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

Original: Lancet January 08, 2021

Author(s): Huang C, Huang L, Wang Y et al

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

Reviewer: Stylianos Loukides, e-Learning Director

Published: 10 Jan, 2021

COVID -19 pandemic resulted in more than 89 million cases and 1.9 million deaths. The long term consequences of SARS-2-COV infection remain unclear and are not solely focusing on the respiratory system.

In this observational study the authors wanted to determine the long-term consequences of patients infected with COVID-19 and discharged from hospital. Furthermore, to investigate any possible risk factors that may affect the above consequences in terms of disease severity.

Subjects were recruited from from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020. Main exclusion criteria were death before follow-up, difficulties in follow up due to mental disorders, readmissions to hospital, immobility and diseases like stroke or/and pulmonary embolism. Data was retrieved from medical records. This data was mainly related to demographic characteristics, remarkable co-morbidities, blood tests, imaging, and treatment interventions. The disease severity was characterised by the highest seven-category scale during the hospital stay as following:

  1. not admitted to hospital with resumption of normal activities
  2. not admitted to hospital, but unable to resume normal activities
  3. admitted to hospital but not requiring supplemental oxygen
  4. admitted to hospital but requiring supplemental oxygen
  5. admitted to hospital requiring high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIV), or both
  6. admitted to hospital requiring extracorporeal membrane oxygenation, invasive mechanical ventilation (IMV), or both
  7. death

During follow up a detailed symptom score was assessed. Quality of life based questionnaire was performed. Exercise capcity was assessed by 6 minutes walking distance. Blood tests were also performed. In a subgroup of patients who were categorized as 3-6 severity scale PFTs and HRCT were performed.

A high heterogeneity was observed during follow up. 2469 patients with COVID-19 were discharged from Jin Yin-tan Hospital between Jan 7, and May 29, 2020. Interestingly, 33 of them died during follow up due to deterioration of their chronic underlying disease. 25 patients were readmitted to hospital for underlying disease complications with one of them admitted for respiratory failure caused by underlying pulmonary fibrosis. Three patients developed ischaemic strokes, and one patient had an acute pulmonary embolism due to deep venous thrombosis of lower limbs after discharge. The remaining 1733 participants underwent a detailed assessment as previously described. 390 patients underwent PFTs, HRCT and ultrasonography of lower limb veins and abdomen.

Fatigue or muscle weakness were the predominant remaining symptoms. Approximately 25% reported anxiety or/and depression. Sleep disturbances were commonly reported. A diminished exercise capacity was reported which was further amplified in severity scale 5-6. A low DLCO and abnormal findings in HRCT were also reported in the highest severity scales. Neutralising antibodies were significantly lower compared with at the acute phase. Some patients experienced renal function impairment.

Comment:

  • These preliminary findings raised some important points. COVID -19 consequences are multidimensional. They are driven by symptoms and impaired quality of life. Considering that patients with mental illness were excluded we can imagine the further difficulties in this specific group of patients. Patients with moderate to severe respiratory disease has both lung function impairment and imaging abnormalities. The latest is somehow crucial since it is still questionable whether these changes are permanent or are resolved in a secondary time-dependent manner.
  • The above findings actually increase the value of the vaccinations as a preventive tool not only for infection but also for future consequences.