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1. Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19

Author

Balram Bhargava, Ashish Sharma, Rajnish Joshi, Amit Patel, Deepak Kumar, Ashish Pathak, Sudhir Bhandari, Manoj Kumar Panigrahi, Prasanta Raghab Mohapatra, Aparna Mukherjee, Pankaj Bhardwaj, Priyanka Ghosh, Gunjan Kumar, Simmi Dube, Nehal M Shah, Hemang M Purohit, Vikas Suri, Arti D Shah, Alka Turuk, Akhil Dhanesh Goel, Manoj Kumar Gupta, Ritin Mohindra, Ashish Bhalla, Star Pala, Balkishan Gupta, Damodar Sahu, Sourin Bhuniya, Abhishek Agrawal, Samiran Panda, Deepak Jain, Arunansu Talukdar, Janakkumar R Khambholja, Nikita Sharma, Geetha R Menon, Subhasis Mukherjee, Puspender Misra, Lokesh Kumar Sharma, Samita S, Himadri Das, Debasis Sarkar, Soumyadeep Ghosh, Moumita Dutta, Shreetama Chakraborty, Tridip Dutta Baruah, Pankaj Kumar Kannauje, Arvind Kumar Shukla, Nitesh Shah, Mary John, Kiranpreet Kaur, Vijay Nongpiur, Sachin K Shivnitwar, Bobba Rohil Krishna, Naveen Dulhani, Jigyasa Gupta, H K Aggarwal, Parshwa Naik, Manisha Panchal, Mayank Anderpa, Nyanthung Kikon, Christina Nzani Humtsoe, Rajaat Vohra, Lipilekha Patnaik, Jagdish Prasad Sahoo, Arun Kokane, Yogiraj Ray, Kruti Rajvansh, Arun Madharia, Neha Shrivastava, Sushila Kataria, Mohammad Shameem, Nazish Fatima, Saumitra Ghosh, Avijit Hazra, Himanshu D, Veeresh B Salgar, Santosh Algur, Kala Yadhav M L, Pavan Kumar M, and Mendu Vishnu Vardhana Rao

Subjects
Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Abstract

Introduction The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities.Methods Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020–October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting.Results Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30–60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6–7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03).Conclusion Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.

Published
2023
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2. Factors associated with adverse COVID-19 outcomes in patients with psoriasis—insights from a global registry–based study

