Four-Month Clinical Status of a Cohort of Patients After Hospitalization for COVID-19

Abstract

The Writing Committee for the COMEBAC Study Group IMPORTANCE Little is known about long-term sequelae of COVID-19.OBJECTIVE To describe the consequences at 4 months in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTSIn a prospective uncontrolled cohort study, survivors of COVID-19 who had been hospitalized in a university hospital in France between March 1 and May 29, 2020, underwent a telephone assessment 4 months after discharge, between July 15 and September 18, 2020. Patients with relevant symptoms and all patients hospitalized in an intensive care unit (ICU) were invited for further assessment at an ambulatory care visit. EXPOSURES Survival of hospitalization for COVID-19.MAIN OUTCOMES AND MEASURES Respiratory, cognitive, and functional symptoms were assessed by telephone with the Q3PC cognitive screening questionnaire and a checklist of symptoms. At the ambulatory care visit, patients underwent pulmonary function tests, lung computed tomographic scan, psychometric and cognitive tests (including the 36-Item Short-Form Health Survey and 20-item Multidimensional Fatigue Inventory), and, for patients who had been hospitalized in the ICU or reported ongoing symptoms, echocardiography. RESULTS Among 834 eligible patients, 478 were evaluated by telephone (mean age, 61 years [SD, 16 years]; 201 men, 277 women). During the telephone interview, 244 patients (51%) declared at least 1 symptom that did not exist before COVID-19: fatigue in 31%, cognitive symptoms in 21%, and new-onset dyspnea in 16%. There was further evaluation in 177 patients (37%), including 97 of 142 former ICU patients. The median 20-item Multidimensional Fatigue Inventory score (n = 130) was 4.5 (interquartile range, 3.0-5.0) for reduced motivation and 3.7 (interquartile range, 3.0-4.5) for mental fatigue (possible range, 1 [best] to 5 [worst]). The median 36-Item Short-Form Health Survey score (n = 145) was 25 (interquartile range, 25.0-75.0) for the subscale "role limited owing to physical problems" (possible range, 0 [best] to 100 [worst]). Computed tomographic lung-scan abnormalities were found in 108 of 171 patients (63%), mainly subtle ground-glass opacities. Fibrotic lesions were observed in 33 of 171 patients (19%), involving less than 25% of parenchyma in all but 1 patient. Fibrotic lesions were observed in 19 of 49 survivors (39%) with acute respiratory distress syndrome. Among 94 former ICU patients, anxiety, depression, and posttraumatic symptoms were observed in 23%, 18%, and 7%, respectively. The left ventricular ejection fraction was less than 50% in 8 of 83 ICU patients (10%). New-onset chronic kidney disease was observed in 2 ICU patients. Serology was positive in 172 of 177 outpatients (97%).CONCLUSIONS AND RELEVANCE Four months after hospitalization for COVID-19, a cohort of patients frequently reported symptoms not previously present, and lung-scan abnormalities were common among those who were tested. These findings are limited by the absence of a control group and of pre-COVID assessments in this cohort. ...

Multidisciplinary approach for post-acute COVID-19 syndrome: time to break down the walls

“…However, the exploration of patients with post-acute COVID-19 syndrome requires a multidisciplinary approach, as complications far exceed the problem of dyspnoea, and it appears that pulmonary and systemic complications can be intimately entangled. Among the many complications are general signs (asthenia, diffuse pain), psychiatric symptoms (post-traumatic stress syndrome, depression, anxiety, insomnia), neurological symptoms (cognitive impairment, dysautonomia), and specific organ lesions affecting cardiovascular, renal, endocrine, ear-nose-throat, gastrointestinal or dermatological systems (Table 1) [9][10][11][12][13][14][15][16]. Most patients with post-acute COVID-19 syndrome experience multiple and overlapping symptoms, in addition to a significant impact on their quality of life [10,[12][13][14][15].…”

“…Among the many complications are general signs (asthenia, diffuse pain), psychiatric symptoms (post-traumatic stress syndrome, depression, anxiety, insomnia), neurological symptoms (cognitive impairment, dysautonomia), and specific organ lesions affecting cardiovascular, renal, endocrine, ear-nose-throat, gastrointestinal or dermatological systems (Table 1) [9][10][11][12][13][14][15][16]. Most patients with post-acute COVID-19 syndrome experience multiple and overlapping symptoms, in addition to a significant impact on their quality of life [10,[12][13][14][15]. Of note, such complications have been described in other post-acute settings and may not be specific to COVID-19 [17,18].…”

“…Given the diversity of symptoms, the management of these patients cannot be limited to a single specialized clinic and requires a multidisciplinary team approach. This is the experience we were able to carry out during the COMEBAC (Consultation MultiExpertise de Bicêtre Après COVID- 19) uncontrolled cohort study, which included 478 adult patients discharged from Bicêtre Hospital (Université Paris-Saclay) [15]. This study strongly supports our vision that screening via telehealth consult followed by a multidisciplinary assessment in outpatient clinics involving multiple specialists on the same day in a single location is likely the most effective way to manage the complexity of post-acute COVID-19 syndrome.…”

Post-acute COVID-19 Syndrome (PACS): A public health emergency

“…As an example of documenting the long-term consequences of COVID-19, a well-conducted study was published by the COMEBAC (COnsultation Multi-Expertise de Bicêtre Après COVID-19) Study Group [17] . This landmark study was carried out in a third-level hospital in the Paris area and included more than 450 patients.…”

Post-Intensive Care Syndrome Associated With Coronavirus Disease: A Single Institutional Study In Tokyo

“…Regarding intensive care unit (ICU)-treated patients, there is a need to evaluate the occurrence of post-intensive care syndrome (PICS) [7] because it has become recognized and is the next care target in the eld of critical care medicine [8-10].PICS is de ned as a new or worsening impairment in physical, mental, or cognitive health status that arises and persists after hospitalization for critical illness [7]. Although there have been recent reports regarding long-term consequences, including fatigue, insomnia, and anxiety or depression, among COVID-19 survivors at or 6 months after acute infection, information regarding critically ill patients remains missing [2,5, 6]. Small-scale studies investigating ICU treated patients with COVID-19 have suggested that respiratory, mobility, and cognitive consequences are common at approximately a month after hospital discharge [3, 6].…”