Buffalo, NY—For the last several months, clinical articles on COVID-19 complications have been published frequently. Now, a large study of U.S. patients seeks to confirm specifically what conditions are associated with novel coronavirus infections and how common they are.

The report in CMAJ (Canadian Medical Association Journal) used deidentified outpatient and inpatient medical claims from a health database in the United States. University of Buffalo–led researchers identified 70,288 patients who had a COVID-19-related health visit between March 1 and April 30, 2020

“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,” writes lead author William Murk of the Jacobs School of Medicine & Biological Sciences at the University at Buffalo.

The study points out that many studies on COVID-19 complications have involved case series or small cohorts that could not establish a causal association with COVID-19 or provide risk estimates in different care settings.

Of patients included in the study, more than half were admitted to hospitals, with about 5% requiring admission to the ICU. Participants had a median age of 65 years, and 55.8% were female. The authors looked at all possible diagnostic codes and identified those that increased in frequency after the onset of COVID-19.

Researchers determined that 69 of 1,724 analyzed ICD-10-CM diagnosis codes were significantly associated with COVID-19. According to the results, disorders indicating both strong association with COVID-19 and high absolute risk included:
• Viral pneumonia (odds ratio [OR], 177.63; 95% confidence interval [CI] 147.19-214.37; absolute risk, 27.6%)
• Respiratory failure (OR 11.36; 95% CI, 10.74-12.02; absolute risk 22.6%)
• Acute kidney failure (OR 3.50; 95% CI, 3.34-3.68, absolute risk, 11.8%)
• Sepsis (OR 4.23, 95% CI, 4.01-4.46, absolute risk, 10.4%)

The authors note that disorders showing strong associations with COVID-19, but low absolute risk, included myocarditis (OR 8.17; 95% CI, 3.58-18.62; absolute risk, 0.1%); disseminated intravascular coagulation (OR 11.83; 95% CI, 5.26-26.62; absolute risk, 0.1%) and pneumothorax (OR 3.38; 95% CI, 2.68-4.26, absolute risk 0.4%).

“We confirmed and provided risk estimates for numerous complications of COVID-19. These results may guide prognosis, treatment decisions and patient counselling,” researchers explain.

The study calculates absolute risk of these hospitalized COVID-19 patients having pneumonia at 27.6%, as well as 22.6% for respiratory failure, 11.8% for kidney failure, and 10.4% for sepsis or systemic inflammation.

Associations also were detected with other lung and cardiovascular conditions, including collapsed lung, blood clotting disorders and heart inflammation, although the risk of these was relatively low.

On the other hand, the study did not indicate that COVID-19 was linked to a higher risk of stroke.

“This study provides estimates of absolute risk and relative odds for all identified diagnoses related to COVID-19, which are needed to help providers, patients and policy-makers understand the likelihood of complications,” the authors suggest.

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