The health status and physical capacity of COVID-19 survivors one year after hospital discharge

A variety of asymptomatic, mild and severe clinical signs have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. SARS-CoV-2 is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic.

background

Prognosis of acute illness has been linked to the need for care in the intensive care unit (ICU), length of stay in hospital (LOS), severe respiratory distress, prior comorbidities, and markers of inflammation. In addition, transcriptomic studies have shown that a small set of regulatory genes could be strong predictors of clinical outcomes in COVID-19 patients. Genome research has shed light on why a certain person might be affected by the effects of COVID-19 and others not.

Several definitions have been proposed for Long-COVID. Overall, a long COVID involves a wide range of ongoing or emerging symptoms within a month of SARS-CoV-2 infection. However, the duration of Long-COVID and its health effects are still unclear.

Although some studies have determined the 12-month consequences of COVID-19, they were based on phone interviews. Therefore, there are hardly any evidence-based studies to determine the extent of the consequences after infection. A recently Plus one The study evaluated the health status and physical capacity of COVID-19 recovered patients one year after hospital discharge.

About the study

This multi-center prospective cohort study included 1,904 SARS-CoV-2 infected patients from three acute care hospitals in Barcelona, ​​Spain. Among these, fifty patients were randomly selected from each center, including 58% males and 42% females.

All selected participants were adults with PCR-confirmed SARS-CoV-2 infection, required hospitalization, and had COVID-19 pneumonia between February 28 and April 15, 2020. The epidemiological and demographic details of the study cohort were obtained along with their economic status, ICU admission details, comorbidities, radiological findings, and laboratory test reports.

At the one-year follow-up, between February 2021 and May 2021, a comprehensive medical evaluation focusing on ongoing symptoms and a full physical examination were performed. During physical examination, all participants who could walk unaided completed a 6-minute walk test (6MWD). In this test, mean peripheral oxygen saturation (SpO2) was recorded before and after the 6MWD. The degree of dyspnea was measured after completion of the 6MWT, based on the Borg rating scale of perceived exertion.

study results

Of the randomly selected patients, 50% were retired and 70% never smoked. The median LOS was nine days and 7% of patients required mechanical ventilation. The peripheral oxygen saturation (SpO2) of the cohort at baseline was ≤ 94%. During the acute phase of the disease, about 23% of patients experienced acute respiratory distress syndrome.

Follow-up revealed that approximately 80% of patients complained of at least one persistent symptom, most commonly dyspnea, followed by arthromyalgia, paraesthesia, subjective memory loss, and asthenia. The results of this study were consistent with previous studies that reported persistent dyspnea after a year of recovery from severe COVID-19 that required hospitalization. Despite a higher percentage of persistent dyspnea, no significant abnormalities were found on chest radiographs.

Due to the presence of interstitial infiltrates, 14% of patients had abnormal radiographs. It was observed that only 7% of the study cohort required hospital admission during the follow-up period.

Multivariate regression analyzes showed that female gender, chronic obstructive pulmonary disease (COPD), and smoking were independent risk factors for persistent dyspnea. Previous studies showed that women were more vulnerable to long COVID. This could be due to hormones that could affect the hyperinflammatory status of the acute phase even after recovery.

Approximately 50% of patients failed to reach the theoretical reference values ​​for the 6MWT test. Only 5% of patients had a desaturation after completing 6 MWT. The reason for the loss of physical capacity in COVID-19 recovered patients could be pulmonary diffusive disorders and extrapulmonary causes such as cytokine disorders, virus-induced myositis, muscle wasting, corticosteroid-induced myopathy and deconditioning.

Conclusions

The main strength of this study was its large multicenter cohort of severely infected COVID-19 patients who were alive at least one year after hospital discharge. However, due to the lack of data on the patients’ baseline situation before hospital admission, the authors could not determine whether some of the symptoms were already prevalent before the COVID-19 infection.

In addition, only a small number of patients were followed up and no control group was evaluated. Another limitation of this study was that the patients included in the cohort became infected during the first wave of COVID-19. Therefore, the results may not accurately reflect the current situation with vaccine prevalence and incidence of SARS-CoV-2 variants.

Taken together, a large number of COVID-19 recoveries from the first wave of the pandemic showed persistent symptoms and poor physical functioning even a year after hospital discharge.