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6-Month Consequences of COVID-19 in Hospitalized Patients
Quick Takes
- In this cohort of patients discharged from the first dedicated COVID-19 hospital in Wuhan, China, 76% of patients had ≥1 residual symptom at follow up ~6 months after the acute illness.
- Common symptoms included fatigue/muscle weakness (63%), sleep problems (23%), and anxiety/depression (23%). Women more commonly reported anxiety/depression than men. Chest pain was reported by 5% and palpitations by 9%.
Study Questions:
What are the long-term consequences of coronavirus disease 2019 (COVID-19) following hospital discharge?
Methods:
This cohort study enrolled patients who were discharged from the first dedicated COVID-19 hospital in Wuhan, China. All patients with laboratory-confirmed COVID-19 discharged between January 7 and May 29, 2020 were considered. Key exclusion criteria were as follows: death prior to follow-up visit, difficult follow-up due to psychiatric disease or hospital readmission, mobility limitations, and patient refusal. Follow-up visits consisted of face-to-face interview, physical exam, questionnaires, and 6-minute walk testing. A subset of patients, including all those who required mechanical ventilation or high-flow oxygen while in hospital (severity scale 5-6), were invited to undergo pulmonary function tests (PFTs) and high-resolution chest computed tomography (CT). Clinical outcomes of interest included symptoms, exercise capacity, health-related quality of life, lung function, and chest CT pattern at follow-up.
Results:
Of the 2,469 patients discharged during the study period, 736 patients were excluded (of whom 33 patients [1.3%] died prior to follow-up), and 1,733 patients were included in the study. The median age of study participants was 57.0 years, and 48% were women. Common comorbidities included hypertension (29%), diabetes (12%), and cardiovascular disease (7%). During hospitalization, 68% of patients required supplemental oxygen, and 4% were admitted to the intensive care unit.
Median follow-up time after symptom onset was 186 days. At follow-up, 76% of patients reported ≥1 symptom. The most common symptoms were fatigue or muscle weakness (63%), sleep difficulties (23%), and hair loss (22%). Chest pain was reported by 5% and palpitations by 9%. Patients with severity scale 5-6 were more likely to have residual symptoms at follow-up, as compared with patients with severity scale 3, who had not required oxygen (odds ratio [OR] for having ≥1 symptom, 2.42; 95% confidence interval [CI], 1.15-5.08; p < 0.05). Anxiety or depression symptoms were reported by 23% of the overall cohort and 32% of those with severity scale 5-6 (OR for comparison with severity scale 3, 1.77; 95% CI, 1.05-2.97; p < 0.05). Women more commonly reported depression than men (OR, 1.80; 95% CI, 1.39-2.34; p < 0.0001). Patients with severe disease were more likely to have reduced diffusing capacity on PFTs (OR, 4.60; 95% CI, 1.85-11.48; p < 0.05) and exhibited larger volumes of lung lesions on CT.
Conclusions:
Residual symptoms such as fatigue, muscle weakness, sleep problems, anxiety, and depression are common in the months after hospitalization for COVID-19 patients. Patients with more severe disease have more residual symptoms and are more likely to have abnormal findings on follow-up PFTs and chest CT.
Perspective:
This cohort study demonstrates a large burden of residual symptomatology following COVID hospitalization. Many of the symptoms reported are nonspecific, potentially making follow-up care more challenging for clinicians. Mental health services and physical rehabilitation programs may be strained in areas with high COVID burden, and studies with long-term follow-up will be needed to determine how resources can be used most effectively. Limitations of this study include selection bias, favoring patients with less severe disease.
Clinical Topics: COVID-19 Hub, Noninvasive Imaging, Prevention, Computed Tomography, Nuclear Imaging, Hypertension
Keywords: Anxiety, Chest Pain, Coronavirus, COVID-19, Depression, Diabetes Mellitus, Exercise Tolerance, Fatigue, Hypertension, Mobility Limitation, Muscle Weakness, Patient Discharge, Patient Readmission, Physical Examination, Primary Prevention, Quality of Life, Respiration, Artificial, Respiratory Function Tests, Sleep Wake Disorders, Tomography, X-Ray Computed
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