Two-Year Health Outcomes in Hospitalized COVID-19 Survivors in China

Abstract

IMPORTANCERelatively little is known about the persistence of symptoms in patients with COVID-19 for more than 1 year after their acute illness. OBJECTIVE To assess the health outcomes among hospitalized COVID-19 survivors over 2 years and to identify factors associated with increased risk of persistent symptoms. DESIGN, SETTING, AND PARTICIPANTS This was a longitudinal cohort study of patients who survived COVID-19 at 2 COVID-19-designated hospitals in Wuhan, China, from February 12 to April 10, 2020. All patients were interviewed via telephone at 1 year and 2 years after discharge. The 2-year follow-up study was conducted from March 1 to April 6, 2022. Statistical analysis was conducted from April 20 to May 5, 2022. The severity of disease was defined by World Health Organization guideline for COVID-19. EXPOSURES COVID-19. MAIN OUTCOMES AND MEASURESThe main outcome was symptom changes over 2 years after hospital discharge. All patients completed a symptom questionnaire for evaluation of symptoms, along with a chronic obstructive pulmonary disease assessment test (CAT) at 1-year and 2-year followup visits. RESULTSOf 3988 COVID-19 survivors, a total of 1864 patients (median [IQR] age, 58.5 [49.0-68.0] years; 926 male patients [49.7%]) were available for both 1-year and 2-year follow-up visits. The median (IQR) time from discharge to follow-up at 2 years was 730 (719-743) days. At 2 years after hospital discharge, 370 patients (19.8%) still had symptoms, including 224 (12.0%) with persisting symptoms and 146 (7.8%) with new-onset or worsening of symptoms. The most common symptoms were fatigue, chest tightness, anxiety, dyspnea, and myalgia. Most symptoms resolved over time, but the incidence of dyspnea showed no significant change (1-year vs 2-year, 2.6% [49 patients] vs 2.0% [37 patients]). A total of 116 patients (6.2%) had CAT total scores of at least 10 at 2 years after discharge. Patients who had been admitted to the intensive care unit had higher risks of persistent symptoms (odds ratio, 2.69; 95% CI, 1.02-7.06; P = .04) and CAT scores of 10 or higher (odds ratio, 2.83; 95% CI, 1.21-6.66; P = .02). CONCLUSIONS AND RELEVANCEIn this cohort study, 2 years after hospital discharge, COVID-19 survivors had a progressive decrease in their symptom burden, but those with severe disease during hospitalization, especially those who required intensive care unit admission, had higher risks of persistent symptoms. These results are related to the original strain of the virus, and their relevance to infections with the Omicron variant is not known.

A systematic review and meta‐analysis of long‐term sequelae of COVID‐19 2‐year after SARS‐CoV‐2 infection: A call to action for neurological, physical, and psychological sciences

“…First domain (i.e., pre-COVID factors) describes risk factor present before SARS-CoV-2 infection and includes older age, female gender, higher BMI, and preexisting comorbidities (such as hypertension, diabetes, asthma, COPD, cardiac disease, chronic liver disease). 3,18,19,24,25 A conflicting report by Van Wambeke et al 26 showed that comorbidities did not correlate with long COVID, but rather with greater return to work. The second domain (i.e., COVID-related factors) describes risk factors present during acute infection with COVID-19 and includes severe infection, 3 and increased symptom burden.…”

“…These predictive factors are described in two domains. First domain (i.e., pre‐COVID factors) describes risk factor present before SARS‐CoV‐2 infection and includes older age, female gender, higher BMI, and pre‐existing comorbidities (such as hypertension, diabetes, asthma, COPD, cardiac disease, chronic liver disease) 3,18,19,24,25 . A conflicting report by Van Wambeke et al 26 showed that comorbidities did not correlate with long COVID, but rather with greater return to work.…”

Symptom Burden among Older COVID-19 Survivors Two Years after Hospital Discharge

“…The prevalence of anxiety in the severe group was significantly higher than that in the nonsevere group (severe vs. nonsevere: 10.2% vs. 5.9%; OR, 1.79; 95% CI: 1.17-2.76; P = 0.01). A total of 890 COVID-19 survivors aged 60 years and above participated in both one-year and two-year follow-up visits on symptom dynamics in a recent study [8]. Among these survivors, a prominent decreasing trend was found in most symptoms.…”

“…At the two-year follow-up, the median (IQR) score of CIS-fatigue was 8 (8-14) and 89 patients (7.7%) had scores of 27 or higher. Patients with severe disease had a nonsignificantly higher median (IQR) CIS-fatigue score (severe vs. nonsevere: 8 [8][9][10][11][12][13][14][15] vs. 8 [8][9][10][11][12][13]) and a higher proportion of patients with the CIS-fatigue score of at least 27 (severe vs. nonsevere: 9.8% [39 patients] vs. 6.6% [50 patients]) (Fig. 3A).…”

“…3B and Supplementary Table 3). Patients who received oxygen therapy had a markedly higher median (IQR) CIS-fatigue score (Yes vs. No: 8 [8][9][10][11][12][13][14] vs. 8 [8-11.3], P = 0.03) as well as a higher proportion of patients with a CIS-fatigue score of at least 27 (Yes vs. No: 8.8% [80 patients] vs. 3.6% [9 patients], P = 0.006) (Fig. 3C).…”