseases.2
To evaluate the effect of COVID-19 infection on the long-term risk of incident AIRD, researchers used data from national claims-based databases in South Korea (K-COV-N) and Japan (JMDC). The binational, longitudinal, propensity-matched cohort study included 10,027,506 Korean patients and 12,218,680 Japanese patients aged ≥20 years, including those with a diagnosis of COVID-19, between January 1, 2020 and January 31. December 2021 and compared them to patients with either influenza infection. or uninfected controls.
As both cohorts came from countries with universal health insurance, the data included information on when patients visited multiple facilities, changed hospitals, or died outside of health care systems. Definitions of exposure and outcomes, general health examinations, and diagnosis codes were the same between the Korean and Japanese groups.
The primary endpoint was the occurrence of AIRD 1, 6, and 12 months after COVID-19 or influenza infection or a matched index date of uninfected controls.
The mean age of the Korean patients was 48.4 years and 50.1% were men. Among this cohort, 3.9% (n = 394,274) experienced a COVID-19 infection and 0.98 (n = 98,596) had influenza. Among the Japanese cohort, 8.2% (n = 1,002,525) were diagnosed with COVID-19 and 0.99 (n = 121,543) were diagnosed with influenza during the study period.
After matching, 225,313 were included in the comparison cohort between those with COVID-19 infection (n = 115,003) and those with influenza (n = 110,310). The median follow-up to compare between patients with COVID-19 and influenza was 11.3 and 12.1 months, respectively, while the median follow-up to compare between patients with COVID-19 and the general population was 11.2 months in both groups.
After propensity score matching, COVID-19 patients had a significantly increased risk of all-cause AIRD, untreated AIRD, treated AIRD, and connective tissue disease compared to uninfected controls (adjusted hazard ratio [aHR]1.25 [95% confidence interval (CI), 1.18 to 1.31]) and influenza-infected controls (aHR, 1.30 [CI, 1.02 to 1.59]). This risk was higher among patients with a more severe acute COVID-19 infection.
The researchers noted limitations including residual confounders and potential referral bias due to the pandemic. Additionally, the results may not be generalizable as the sample population consisted of all Asian patients diagnosed before the Omicron variant.
“This population-based cohort study shows that the increased risk of incident AIRD extends up to 12 months after SARS-CoV-2 infection,” the researchers concluded. “Care strategies for patients surviving COVID-19 should pay close attention to the manifestations of AIRD, especially after severe COVID-19.”
References
- Kim MS, Lee H, Lee SW, et al. Long-term autoimmune inflammatory rheumatic outcomes of COVID-19: a binational cohort study. Ann Intern Med. Published online March 5, 2024. doi:10.7326/M23-1831
- Xie Y, Al-Aly Z. Risks and burdens of incident diabetes in long COVID: a cohort study. Lancet Diabetes Endocrinol. 2022;10:311-321. [PMID: 35325624] doi:10.1016/S2213-8587(22)00044-4