‘Diverse array’ of heart, lung, kidney complications of COVID-19
A large study of patients in the United States diagnosed with COVID-19 highlights a broad range of complications, according to new research.
“The more common complications that we identified — including viral pneumonia, respiratory failure, acute kidney failure and sepsis — were expected, as they have been well described in the literature. We also identified less common complications, previously described in case series or small studies, such as disseminated intravascular coagulation, pneumothorax, myocarditis and rhabdomyolysis,” William Murk, PhD, MPH, from the Jacobs School of Medicine and Biological Sciences in Buffalo, New York, and colleagues wrote in the Canadian Medical Association Journal.
Researchers used U.S. health claims from HealthVerity’s Marketplace data set to compare the frequency of ICD-10-CM diagnosis codes that occurred before and after the onset of the COVID-19 pandemic in an exposure-crossover design. The researchers computed risk estimates and ORs of COVID-19 association for every diagnostic code.
The study included 70,288 patients (median age, 65 years; 55.8% women) who received a COVID-19 diagnosis from March through April. Fifty-three percent of patients were admitted to the hospital and nearly 5% to the ICU. New York (19.2%), New Jersey (10.2%), Michigan (9.3%), Pennsylvania (7.5%) and Illinois (7.2%) were the most common states of residence among the patients included in the study.
In total, 69 of 1,724 ICD-10-CM diagnosis codes were significantly associated with COVID-19 infection, according to the results.
Viral pneumonia (absolute risk, 27.6%; OR = 177.63; 95% CI, 147.19-214.37), respiratory failure (absolute risk, 22.6%; OR = 11.36; 95% CI, 10.74-12.02), acute kidney failure (absolute risk, 11.8%; OR = 3.5; 95% CI, 3.34-3.68) and sepsis (absolute risk, 10.4%; OR = 4.23; 95% CI, 4.01-4.46) showed strong association with COVID-19 infection and high absolute risk, according to the results.
Acute myocarditis (absolute risk, 0.1%; OR = 8.17; 95% CI, 3.58-18.62), disseminated intravascular coagulation (absolute risk, 0.1%; OR = 11.83; 95% CI, 5.26-26.62) and pneumothorax (absolute risk, 0.4%; OR = 3.38; 95% CI, 2.68-4.26) showed strong associations with COVID-19 infection, but low absolute risk, according to the results.
“Although COVID-19 has been widely reported to increase the risk of stroke, this was not seen in our study,” the researchers wrote. “For I63 (“cerebral infarction”) in our overall population, we observed an OR of 0.58 and an overall risk of 1.5%, suggesting that while patients with COVID-19 do experience stroke at significant frequencies, a causal association with COVID-19 was not supported in this population.”
The researchers noted that multisystem inflammatory syndrome in children was not directly assessed due to no specific ICD-10-CM code.
“After analyzing all possible diagnosis codes, we confirm that COVID-19 is also associated with a diverse array of additional cardiac, thrombotic and other conditions, although the overall risks for most of these complications are comparatively low,” the researchers wrote. “Understanding the full range of associated conditions can aid in prognosis, guide treatment decisions and better inform patients as to their actual risks for the variety of COVID-19 complications reported in the literature and media.”
The researchers cited limitations of the current study, including identification of COVID-19 cases using diagnostic codes and risk estimates that may be greater than in the general population because patients in this study were more likely to have comorbidities.
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