Risk factors for long-term consequences of COVID-19 in hospitalised adults in Moscow using the ISARIC Global follow-up protocol: StopCOVID cohort study

Abstract

Background The long-term sequalae of COVID-19 remain poorly characterised. In this study, we aimed to assess long-standing symptoms (LS) (symptoms lasting from the time of discharge) in previously hospitalised patients with COVID-19 and assess associated risk factors. Methods This is a longitudinal cohort study of adults (18 years of age and above) with clinically diagnosed or laboratory-confirmed COVID-19 admitted to Sechenov University Hospital Network in Moscow, Russia. Data were collected from patients discharged between April 8 and July 10, 2020. Participants were interviewed via telephone using Tier 1 ISARIC Long-term Follow-up Study CRF and the WHO CRF for Post COVID conditions. Reported symptoms were further categorised based on the system(s) involved. Additional information on dyspnoea, quality of life and fatigue was collected using validated instruments. Multivariable logistic regressions were performed to investigate risk factors for development of LS categories. Findings Overall, 2,649 of 4,755 patients discharged from the hospitals were available for the follow-up and included in the study. The median age of the patients was 56 years (IQR, 46-66) and 1,353 (51.1%) were women. The median follow-up time since hospital discharge was 217.5 (200.4-235.5) days. At the time of the follow-up interview 1247 (47.1%) participants reported LS. Fatigue (21.2%, 551/2599), shortness of breath (14.5%, 378/2614) and forgetfulness (9.1%, 237/2597) were the most common LS reported. Chronic fatigue (25%, 658/2593) and respiratory (17.2% 451/2616) were the most common LS categories. with reporting of multi-system involvement (MSI) less common (11.3%; 299). Female sex was associated with LS categories of chronic fatigue with an odds ratio of 1.67 (95% confidence interval 1.39 to 2.02), neurological (2.03, 1.60 to 2.58), mood and behaviour (1.83, 1.41 to 2.40), dermatological (3.26, 2.36 to 4.57), gastrointestinal (2.50, 1.64 to 3.89), sensory (1.73, 2.06 to 2.89) and respiratory (1.31, 1.06 to 1.62). Pre-existing asthma was associated with neurological (1.95, 1.25 to 2.98) and mood and behavioural changes (2.02, 1.24 to 3.18) and chronic pulmonary disease was associated with chronic fatigue (1.68, 1.21 to 2.32). Interpretation 6 to 8 months after acute infection episode almost a half of patients experience symptoms lasting since hospital discharge. One in ten individuals experiences MSI. Female sex is the main risk factor for majority of the LS categories. chronic pulmonary disease is associated with a higher risk of chronic fatigue development, and asthma with neurological and mood and behaviour changes. Individuals with LS and MSI should be the main target for future research and intervention strategies.

Persisting symptoms three to eight months after non-hospitalized COVID-19, a prospective cohort study

“…Our results are consistent with a recent report of non-hospitalized COVID-19 patients, where 55% had at least one persisting symptom at six months follow-up, and persisting symptom severity was dependent on disease severity [ 6 ]. Our main finding, that a significant proportion of COVID-19 patients do not recover completely after three to eight months is also consistent with unpublished surveys without control groups in non-hospitalized and hospitalized patients [ 5 , 16 , 17 ]. These surveys also describe a possible long-COVID syndrome that include cognitive symptoms not covered in our questionnaires, which may serve to explain why our COVID-19 patients reported a worsening of health while their burden of airway symptoms at follow-up was lower than the controls.…”

Self-reported Memory Problems 8 Months After COVID-19 Infection

“…PASC may be found to affect a high proportion of people who had mild cases of COVID-19, and there is an urgent need for a detailed description of PASC in nonhospitalized patients. 2 , 3 This cohort study examines self-reported memory problems 8 months after COVID-19 infection.…”

Recovery from Covid-19 critical illness: a secondary analysis of the ISARIC4C CCP-UK cohort study and the RECOVER trial

“…Many patients who survive acute-Covid-19 experience persistent symptoms beyond 4 weeks, known as 'long-Covid' 8 . This includes a wide range of symptoms, such as breathlessness, fatigue, muscle pain, many of which overlap with PICS and other post-viral syndromes 1,[9][10][11][12][13][14][15][16] . The most common symptom of long-Covid described following both community and hospital-managed acute-Covid-19 was fatigue: fatigue was reported in 97.7% of community-managed cases who reported symptoms lasting over 28 days, and in 83% and 98% of UK and China patients respectively greater than 3-months after hospital discharge following admission with acute-Covid-19 11,16,17 .…”