Acute and post-acute respiratory complications of SARS-CoV-2 infection: population-based cohort study in South Korea and Japan

Yujin Choi, Hyeon Jin Kim, Jaeyu Park, Myeongcheol Lee, Sunyoung Kim, Ai Koyanagi, Lee Smith, Min Seo Kim, Masoud Rahmati, Hayeon Lee (), Jiseung Kang () and Dong Keon Yon ()
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Yujin Choi: Kyung Hee University College of Medicine
Hyeon Jin Kim: Kyung Hee University College of Medicine
Jaeyu Park: Kyung Hee University College of Medicine
Myeongcheol Lee: Kyung Hee University College of Medicine
Sunyoung Kim: Kyung Hee University Medical Center, Kyung Hee University College of Medicine
Ai Koyanagi: Parc Sanitari Sant Joan de Deu
Lee Smith: Anglia Ruskin University
Min Seo Kim: Broad Institute of MIT and Harvard
Masoud Rahmati: Aix-Marseille University
Hayeon Lee: Kyung Hee University College of Medicine
Jiseung Kang: Harvard Medical School
Dong Keon Yon: Kyung Hee University College of Medicine

Nature Communications, 2024, vol. 15, issue 1, 1-12

Abstract: Abstract Considering the significant burden of post-acute COVID-19 conditions among patients infected with SARS-CoV-2, we aimed to identify the risk of acute respiratory complications or post-acute respiratory sequelae. A binational population-based cohort study was conducted to analyze the risk of acute respiratory complications or post-acute respiratory sequelae after SARS-CoV-2 infection. We used a Korean nationwide claim-based cohort (K-COV-N; n = 2,312,748; main cohort) and a Japanese claim-based cohort (JMDC; n = 3,115,606; replication cohort) after multi-to-one propensity score matching. Among 2,312,748 Korean participants (mean age, 47.2 years [SD, 15.6]; 1,109,708 [48.0%] female), 17.1% (394,598/2,312,748) were infected with SARS-CoV-2. The risk of acute respiratory complications or post-acute respiratory sequelae is significantly increased in people with SARS-CoV-2 infection compared to the general population (acute respiratory complications: HR, 8.06 [95% CI, 6.92-9.38]; post-acute respiratory sequelae: 1.68 [1.62-1.75]), and the risk increased with increasing COVID-19 severity. We identified COVID-19 vaccination as an attenuating factor, showing a protective association against acute or post-acute respiratory conditions. Furthermore, while the excess post-acute risk diminished with time following SARS-CoV-2 infection, it persisted beyond 6 months post-infection. The replication cohort showed a similar pattern in the association. Our study comprehensively evaluates respiratory complications in post-COVID-19 conditions, considering attenuating factors such as vaccination status, post-infection duration, COVID-19 severity, and specific respiratory conditions.

Date: 2024
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DOI: 10.1038/s41467-024-48825-w

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