Clinical outcomes of COVID-19 in patients 6-months after hospital discharge in Wuhan, China

1. Fatigue or muscle weakness, sleep difficulties, and anxiety or depression were the most common symptoms among recovered patients 6 months after discharge.

2. Patients with severe COVID-19 had worsened pulmonary diffusion capacities and abnormal chest imaging manifestations at 6 months after discharge.

Evidence Rating Level: 2 (Good) 

Study Rundown: Extensive research has been done to understand the short-term effects of COVID-19; however, long-term consequences of the illness remain elusive. Documentation of the lung function, along with physical and psychological complications of discharged patients is needed. This cohort study aimed to describe the long-term health consequences of patients hospitalized with COVID-19 and identify the associated risk factors, including disease severity. Patients were interviewed for evaluation of symptoms and health-related quality of life, received blood tests, underwent physical examinations and a 6-minute walking test. Additionally, disease severity during hospital stay was determined using a seven-category scale and patients with the highest scores (scale 3-6) received a pulmonary function test, high resolution chest CT, and ultrasonography. According to study results, fatigue or muscle weakness and sleep difficulties were the most common symptoms among patients at 6 months after discharge. Additionally, patients who were more severely ill during their hospital stay had more severely impaired pulmonary diffusion capacities and abnormal chest imaging manifestations. This study was limited by the lack of heterogeneity in sampling as only a single medical center in Wuhan was assessed. Perhaps, inclusion of data from surrounding hospitals could have helped to validate the study findings. Nevertheless, this is the largest cohort study with the longest follow-up duration assessing the long-term health consequences of patients who were previously admitted for COVID-19.

Click to read the study in The Lancet

Relevant Reading: Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

In-depth [prospective cohort]: Between Jan 7 and May 29, 2020, 2469 patients with COVID-19 were discharged from Jin Yin-tan Hospital in Wuhan, China. Of these, 1733 were enrolled at the 6-month follow-up, conducted between Jun 16 and Sept 3, 2020, and included in the analysis. Included patients were those with laboratory confirmed COVID-19 who were discharged from hospital during the study period. Patients who died before the follow-up visit or for whom follow-up could not be conducted were excluded. Among 1733 enrolled patients, the median age was 57.0 (interquartile range [IQR] 47.0-65.0) years and majority (n=897, 52%) were male.

The most common comorbidity, at baseline, was hypertension (n=505, 29%), followed by diabetes (n=207, 12%), and cardiovascular disease (n=128, 7%). In addition, 68% (1172 of 1733) required oxygen therapy during their hospital stay. At the 6-month follow-up, 76% of patients reported ³ 1 symptom and the risk of symptom presentation was higher among participants with scale 5-6 than those with scale 3 (odds ratio [OR] 2.42, 95% confidence interval [CI] 1.15-5.08). The most common symptoms after discharge were fatigue or muscle weakness (63%, 1038 of 1655), sleep difficulties (26%, 437 of 1655), and anxiety or depression (23%, 367 of 1617). The proportions of median 6-min walking distance less than the lower limit of normal were 29% for severity scale 5-6, 22% for scale 4, and 24% for scale 3. Corresponding proportions of patients with diffusion impairment were 56%, 29%, and 22%, respectively. Median CT scores were 5.0 (IQR 4.0-6.0) for severity scale 5-6, 4.0 (IQR 3.0-5.0) for scale 4, and 3.0 (IQR 2.0-5.0) for scale 3. Of 1016 patients with non-acute kidney injury and normal eGFR at baseline, 822 had eGFR available at follow up and 107 (13%) had decreased eGFR. Furthermore, seropositivity (96.2% vs 58.5%) and median titres (19.0 vs 10.0) of neutralizing antibodies were significantly lower at follow-up than at the acute phase. Findings from this study suggest that at 6 months after acute infection, COVID-19 survivors were mainly affected with fatigue or muscle weakness and sleep difficulties, and those who were severely ill during hospitalization had more severe long-term complications.

Image: PD

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