At least seven hours of sleep protects against all-cause mortality in sleep apnea patients: JAMA

China: A cohort study of 2574 participants with obstructive sleep apnea (OSA) revealed significantly higher risks of all-cause mortality in individuals sleeping less than 7 hours compared to those with objective sleep duration of at least 7 hours, independent of apnea-hypopnea index (AHI).

“There is a need for further studies to investigate the health benefits of extending sleep length among patients with obstructive sleep apnea and short sleep duration,” the researchers wrote in JAMA Network Open.

Obstructive sleep apnea is a common sleep disorder with several adverse health outcomes, including cognitive decline and cardiovascular disease. Studies have revealed significantly higher all-cause mortality risk among patients with moderate-severe or severe OSA. However, AHI, a traditionally used assessment of OSA severity, was not always found to predict mortality in OSA patients. Therefore, there is a need for other measurements in addition to AHI to identify people with OSA at high risk of poor prognosis.

Sleep duration is the most important biomarker of sleep quantity and affects multiple systems. However, there is no clarity on the association between sleep duration and all-cause mortality among patients with obstructive sleep apnea. Therefore, Yiqi Lin, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China, and colleagues analyzed data of patients with OSA from the Sleep Heart Health Study (SHHS) and compared all-cause mortality risks in the groups of different subjective or objective sleep duration to determine the association between sleep duration and all-cause mortality in OSA.

The study included 2574 participants with OSA defined by AHI greater than or equal to 15 from SHHS; all of them had data on all-cause mortality. Participants were categorized into four groups with objective sleep duration of (1) at least 7 hours, (2) 6 to less than 7 hours, (3) 5 to less than 6 hours, and (4) less than 5 hours, which was determined by total sleep time on polysomnography (PSG) at baseline.

The risk of all-cause mortality, defined as deaths from any cause, was compared among 4 OSA groups using Cox regression models.

The researchers reported the following findings:

· 2574 participants with OSA were included (63.2% men; mean age, 65.4 years). Overall, 688 all-cause deaths were observed in participants.

· Compared with the group sleeping at least 7 hours, the groups sleeping 6 to less than 7 hours (hazard ratio [HR], 1.53), 5 to less than 6 hours (HR, 1.40), and less than 5 hours (HR, 1.64) had significantly higher risks of all-cause mortality independent of AHI.

· Sensitivity analyses were performed among participants with available data of positive airway pressure treatment during follow-up and the finding was mostly consistent, albeit the HR for the group of 5 to less than 6 hours was not statistically significant.

“Our study reported that participants with OSA with shorter sleep duration were at higher risk of all-cause deaths independent of AHI, compared to those with objective sleep duration of at least 7 hours,” the researchers wrote. “This finding was mostly consistent among participants with available CPAP treatment data during follow-up.”

Interestingly, the researchers found no significant association between all-cause mortality and self-reported habitual sleep duration in OSA.

“There would be a need for further research to shed light on its underlying mechanism and possible health benefits of extending sleep length among OSA patients with short sleep duration by sleep education or other sleep intervention,” they concluded.

Reference:

Lin Y, Wu Y, Lin Q, et al. Objective Sleep Duration and All-Cause Mortality Among People With Obstructive Sleep Apnea. JAMA Netw Open. 2023;6(12):e2346085. doi:10.1001/jamanetworkopen.2023.46085

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Peribulbar anaesthesia in ophthalmic surgery linked to development of pulmonary oedema

Researchers have found in  new study that Peribulbar anaesthesia in ophthalmic surgery was linked to development of  pulmonary oedema. Further it was found that majority of patients developed Pulmonary oedema during vitreoretinal procedures, particularly diabetic vitrectomies.

The research has been published in the Indian Journal of Anaesthesia. 

Recently published research investigates the occurrence of pulmonary edema (PE) in patients undergoing ophthalmic surgeries under regional anaesthesia.

