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‘Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19

Our take —

Anecdotal evidence on “Long COVID” suggests it is a pervasive problem, but its prevalence, etiology, and clinical extent have not been well researched. This study examined follow-up data an average of 54 days after hospital discharge among 384 COVID-19 patients. More than half of patients reported persistent fatigue and breathlessness, and about one-third reported persistent cough. Additionally, some participants still had abnormal laboratory values and chest x-ray results. These results highlight a number of persistent symptoms, but should be considered as preliminary and descriptive, given that pre-COVID data were not available and participants may not be representative of all those infected with SARS-CoV-2.

Study design

Retrospective Cohort

Study population and setting

This brief report detailed follow-up data collected on 384 patients (mean age: 60 years, 62% male, 43% from Black, Asian, or other minority ethnic background) with prior COVID-19 (diagnosed by nasopharyngeal swab). The population included patients who were discharged from one of three London hospitals between April and June 2020. Most data were collected four to six weeks after discharge by phone, including self-reported physical and psychological symptom burden and trajectory, but patients who had abnormal blood tests or chest x-ray findings at discharge were invited to return in person for re-evaluation.

Summary of Main Findings

Of the 384 participants included, median length of hospital stay was 6.5 days, 14.5% required ICU care, and 7.1% were intubated. At follow-up (median 54 days after discharge), 53% of participants reported persistent breathlessness, 34% reported persistent cough, 69% reported persistent fatigue, but the intensity for each of these symptoms were reported as improving in 81%, 75%, and 80% of participants, respectively. All laboratory values improved over time, though 7% (of n=247) had lymphopenia, 30% (of n=229) still had elevated d-dimer levels, and 10% (of n=190) had elevated C-reactive protein. Of 244 patients with follow-up chest x-rays, 9% showed significant deterioration.

Study Strengths

The study collected a number of clinical parameters during and following COVID-19 hospitalization.

Limitations

Only 80% of eligible participants were included in the study, and sub-analyses were restricted to smaller and variably sized populations; it is unclear how results might be different if the full eligible population were included. The study population included only patients who were hospitalized, though few had a prolonged stay in the ICU, so the results may not be generalizable to mild cases (not requiring hospitalization) or severe cases. All symptom trajectories were self-reported, which may lead to either an over- or underestimation of symptom resolution. Follow-up data were compared to admission and pre-discharge data, not pre-COVID data, so it is unclear whether COVID-19 is responsible for the persistently elevated laboratory parameters in some patients.

Value added

This is the first published report of symptom burden, laboratory markers, and chest imaging in the weeks following hospitalization with COVID-19.

This review was posted on: 20 November 2020