Author

Silvia Pérez-Barrio, Lucy Moorhead, Manpreet Lakhan, Saskia Reeken, Vito Zeeshaan Hasab, Rogelio Mercado-Seda, Gustavo Anibal Cardozo, Georgi Popov, Enrique Loayza, Marie-Louise Svensson, Emmanuel Mahe, Fernando Valenzuela, Victoria King, Michela Magnano, Danielle Brassard, Annette Essex, Deanna Cummings, Manisha Panchal, Trupti V. Desai, Jennifer E. Carolan, Areti Makrygeorgou, Zenas Z N Yiu, Teena Mackenzie, Esteban Daudén, Emmanuel Toni, Ian Pearson, Andrea Carugno, Lorraine Gribben, Leontien de Graaf, Liv Eidsmo, Esther A. Balogh, Gloria Aparicio, Andrew Pink, Manel Velasco, Adrienne J. van Geest, Steven R. Feldman, Tiago Torres, Elzbieta Klujszo, Malcolm H.A. Rustin, Ignacio Yanguas, Anthony Bewley, Eliseo Martínez-García, Benhadou Farida, Emily Dwyer, Susannah Hoey, Richard B. Warren, Esther E. Freeman, Diana Ruiz Genao, Rohima Khatun, Giulia Rech, Elena B. Hawryluk, Zahira Koreja, Ricardo Romiti, Gonzalez A. Cesar, Alice Mwale, Charlotte Barclay, Aadarsh Shah, Catherine Quinlan, Kathryn G. Kerisit, Christopher E.M. Griffiths, Carla Tubau Prims, Lone Skov, Céline Phan, Vincent Descamps, Jenny Hughes, Siew Eng Choon, Shanti Ayob, Efrossini Carras, Girard Celine, Jo Lambert, Alberto Barea, Jonathan Barker, Reinhart Speeckaert, Raquel Rivera, Portia Goldsmith, Nick Dand, Beatriz Pérez-Suárez, Andrew DeCrescenzo, F. Meynell, Francesca Capon, Toomas Talme, Teresa Tsakok, Deepti Kolli, Stefano Piaserico, Jamie Weisman, Manuel D. Franco, K.J. Mason, Pablo De Caso, Catriona Maybury, Rachel Bak, Ann Sergeant, Keith Wu, Graham A. Johnston, Alexandra Paolino, Cécile Lesort, Mark Vandaele, H. McAteer, Birgitta Wilson Claréus, Sinead Langan, Jose-Manuel Carrascosa, Enikö Sonkoly, Claudia de la Cruz, Maruska Marovt, Luigi Naldi, Leila Asfour, Paola Di Meglio, Jose-Maria Ortiz-Salvador, Alekya Singapore, Peter Jenkin, Romana Ceovic, R. Taberner, P.J. Hampton, Alberto Romero-Maté, Russell W. Cohen, Omid Zargari, Maria Teresa Rossi, Devon E. McMahon, Denis Jullien, Bola Coker, Carrie Davis, Georgie King, Catherine H. Smith, Richard Woolf, Luis Puig, Ann Jones, Astrid van Huizen, Joseph J. Schwartz, Paolo Gisondi, Phyllis I. Spuls, Satveer K. Mahil, Sarah Kirk, Paulo Varela, K. Jackson, Ana Maria Morales Callaghan, Vito Di Lernia, Lieve Meuleman, Claudio Greco, Simina Stefanescu, Hervé Bachelez, Ana Martinez, Dermatology, AII - Inflammatory diseases, APH - Methodology, APH - Quality of Care, Mahil, S, Dand, N, Mason, K, Yiu, Z, Tsakok, T, Meynell, F, Coker, B, Mcateer, H, Moorhead, L, Mackenzie, T, Rossi, M, Rivera, R, Mahe, E, Carugno, A, Magnano, M, Rech, G, Balogh, E, Feldman, S, De La Cruz, C, Choon, S, Naldi, L, Lambert, J, Spuls, P, Jullien, D, Bachelez, H, Mcmahon, D, Freeman, E, Gisondi, P, Puig, L, Warren, R, Di Meglio, P, Langan, S, Capon, F, Griffiths, C, Barker, J, Smith, C, Shah, A, Barea, A, Romero-Mate, A, Singapore, A, Paolino, A, Mwale, A, Morales Callaghan, A, Martinez, A, Decrescenzo, A, Pink, A, Jones, A, Sergeant, A, Essex, A, Bewley, A, Makrygeorgou, A, van Huizen, A, Perez-Suarez, B, Farida, B, Clareus, B, Prims, C, Davis, C, Quinlan, C, Maybury, C, Cesar, G, Barclay, C, Greco, C, Brassard, D, Cummings, D, Kolli, D, Descamps, V, Genao, D, Carras, E, Hawryluk, E, Martinez-Garcia, E, Klujszo, E, Dwyer, E, Toni, E, Sonkoly, E, Loayza, E, Dauden, E, Valenzuela, F, Popov, G, King, G, Celine, G, Aparicio, G, Johnston, G, Cardozo, G, Pearson, I, Yanguas, I, Weisman, J, Carolan, J, Hughes, J, Ortiz-Salvador, J, Carrascosa, J, Schwartz, J, Jackson, K, Kerisit, K, Wu, K, Asfour, L, de Graaf, L, Lesort, C, Meuleman, L, Eidsmo, L, Skov, L, Gribben, L, Rustin, M, Velasco, M, Panchal, M, Lakhan, M, Franco, M, Svensson, M, Vandaele, M, Marovt, M, Zargari, O, De Caso, P, Varela, P, Jenkin, P, Phan, C, Hampton, P, Goldsmith, P, Bak, R, Speeckaert, R, Romiti, R, Woolf, R, Mercado-Seda, R, Khatun, R, Ceovic, R, Taberner, R, Cohen, R, Stefanescu, S, Kirk, S, Reeken, S, Ayob, S, Perez-Barrio, S, Piaserico, S, Hoey, S, Torres, T, Talme, T, Desai, T, van Geest, A, King, V, Di Lernia, V, Koreja, Z, and Hasab, V