The study is a retrospective observational analysis of patients who developed Pulmonary oedema during ophthalmic surgical procedures scheduled between 2019 and 2021. A total of 56,334 surgeries performed under regional anaesthesia were studied, and 27 patients (0.047%) developed Pulmonary oedema. The mean age of occurrence was 55.8 years, with hypertension and diabetes being the most common comorbidities among the affected patients. The majority of patients developed Pulmonary oedema during vitreoretinal procedures, particularly diabetic vitrectomies. Symptoms included breathing discomfort, tachypnoea, tachycardia, elevated blood pressure, and decreased oxygen saturation levels. The authors note that the incidence of Pulmonary oedema in this study was higher than the previously reported 0.006% incidence of major systemic complications in patients receiving peri-bulbar block. They also discuss the association between PE occurrence and the use of phenyl epinephrine eye drops, as well as the impact of underlying systemic comorbidities on lowering the threshold for Pulmonary oedema development. The paper suggests that slow diffusion of local anaesthetics into the medulla and suboptimal ventricular function due to systemic comorbid conditions may contribute to the development of Pulmonary oedema in these patients. The study provides valuable insights into the incidence and associated factors of Pulmonary oedema in ophthalmic surgeries under regional anaesthesia, highlighting the need for further research to understand and prevent such complications in this patient population.

Reference –

Kasanavesi, Ramakrishna Chaitanya; Dave, Vivek Pravin1; Jalali, Subhadra1; Rao, Rajanarsing. Pulmonary oedema in ophthalmic surgeries under peribulbar anaesthesia: A retrospective analysis. Indian Journal of Anaesthesia 67(11):p 1009-1010, November 2023. | DOI: 10.4103/ija.ija_623_23 

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Hormonal Contraceptives Increase Breast Cancer Risk in Women of Reproductive Age

A recent comprehensive study published in the Cancers Journal indicated a higher risk of breast cancer (BC) among women who have used hormonal contraceptives (HC) during their lifetime. This study shows the intricate relationship between hormonal contraceptives and breast cancer with a special focus on women of reproductive age.

The data from observational studies around the years 2015 to 2022 were pooled. This examined a total of 724 studies and narrowed down to 22 for meta-analysis by including 19 case-control studies and 3 cohort studies. The findings of the study revealed a significantly elevated risk of developing breast cancer in ever-users of hormonal contraceptives (pooled OR = 1.33; 95% CI = 1.19 to 1.49). The risk was found to be intensified in case-control studies (pooled OR = 1.44, 95% CI = 1.21 to 1.70) and in studies strictly defining menopausal status (pooled OR = 1.48; 95% CI, 1.10 to 2.00).

The study suggests a urging caution in interpreting the results because of the substantial heterogeneity (>70%) among studies. Factors like study design, variable measurement, confounders, and potential publication biased the contribution to the complexity. While the overall risk of breast cancer appeared to be elevated in users or ever-users of modern hormonal contraceptives, the findings emphasize the need for careful consideration of these variables when interpreting and applying the results in clinical practice.

This study contributes to the ongoing void surrounding the impact of hormonal contraceptives on women’s health. These findings highlight the importance of continuous research and a precise understanding of the diverse factors influencing the risk of breast cancer in the context of hormonal contraceptive use among women of reproductive age.

Source:

Torres-de la Roche, L. A., Acevedo-Mesa, A., Lizarazo, I. L., Devassy, R., Becker, S., Krentel, H., & De Wilde, R. L. (2023). Hormonal Contraception and the Risk of Breast Cancer in Women of Reproductive Age: A Meta-Analysis. In Cancers (Vol. 15, Issue 23, p. 5624). MDPI AG. https://doi.org/10.3390/cancers15235624

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Epigenetic alterations can cause type 2 diabetes, claims study

Sweden: A new study published in Nature Communications has provided increased support for the idea that epigenetic changes can cause type 2 diabetes. The researchers at Lund University now aim to develop methods for disease prevention. 

