Risks of major arterial and venous thrombotic diseases after hospitalisation for influenza, pneumonia, and COVID-19: A population-wide cohort in 2.6 million people in Wales
Year: 2024
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: Pneumonia, influenza, COVID-19, and other common infections might increase the risk of thrombotic events acutely through an interaction between inflammation and the thrombotic system. The long-term risks of arterial and venous thrombotic events following hospitalisation for COVID-19 and hospitalisation for pneumonia or influenza are unclear. MATERIALS AND METHODS: In a population-wide cohort of linked Welsh health data of adults, we calculated the incidence of arterial and venous thrombosis after hospitalisation for COVID-19 (2020-2021). We then compared this post-hospitalisation incidence with the incidence prior to COVID-19 hospitalisation in the same individuals, and with the incidence in individuals who were never hospitalised for COVID-19. We then repeated this analysis for hospitalisation for pneumonia or influenza in a separate cohort (2016-2019). We estimated adjusted hazard ratios (aHRs) in separate time periods starting from the date of the first infection that resulted in hospitalisation (day 0, 1 to 7 days, 2 to 4 weeks, 5 to 16 weeks, and 17 to 75 weeks) using time-varying Cox regression. Confounders included age, sex, smoking status, obesity, deprivation (fifths of Welsh Index of Multiple Deprivation), rural or urban setting, care home attendance, Elixhauser comorbidity index, surgery in the last year, medications (e.g. lipid-lowering and antiplatelet/anticoagulant use), hypertension and/or hypertensive medication use, and past medical history of chronic kidney disease, diabetes, chronic obstructive pulmonary disease, dementia, cancer, or any CVD. RESULTS: For the first arterial thrombosis, the aHRs were 3.80 (95 % CI: 2.50-5.77) between days 1-7, 5.24 (4.21-6.51) between weeks 2-4, 2.12 (1.72-2.60) between weeks 5-16, and 1.60 (1.38-1.86) between weeks 17-75 after hospitalisation for COVID-19. The corresponding aHRs after hospitalisation for pneumonia/influenza were: 5.42 (4.35-6.75), 3.87 (3.32-4.49), 1.96 (1.74-2.21), and 1.41 (1.30-1.53). For first venous thrombosis, aHRs were 7.47 (3.56-15.7) between days 1-7, 22.6 (17.5-29.1) between weeks 2-4, 6.58 (4.98-8.68) between weeks 5-16, and 2.25 (1.67-3.02) between weeks 17-75 after hospitalisation for COVID-19. The corresponding aHRs after hospitalisation for pneumonia/influenza were: 15.1 (10.3-22.0), 11.8 (9.23-15.1), 5.80 (4.75-7.08), and 1.89 (1.57-2.29). Excess risk was highest in individuals aged ≥60 years, in whom we estimated 2,700 and 2,320 additional arterial and 1,270 and 840 additional venous events after 100,000 hospitalisations for COVID-19 and pneumonia/influenza, respectively. CONCLUSIONS: Both hospitalisation for COVID-19 and pneumonia/influenza increase the risk of arterial and venous thrombosis. Preventative healthcare policies are needed for cardiovascular risk factor management, vaccination, and anticoagulation in high-risk patients with hospitalised or severe infections.
Source: Thrombosis Research
Authors: Spencer Keene, Hoda Abbasizanjani, Fatemeh Torabi, Rochelle Knight, Venexia Walker, Elena Raffetti, Genevieve Cezard, Samantha Ip, Alexia Sampri, Thomas Bolton, Rachel Denholm, Kamlesh Khunti, Ashley Akbari, Jennifer Quint, Spiros Denaxas, Cathie Sudlow, Emanuele Di Angelantonio, Jonathan A.C. Sterne, Angela Wood, William N. Whiteley
Institutions: University of Cambridge, British Heart Foundation, Swansea University, University of Bristol, NIHR Bristol Biomedical Research Centre, MRC Integrative Epidemiology Unit, NIHR Applied Research Collaboration West, University of Pennsylvania, Karolinska Institutet, Cambridge Centre for AI in Medicine, Health Data Research UK, University of Leicester, Imperial College London, UCL Biomedical Research Centre, University College London, Human Technopole, NIHR Cambridge Biomedical Research Centre, University of Edinburgh
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,170
Funders: Wellcome Trust, Health and Care Research Wales, Scottish Government, UK Research and Innovation, Public Health Wales, National Institute for Health and Care Research, British Heart Foundation, Department of Health and Social Care, Cardiff University, Swansea University, Public Health Agency, Welsh Ambulance Services NHS Trust, Wales Institute of Social and Economic Research and Data, Chief Scientist Office, Scottish Government Health and Social Care Directorate, Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Health and Social Care Research and Development Division, NIHR Leicester Biomedical Research Centre
Awards: Controlling COVID19 through enhanced population surveillance and intervention (Con-COV): a platform approach, G171866114, G1898492273, G2045002217, G2328232902, Large-scale integrative genomic studies of high-dimensional traits in cardiovascular diseases (renewal), G2465463101, G2956813274, G3406941151, G5546567188, Administrative Data Research Centres 2018, Large-scale integrative studies of risk factors in coronary heart disease: from discovery to application (renewal). (Joint funding with MRC), Research Excellence, BHF Data Science Centre, G8415457339, G885813400
OpenAlex ID: W4404494640