PT  - JOURNAL ARTICLE
AU  - Mainous, Arch
AU  - Rooks, Benjamin
AU  - Orlando, Frank
TI  - The Impact of Initial COVID-19 Episode Inflammation Among Adults on Mortality Within 12 Months Post Hospital Discharge
AID  - 10.1370/afm.21.s1.3496
DP  - 2023 Jan 01
TA  - The Annals of Family Medicine
PG  - 3496
VI  - 21
IP  - Supplement 1
4099  - http://www.annfammed.org/content/21/Supplement_1/3496.short
4100  - http://www.annfammed.org/content/21/Supplement_1/3496.full
SO  - Ann Fam Med2023 Jan 01; 21
AB  - Context: Significant inflammation is present in a COVID-19 episode. Post-acute COVID-19 mortality is a concern after recovery from the initial episode. It is unclear if inflammation in the initial episode is associated with post-acute COVID-19 mortality.Objective: The goal of this study was to determine the relationship between systemic inflammation in COVID-19 hospitalized adults and mortality after recovery from COVID-19.Design, Setting, and Participants: An analysis of electronic health records (EHR) for patients from 1 January, 2020 through 31 December, 2021 was performed for a cohort of COVID-19 positive hospitalized adult patients. 1,207 patients were followed for 12 months post COVID-19 episode at one health system.Main Outcome Measures: 12-month risk of mortality associated with inflammation, C-reactive protein (CRP), was assessed in Cox regressions adjusted for age, sex, race and comorbidities. Analyses evaluated whether steroids, anti-inflammatory medications, prescribed upon discharge were associated with later mortality.Results: Elevated CRP was associated other indicators of severity of the COVID-19 hospitalization including, supplemental oxygen and intravenous dexamethasone. Elevated CRP was associated with an increased mortality risk after recovery from COVID-19. This effect was present for both unadjusted (HR=1.60; 95% CI 1.18, 2.17) and adjusted analyses (HR=1.61; 95% CI 1.19, 2.20) when CRP was split into high and low groups at the median. Oral steroid prescriptions at discharge were found to be associated with a lower risk of death post-discharge (adjusted HR = 0.49; 95% CI 0.33, 0.74).Conclusions: Hyperinflammation present with severe COVID-19 is associated with an increased mortality risk after hospital discharge. Although suggestive, treatment with anti-inflammatory medications like steroids upon hospital discharge is associated with a decreased post-acute COVID-19 mortality risk.