“Our new extensive study confirms our previous findings from smaller studies, showing that epigenetic changes can contribute to the development of type 2 diabetes. In this study, we have also identified new genes that impact the development of the disease. Our hope is that with the help of these results, we can develop methods that can be used to prevent type 2 diabetes,” says Charlotte Ling, professor of diabetes and epigenetics at Lund University’s Diabetes Centre (LUDC), who led the study.

We inherit our genes from our parents, and they seldom change. However, epigenetic changes that arise due to environmental and lifestyle factors can affect the function of genes.

The same epigenetic changes

The researchers studied epigenetics in insulin-producing cells from donors and found 5584 sites in the genome with changes that differed between 25 individuals with type 2 diabetes and 75 individuals without the disease. The same epigenetic changes found in people with type 2 diabetes were also found in individuals with elevated blood sugar levels, which increase the risk of developing the disease.

“Those of us who study epigenetics, have long tried to understand whether epigenetic changes cause type 2 diabetes or if the changes occur after the disease has already developed. Because we saw the same epigenetic changes in people with type 2 diabetes and individuals at risk for the disease, we conclude that these changes may contribute to the development of type 2 diabetes,” says Tina Rönn, lead author and researcher at LUDC.

The study identified 203 genes with different expressions in individuals with type 2 diabetes compared to the control group. The researchers found that the gene RHOT1 showed epigenetic changes in people with type 2 diabetes and that it also played a key role in insulin secretion in insulin-producing cells. When they knocked out the gene expression of RHOT1 in cells from donors without type 2 diabetes, insulin secretion decreased.

“When we examined the same type of cells in rats with diabetes, we found a lack of RHOT1, confirming the gene’s importance for insulin secretion,” says Tina Rönn.

Methods that can prevent the disease

One goal of the research is to develop a blood-based biomarker that can predict who is at risk of developing type 2 diabetes. Therefore, the researchers investigated whether their results from insulin-producing cells in the pancreas were reflected in the blood of living people. They found epigenetic changes in the blood of a group of 540 people without the disease and they linked this to the future development of type 2 diabetes in half of the individuals.

Factors such as unhealthy diet, sedentary lifestyle, and ageing increase the risk of type 2 diabetes, and they also affect our epigenetics. With the new study, researchers have identified new mechanisms that may make it possible to develop methods to help prevent type 2 diabetes.

“If we succeed in developing an epigenetic biomarker, we can identify individuals with epigenetic changes before they become ill. These individuals can, for example, receive personalised lifestyle advice that can reduce their risk of disease, or we can develop methods that aim to correct the activity of certain genes using epigenetic editing,” says Charlotte Ling.

Reference:

Rönn, T., Ofori, J.K., Perfilyev, A. et al. Genes with epigenetic alterations in human pancreatic islets impact mitochondrial function, insulin secretion, and type 2 diabetes. Nat Commun 14, 8040 (2023). https://doi.org/10.1038/s41467-023-43719-9.

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Loss of auditory nerve may trigger tinnitus even in people with normal hearing

A new study from Mass Eye and Ear investigators shows that individuals who report tinnitus, which present as a ringing in the ears in more than one out of ten adults worldwide, are experiencing auditory nerve loss that is not picked up by conventional hearing tests. This work is part of a P50 grant awarded by the National Institutes of Health (NIH) to Mass Eye and Ear researchers within the Eaton-Peabody Laboratories (EPL) for their work on cochlear synaptopathy, which is commonly referred to as “hidden hearing loss.” The results from this study provide a better understanding on the origins of tinnitus and are published November 30th in Scientific Reports.

“Beyond the nuisance of having persistent ringing or other sounds in the ears, tinnitus symptoms are debilitating in many patients, causing sleep deprivation, social isolation, anxiety and depression, adversely affecting work performance, and reducing significantly their quality of life,” said senior author Stéphane F. Maison, PhD, CCC-A, a principal investigator at Mass Eye and Ear, a member of Mass General Brigham, and clinical director of the Mass Eye and Ear Tinnitus Clinic.

“We won’t be able to cure tinnitus until we fully understand the mechanisms underlying its genesis. This work is a first step toward our ultimate goal of silencing tinnitus.”

