Abstract
Objectives:
To generate comprehensive evidence on the risk of clinical sequelae involving different organ systems over time after coronavirus disease 2019 (COVID-19) infection.
Design:
Multinational retrospective cohort study.
Setting:
Electronic medical records from the US, UK, France, Germany and Italy standardised to the Observational Medical Outcomes Partnership Common Data Model.
Participants:
A total of 303,251 individuals with a COVID-19 infection between 1 December 2019 and 1 December 2020 and propensity score matched non-COVID-19 comparators from 22,108,925 eligible candidates.
Main outcome measures:
Incidence of 73 clinical sequelae involving multiple organ systems including the respiratory, cardiovascular, dermatological and endocrine systems over the short- (0–6 months), medium- (6–12 months) and long-term (1–2 years) after COVID-19 infection. The hazard ratio (HR) and 95% confidence interval (95% CI) of individual disease outcomes were estimated using Cox proportional hazard regression.
Results:
Individuals with COVID-19 incurred a greater risk of clinical sequelae involving multiple organ systems including respiratory (France HR 2.23, 95%CI [2.10,2.37] to Italy 13.13 [11.80,14.63]), cardiovascular (Germany 1.39 [1.30,1.50] to US 1.79 [1.74,1.85]) and dermatological (UK 1.13 [1.01,1.25] to Italy 1.77 [1.42,2.21]) disorder over the short-term. While the risk of clinical sequelae has largely subsided during the medium-term, the risk of cardiovascular- (US 1.16 [1.11,1.21], France 1.10 [1.01,1.19]) and endocrine- (US 1.18 [1.12,1.24], Germany 1.15 [1.03,1.29]) related complications may continue to persist for up to two years.
Conclusions:
Through a network of multinational healthcare databases, this study generated comprehensive and robust evidence supporting the extensive multi-organ involvement of post-COVID-19 condition over the short-term period and the subside in risk for most complications over the medium- and long-term.
To generate comprehensive evidence on the risk of clinical sequelae involving different organ systems over time after coronavirus disease 2019 (COVID-19) infection.
Design:
Multinational retrospective cohort study.
Setting:
Electronic medical records from the US, UK, France, Germany and Italy standardised to the Observational Medical Outcomes Partnership Common Data Model.
Participants:
A total of 303,251 individuals with a COVID-19 infection between 1 December 2019 and 1 December 2020 and propensity score matched non-COVID-19 comparators from 22,108,925 eligible candidates.
Main outcome measures:
Incidence of 73 clinical sequelae involving multiple organ systems including the respiratory, cardiovascular, dermatological and endocrine systems over the short- (0–6 months), medium- (6–12 months) and long-term (1–2 years) after COVID-19 infection. The hazard ratio (HR) and 95% confidence interval (95% CI) of individual disease outcomes were estimated using Cox proportional hazard regression.
Results:
Individuals with COVID-19 incurred a greater risk of clinical sequelae involving multiple organ systems including respiratory (France HR 2.23, 95%CI [2.10,2.37] to Italy 13.13 [11.80,14.63]), cardiovascular (Germany 1.39 [1.30,1.50] to US 1.79 [1.74,1.85]) and dermatological (UK 1.13 [1.01,1.25] to Italy 1.77 [1.42,2.21]) disorder over the short-term. While the risk of clinical sequelae has largely subsided during the medium-term, the risk of cardiovascular- (US 1.16 [1.11,1.21], France 1.10 [1.01,1.19]) and endocrine- (US 1.18 [1.12,1.24], Germany 1.15 [1.03,1.29]) related complications may continue to persist for up to two years.
Conclusions:
Through a network of multinational healthcare databases, this study generated comprehensive and robust evidence supporting the extensive multi-organ involvement of post-COVID-19 condition over the short-term period and the subside in risk for most complications over the medium- and long-term.
| Original language | English |
|---|---|
| Pages (from-to) | 213-229 |
| Number of pages | 17 |
| Journal | Journal of the Royal Society of Medicine |
| Volume | 118 |
| Issue number | 7 |
| Early online date | 8 Jul 2025 |
| DOIs | |
| Publication status | Published - 8 Jul 2025 |
Bibliographical note
Copyright © The Royal Society of Medicine. This accepted manuscript version is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License [https://creativecommons.org/licenses/by-nc-nd/4.0/]. The published version is available at, 'Lam ICH, Chai Y, Man KKC, et al. (2025) The short-, medium- and long-term risk and the multi-organ involvement of clinical sequelae after COVID-19 infection: a multinational network cohort study. Journal of the Royal Society of Medicine', https://doi.org/10.1177/01410768251352666.Funding
This work was supported by Collaborative Research Fund, University Grants Committee, the HKSAR Government (Principal Investigator: ICK Wong; Ref. No. C7154-20GF); and Research Grant from the Health Bureau, the HKSAR Government (Principal Investigator: ICK Wong; Ref. No. COVID19F01). ICKW is partially supported by the Laboratory of Data Discovery for Health (D 2 4H) funded by the AIR@InnoHK administered by Innovation and Technology Commission.
Keywords
- COVID-19
- SARS-CoV-2
- post-COVID-19 conditions
- long COVID
- post-acute sequelae of SARS-CoV-2
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