Subjects
Male, IMID, immune-mediated inflammatory disease, immunosuppressant, BMI, body mass index, ACEi, angiotensin-converting enzyme inhibitor, PsoProtect, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 infecTion, Logistic regression, Systemic therapy, 030207 dermatology & venereal diseases, 0302 clinical medicine, RC705, Interquartile range, COVID-19, biologics, hospitalization, immunosuppressants, psoriasis, risk factors, Risk Factors, Epidemiology, Immunology and Allergy, 030212 general & internal medicine, Registries, NSAID, non-steroidal anti-inflammatory drug, 610 Medicine & health, COVID-19, Coronavirus disease 2019, TNF, tumor necrosis factor, Age Factors, Middle Aged, Hospitalization, risk factor, 95% CI, 95% confidence interval, Female, JAK, Janus kinase, biologic, Adult, medicine.medical_specialty, Immunology, Lower risk, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, Article, 03 medical and health sciences, Sex Factors, Internal medicine, Psoriasis, medicine, Humans, SARS-CoV-2, IFN, interferon, IQR, interquartile range, psoriasi, business.industry, Odds ratio, medicine.disease, ARB, angiotensin II receptor blocker, IL, interleukin, OR, odds ratio, business, Body mass index
Abstract

Background The multi-morbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse COVID-19 outcomes but data are limited. Objective Characterize the course of COVID-19 in psoriasis and identify factors associated with hospitalization. Methods Clinicians reported psoriasis patients with confirmed/suspected COVID-19 via an international registry, PsoProtect. Multiple logistic regression assessed the association between clinical/demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviours. Results Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% a non-biologic and 10% no systemic treatment for psoriasis. 348 (93%) fully recovered from COVID-19, 77 (21%) were hospitalized and nine (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted OR 1.59 per 10 years, 95% CI 1.19-2.13), male sex (OR 2.51, 95% CI 1.23-5.12), non-white ethnicity (OR 3.15, 95% CI 1.24-8.03) and comorbid chronic lung disease (OR 3.87, 95% CI 1.52-9.83). Hospitalization was more frequent in patients using non-biologic systemic therapy than biologics (OR 2.84, 95% CI 1.31-6.18). No significant differences were found between biologic classes. Independent patient-reported data (n=1,626 across 48 countries) suggested lower levels of social isolation in individuals receiving non-biologic systemic therapy compared to biologics (OR 0.68, 95% CI 0.50-0.94). Conclusion In this international moderate-severe psoriasis case series, biologics use was associated with lower risk of COVID-19-related hospitalization than non-biologic systemic therapies, however further investigation is warranted due to potential selection bias and unmeasured confounding. Established risk factors (being older, male, non-white ethnicity, comorbidities) were associated with higher hospitalization rates. Clinical Implications We identify risk factors for COVID-19-related hospitalization in psoriasis patients, including older age, male sex, non-white ethnicity and comorbidities. Use of biologics was associated with lower hospitalization risk than non-biologic systemic therapies., Capsule summary: In this global registry-based study, risk factors for COVID-19-related hospitalization in psoriasis patients were older age, male sex, non-white ethnicity and comorbidities. Use of biologics was associated with lower hospitalization risk than non-biologic systemic treatment.

Published
2021

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