Many individuals with hearing loss report a buzzing, humming, ringing or even roaring sound in their ears.

It’s been a longstanding idea that these symptoms, known as tinnitus, arise as a result of a maladaptive plasticity of the brain.

In other words, the brain tries to compensate for the loss of hearing by increasing its activity, resulting in the perception of a phantom sound, tinnitus.

Until recently though, this idea was disputed as some tinnitus sufferers have normal hearing tests.

However, the discovery of cochlear synaptopathy back in 2009 by Mass Eye and Ear investigators brought back to life this hypothesis as it was evidenced that patients with a normal hearing test can have a significant loss to the auditory nerve.

In view of this paradigm shift in the way researchers and clinicians think about hearing loss, Maison and his team sought to determine if such hidden damage could be associated with the tinnitus symptoms experienced by a cohort of normal hearing participants.

By measuring the response of their auditory nerve and brainstem, the researchers found that chronic tinnitus was not only associated with a loss of auditory nerve but that participants showed hyperactivity in the brainstem.

“Our work reconciles the idea that tinnitus may be triggered by a loss of auditory nerve, including in people with normal hearing,” said Maison.

In terms of future directions, the investigators aim to capitalize on recent work geared toward the regeneration of auditory nerve via the use of drugs called neurotrophins.

“The idea that, one day, researchers might be able to bring back the missing sound to the brain and, perhaps, reduce its hyperactivity in conjunction with retraining, definitely brings the hope of a cure closer to reality,” Maison added.

Reference:

Viacheslav Vasilkov, Benjamin Caswell-Midwinter, Yan Zhao, Victor de Gruttola, David H. Jung, M. Charles Liberman, Stéphane F. Maison. Evidence of cochlear neural degeneration in normal-hearing subjects with tinnitus. Scientific Reports, 2023; 13 (1) DOI: 10.1038/s41598-023-46741-5.

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Pro-inflammatory diet in American adults linked with increased gout risk

A recent study unveiled a significant correlation between dietary habits and the risk of developing gout in US adults. The findings of the study were published in Heliyon Journal.

The study was based on data from the 2007-2018 National Health and Nutrition Examination Survey and included 27,710 participants in a critical analysis of the Dietary Inflammatory Index (DII) and its potential association with gout.

The research utilized restricted cubic splines (RCS) and the scientists modeled the nonlinear dynamics of this association. Propensity score matching (PSM) was subsequently applied to look deeper into potential relationships, and a subgroup analysis provided a nuanced perspective.

The results found a compelling link between dietary inflammation and gout risk. the participants in the highest DII quartile exhibited a 31% high susceptibility to gout in the univariate regression model. After meticulous adjustments for variables such as drinking, smoking, gender, race, age, and BMI, a positive correlation between gout risk and DII persisted. The RCS analysis demonstrated a sharp rise in gout risk with increasing DII values and another sharp increase when DII surpassed approximately 2.5 separated with a plateau in between.

After implementing PSM, the positive correlation between DII and gout remained robust in a fully adjusted multivariable model. Also, subgroup analysis brought forth intriguing nuances, with no statistically significant link found in females, blacks, Mexicans, or smokers.

The findings show that higher levels of pro-inflammation in diets correlate with an elevated risk of gout, and this suggest anti-inflammatory diet that could be pivotal in preventing and ameliorating gout in adults. This research highlights the nuanced relationship between diet and health but also offers practical insights for the development of preventive strategies for this painful condition.

Reference:

Zhang, Y., Song, J., Lai, Y., Li, A., Zhang, Y., Zhou, H., Zhao, W., Zong, Z., Wu, R., & Li, H. (2023). Association between the dietary inflammatory index and gout in the National Health and Nutrition Examination Survey 2007–2018. In Heliyon (Vol. 9, Issue 12, p. e22930). Elsevier BV. https://doi.org/10.1016/j.heliyon.2023.e22930

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Omalizumab safely manages Chronic spontaneous urticaria during pregnancy

Treating a pregnant patient with chronic spontaneous urticaria (CSU) can be quite challenging. According to recent findings, most CSU treatments for pregnant patients involved the use of second-generation H1-antihistamines (sgAHs), while information on the safety of Omalizumab is limited.

