Patient outcomes after hospitalisation with COVID-19 and implications for follow-up; results from a prospective UK cohort

Abstract

Background: COVID19 causes a wide spectrum of disease. However, the incidence and severity of sequelae after the acute infection is uncertain. Data measuring the longer-term impact of COVID19 on symptoms, radiology and pulmonary function are urgently needed to inform patients and plan follow up services. Methods: Consecutive patients hospitalised with COVID19 were prospectively recruited to an observational cohort with outcomes recorded at 28 days. All were invited to a systematic follow up at 12 weeks, including chest radiograph, spirometry, exercise test, blood tests, and health-related quality of life (HRQoL) questionnaires. Findings: Between 30th March and 3rd June 2020, 163 patients with COVID19 were recruited. Median hospital length of stay was 5 days (IQR 2 to 8) and 30 patients required ITU or NIV, 19 patients died. At 12 weeks post admission, 134 were available for follow up and 110 attended. Most (74%) had persistent symptoms (notably breathlessness and excessive fatigue) with reduced HRQoL. Only patients with disease sufficiently severe to warrant oxygen therapy in hospital had abnormal radiology, clinical examination or spirometry at follow up. Thirteen (12%) patients had an abnormal chest X-ray with improvement in all but 2 from admission. Eleven (10%) had restrictive spirometry. Blood test abnormalities had returned to baseline in the majority (104/110). Interpretation: Patients with COVID19 remain highly symptomatic at 12 weeks, however, clinical abnormalities requiring action are infrequent, especially in those without a supplementary oxygen requirement during their acute illness. This has significant implications for physicians assessing patients with persistent symptoms, suggesting that a more holistic approach focussing on rehabilitation and general wellbeing is paramount. Funding: Southmead Hospital Charity

Long-term COVID-19 symptoms in a large unselected population

“…To date, there has been little research looking for factors that predispose to long-term COVID-19 symptoms. Our finding that the initial severity of the illness is correlated with long-term outcomes is in line with the higher rates of long-term symptoms found in previous studies of hospitalized patients and a previous observation that more severely ill hospitalized patients have more long-term symptoms 6,7 . Our study was underpowered to identify other factors predisposing to long-term symptoms, though we do identify a significant association between the initial symptom of dyspnea and symptoms lasting longer than 30 days.…”

“…Previous studies of long-term symptoms from COVID-19 have typically focused on distinct subsets of COVID-19 patients and in particular have not included mild cases or population controls 6,12,13 . Previous studies of hospitalized COVID-19 patients found that 74-88% of COVID-19 patients who have severe initial illness still have symptoms after 50-80 days 6,7 . Another patient-led study found that >80% of those who self-recruit into a COVID-19 study on long-term symptoms still have symptoms after 50 days 12 .…”

Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact

“…As prevention efforts have focused on minimizing mortality, the morbidity of COVID-19 illness has been underappreciated. Recent studies show that a growing number of patients with COVID-19 will experience prolonged symptoms, the profile and timeline of which remains uncertain [2][3][4][5][6]. Early in the course of the pandemic, patients identified this trend, referring to themselves as "Long-Haulers" and the prolonged illness as "Long COVID" [7].…”

COVID-19 and cardiac considerations in the community

“…6 Nor is it apparent to what extent cardiorespiratory pathophysiology explains the persistent fatigue, dyspnoea, or chest pain in up to 74% of patients 2-3 months postadmission. 1,10 Large population based multiorgan studies are underway to address these questions. Perhaps we should be reassured that most of the patients in the CMR studies had normal ventricular function, N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and cardiac troponin levels at the time of the scan.…”