6-month consequences of COVID-19 in patients discharged from hospital: a cohort study

Background The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity. Methods We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7 and May 29, 2020. Patients who died before follow-up; patients for whom follow-up would be difficult because of psychotic disorders, dementia, or readmission to hospital; those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism; those who declined to participate; those who could not be contacted; and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5-6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received SARS-CoV-2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and longterm health consequences. Findings In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57 center dot 0 years (IQR 47 center dot 0-65 center dot 0) and 897 (52%) were male and 836 (48%) were female. The follow-up study was done from June 16 to Sept 3, 2020, and the median follow-up time after symptom onset was 186 center dot 0 days (175 center dot 0-199 center dot 0). Fatigue or muscle weakness (52%, 855 of 1654) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1616) of patients. The proportions of 6-min walking distance less than the lower limit of the normal range were 17% for those at severity scale 3, 13% for severity scale 4, and 28% for severity scale 5-6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5-6, and median CT scores were 3 center dot 0 (IQR 2 center dot 0-5 center dot 0) for severity scale 3, 4 center dot 0 (3 center dot 0-5 center dot 0) for scale 4, and 5 center dot 0 (4 center dot 0-6 center dot 0) for scale 5-6. After multivariable adjustment, patients showed an odds ratio (OR) of 1 center dot 61 (95% CI 0 center dot 80-3 center dot 25) for scale 4 versus scale 3 and 4 center dot 60 (1 center dot 85-11 center dot 48) for scale 5-6 versus scale 3 for diffusion impairment; OR 0 center dot 88 (0 center dot 66-1 center dot 17) for scale 4 versus scale 3 and OR 1 center dot 76 (1 center dot 05-2 center dot 96) for scale 5-6 versus scale 3 for anxiety or depression, and OR 0 center dot 87 (0 center dot 68-1 center dot 11) for scale 4 versus scale 3 and 2 center dot 75 (1 center dot 61-4 center dot 69) for scale 5-6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96 center dot 2% vs 58 center dot 5%) and median titres (19 center dot 0 vs 10 center dot 0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with an estimated glomerular filtration rate (eGFR) of 90 mL/min per 1 center dot 73 m(2) or more at acute phase had eGFR less than 90 mL/min per 1 center dot 73 m(2) at follow-up. Interpretation At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery. Copyright (c) 2023 Elsevier Ltd. All rights reserved.