A study found Omalizumab to be a safe treatment option for pregnant women with a history of chronic spontaneous urticaria. This study was led by Cataldo Patruno and colleagues and was published in Clinical and Experimental Dermatology.

This study assessed the effectiveness and safety of Omalizumab for individuals with severe chronic spontaneous urticaria (CSU) who are either pregnant during treatment or initiate the medication during pregnancy in a typical clinical practice setting.

A team of researchers performed a retrospective analysis on women who were 18 years old or older, pregnant, and had received one or more doses of Omalizumab at any point during their pregnancy or were taking Omalizumab at the time of conception or within the eight weeks before conception.

Key findings are:

  • Twenty-nine pregnant patients were evaluated. There were two groups, A and B.
  • In group A, 23 patients, constituting 79.31%, conceived during omalizumab therapy.
  • In group B, six patients, constituting 20.69%, initiated omalizumab therapy during pregnancy.
  • Among group A, 23 births and one miscarriage were reported.
  • 15/23 patients discontinued Omalizumab after discovering the pregnancy state, while 8/23 patients were exposed to Omalizumab during the entire pregnancy period.
  • In group B, Omalizumab was introduced at 10.83 ± 3.60 weeks of gestation. The patients in this group were exposed to it until the end of pregnancy. This group had seven live-born infants, including five singletons and one twin pair.
  • No adverse events, complications or congenital anomalies were reported.

The objective of this retrospective study was to evaluate the efficacy and safety of Omalizumab in a cohort of 29 pregnant women who had severe chronic spontaneous urticaria and were resistant to second-generation H1-antihistamines.

They said Omalizumab for managing CSU before and during pregnancy does not negatively affect maternal and fetal outcomes.

Reference:

Cataldo Patruno et al. Safety of Omalizumab for chronic urticaria during pregnancy: a real-life study, Clinical and Experimental Dermatology, 2023; llad386.

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Prehospital tourniquet use tied to improved mobility and limb preservation in vascular extremity trauma

Recent data suggest tourniquet use decreases shock without increasing limb complications, supporting its use in prehospital settings.

According to a recent study published in Surgery, researchers from Case Western Reserve University, Cleveland, said that Encouraging tourniquet use in the civilian setting may improve outcomes and reduce limb loss risk, as it has been associated with increased functional mobility and decreased delayed amputation.

The researchers in this study established the Hypothesis that Prehospital tourniquet use in vascular extremity trauma reduces delayed amputation and improves mobility compared to no prehospital tourniquet application.

The team evaluated adults with extremity vascular trauma at an urban Level 1 trauma centre (2016-2021). Outcomes included delayed amputation and mobility at discharge, measured by the 6 Clicks Basic Mobility Score. Higher scores indicated better mobility. Data on injury mechanisms, lactate, transfusions, mortality, and kidney injury were also collected. χ2, Fisher Exact and Wilcoxon tests were used to perform comparisons.

The results of this study could be summarised as follows:

  • Of 232 patients, prehospital tourniquet application had no association with mortality or lactate level.
  • The prehospital tourniquet application group had more transfusions, lower acute kidney injury rates, and fewer delayed amputations.
  • Ninety-one patients, (45 in prehospital tourniquet application and 46 without it) were evaluated for “Moving between Bed and Chair” in the “6 Clicks” Basic Mobility Score. Those in the prehospital tourniquet application group had higher levels of independence.

In this study, they said we used the “6 Clicks” score to assess the differences in functional mobility between patients who had extremity vascular trauma with and without tourniquet use.

The use of Prehospital tourniquets was associated with fewer delayed amputations. The outcomes were favourable, including higher functional mobility and decreased delayed amputation.

The results of this study suggest that tourniquet use should be encouraged in the civilian setting as it improves outcomes and reduces limb loss risk.

Reference:

Thai, A. P., Tseng, E. S., Kishawi, S., Robenstine, J. C., & Ho, V. P. (2023). Prehospital tourniquet application in extremity vascular trauma: Improved functional outcomes. Surgery, 174(6), 1471–1475. https://doi.org/10.1016/j.surg.2023.08.002

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Urinary endocrine-disrupting chemicals do not increase risk of metabolic syndrome among women

A recent multiethnic study highlighted the potential connection between exposure to certain environmental chemicals and the prevalence of metabolic syndrome (MetS) in women. The findings of the study were published in the Journal of the Endocrine Society.

Metabolic syndrome is a group of conditions associated with an elevated risk of cardiovascular disease, includes factors like high blood pressure, elevated fasting glucose, increased triglycerides, expanded waist circumference, and low levels of high-density lipoprotein cholesterol.

This analysis focused on four classes of urinary endocrine-disrupting chemicals (EDCs), the bisphenol A (BPA), triclosan, parabens, and phthalates. The study involved 1728 women after adjusting for variables such as age, body mass index (BMI), racial and ethnic background, and breast cancer status.

The results showed that metabolic syndrome was identified in 30.0% of the women. There were no statistically significant associations between MetS and BPA, triclosan, or phthalate metabolite excretion. Also, an intriguing inverse relationship emerged with total parabens (Ptrend = .002) was noticed which indicated a potential protective effect against metabolic syndrome.

The study explored potential variations in these associations based on race, ethnicity, and BMI. While these were suggestive of inverse associations between EDCs and MetS among Latino and African American women, no statistically significant heterogeneity was detected in those with a BMI under 30 kg/m2.

The findings of this study suggest a complex interplay between environmental exposures and metabolic health, particularly among women. This inverse association observed here with parabens prompts further investigation into the potential protective role of these chemicals in the context of MetS.

Reference:

Ihenacho, U., Guillermo, C., Wilkens, L. R., Franke, A. A., Tseng, C., Li, Y., Sangaramoorthy, M., Derouen, M. C., Haiman, C. A., Stram, D. O., Le Marchand, L., Cheng, I., & Wu, A. H. (2023). Association of endocrine disrupting chemicals with the Metabolic syndrome among women in the Multiethnic Cohort Study. Journal of the Endocrine Society, 7(12). https://doi.org/10.1210/jendso/bvad136

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‘Long flu’ has emerged as consequence similar to long COVID

Since the COVID-19 pandemic began, extensive research has emerged detailing the virus’s ability to attack multiple organ systems, potentially resulting in a set of enduring and often disabling health problems known as long COVID. Now, new research from Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System indicates that people hospitalized with seasonal influenza also can suffer long-term, negative health effects, especially involving their lungs and airways.

The new study comparing the viruses that cause COVID-19 and the flu also revealed that in the 18 months after infection, patients hospitalized for either COVID-19 or seasonal influenza faced an increased risk of death, hospital readmission, and health problems in many organ systems. Further, the time of highest risk was 30 days or later after initial infection.

“The study illustrates the high toll of death and loss of health following hospitalization with either COVID-19 or seasonal influenza,” said senior author Ziyad Al-Aly, MD, a clinical epidemiologist at Washington University. “It’s critical to note that the health risks were higher after the first 30 days of infection. Many people think they’re over COVID-19 or the flu after being discharged from the hospital. That may be true for some people. But our research shows that both viruses can cause long-haul illness.”

The findings are published Dec. 14 in The Lancet Infectious Diseases.

The statistical analysis spanned up to 18 months post-infection and included a comparative evaluation of risks of death, hospital admissions and 94 adverse health outcomes involving the body’s major organ systems.

“A review of past studies on COVID-19 versus the flu focused on a short-term and narrow set of health outcomes,” said Al-Aly, who treats patients within the VA St. Louis Health Care System and is an assistant professor of medicine at Washington University. “Our novel approach compared the long-term health effects of a vast array of conditions. Five years ago, it wouldn’t have occurred to me to examine the possibility of a ‘long flu.’ A major lesson we learned from SARS-CoV-2 is that an infection that initially was thought to only cause brief illness also can lead to chronic disease. This revelation motivated us to look at long-term outcomes of COVID-19 versus flu.

“We wanted to know whether and to what degree people with flu also experience long-term health effects,” Al-Aly said. “The big answer is that both COVID-19 and the flu led to long-term health problems, and the big aha moment was the realization that the magnitude of long-term health loss eclipsed the problems that these patients endured in the early phase of the infection. Long COVID is much more of a health problem than COVID, and long flu is much more of a health problem than the flu.”

However, the overall risk and occurrence of death, hospital admissions, and loss of health in many organ systems are substantially higher among COVID-19 patients than among those who have had seasonal influenza, Al-Aly said. “The one notable exception is that the flu poses higher risks to the pulmonary system than COVID-19,” he said. “This tells us the flu is truly more of a respiratory virus, like we’ve all thought for the past 100 years. By comparison, COVID-19 is more aggressive and indiscriminate in that it can attack the pulmonary system, but it can also strike any organ system and is more likely to cause fatal or severe conditions involving the heart, brain, kidneys and other organs.”

The researchers analyzed de-identified medical records in a database maintained by the U.S. Department of Veterans Affairs, the nation’s largest integrated health-care delivery system. They evaluated information involving 81,280 patients hospitalized for COVID-19 at some point from March 1, 2020, through June 30, 2022, as well as 10,985 patients hospitalized for seasonal influenza at some point from Oct. 1, 2015, through Feb. 28, 2019.

Patients represented multiple ages, races and sexes.

Regarding both viruses, patient vaccination status did not affect results. Those in the COVID-19 cohort were hospitalized during the pre-delta, delta and omicron eras.

During the overall 18-month study period, patients who had COVID-19 faced a 50% higher risk of death than those with seasonal influenza. This corresponded to about eight more deaths per 100 persons in the COVID-19 group than among those with the flu.

Although COVID-19 showed a greater risk of health loss than seasonal influenza, infection with either virus carried significant risk of disability and disease. The researchers found COVID-19 exhibited increased risk of 68% of health conditions examined across all organ systems (64 of the 94 adverse health outcomes studied), while the flu was associated with elevated risk of 6% of health conditions (six of the 94) — mostly in the respiratory system.

Also, over 18 months, COVID-19 patients experienced an increased risk of hospital readmission as well as admission to an intensive care unit (ICU). For every 100 persons in each group, there were 20 more hospital admissions and nine more ICU admissions in COVID-19 than flu.

“Our findings highlight the continued need to reduce the risk of hospitalization for these two viruses as a way to alleviate the overall burden of health loss in populations,” Al-Aly said. “For both COVID-19 and seasonal influenza, vaccinations can help prevent severe disease and reduce the risk of hospitalizations and death. Optimizing vaccination uptake must remain a priority for governments and health systems everywhere. This is especially important for vulnerable populations such as the elderly and people who are immunocompromised.”

In both COVID-19 and the flu, more than half of death and disability occurred in the months after infection as opposed to the first 30 days, the latter of which is known as the acute phase.

“The idea that COVID-19 or flu are just acute illnesses overlooks their larger long-term effects on human health,” Al-Aly said. “Before the pandemic, we tended to belittle most viral infections by regarding them as somewhat inconsequential: ‘You’ll get sick and get over it in a few days.’ But we’re discovering that is not everyone’s experience. Some people are ending up with serious long-term health issues. We need to wake up to this reality and stop trivializing viral infections and understand that they are major drivers of chronic diseases.”

Reference:

Yan Xie, Taeyoung Choi, Ziyad Al-Aly. Long-term outcomes following hospital admission for COVID-19 versus seasonal influenza: a cohort study. The Lancet Infectious Diseases, 2023; DOI: 10.1016/S1473-3099(23)00684-9

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