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Persistent Symptoms in Patients after Acute COVID-19

Our take —

Anecdotal evidence has long suggested that many people suffer persistent symptoms following COVID-19 recovery. In this account of follow-up among 143 patients previously hospitalized with COVID-19, most (77%) were still experiencing at least one symptom and 44% self-reported worsened quality of life in the months following initial infection, but the degree to which these are related to initial disease severity or pre-existing comorbidities remains unclear. Additional research in this area is important to better understand the mid- and long-term complications of COVID-19 and to inform future healthcare strategies.

Study design

Other

Study population and setting

This study characterized persistent symptoms and quality of life among 143 patients discharged from a hospital after recovery from COVID-19 in Rome, Italy and followed-up between April 21 and May 29, 2020. Eligibility criteria for the study included no fever for 3 consecutive days, improvement in other symptoms, and 2 negative test results for SARS-CoV-2. Patients received a comprehensive medical exam, and clinical data, including clinical history, pharmacological history, lifestyle factors, vaccination status, and body measurements, were collected using a standardized questionnaire. Patients reported pre-COVID and post-COVID quality of life using the EuroQol visual analog scale (0=worst, 100=best), and a difference of 10 points was considered as worsened quality of life.

Summary of Main Findings

Among 179 potentially eligible participants, 14 patients refused to participate and 22 were ineligible due to a positive SARS-CoV-2 test, leaving a study population that included 143 patients (mean age: 56.5 years, 37% female) who had previously been hospitalized for COVID-19. 73% of patients were diagnosed with pneumonia during hospitalization, 53% received oxygen therapy, 15% received non-invasive mechanical ventilation, and 5% received mechanical ventilation. Follow-up assessments occurred a mean of 60 days (SD=14) after initial symptom onset, and 36 days (SD=13) after discharge. At the time of assessment, only 12.6% of participants were symptom-free; more than half of patients (55%) reported 3 or more symptoms and 44% reported worsened quality of life. The most frequent persistent symptoms were fatigue, dyspnea, joint pain, and chest pain.

Study Strengths

This cohort study includes detailed medical assessment of persistent symptoms following hospitalization with COVID-19.

Limitations

This was a single-center study with a relatively small sample size, and was limited to COVID-19 patients who were hospitalized upon initial infection; the results may not be generalizable, therefore, to patients with mild disease or who did not require hospitalization. Patient follow-up was limited (mean time between hospital discharge and assessment was 36 days), so longer-term sequelae were not assessed. Quality of life was self-reported and collected retrospectively (participants reported both current and pre-COVID quality of life at the time of their visit). Recall bias (reporting of pre-COVID quality of life is dependent on current symptoms/quality of life) and poor recall (inability to accurately recall previous quality of life) are both likely. It is unknown whether patients experienced any of the symptoms (due to comorbidity or previous illness) prior to their initial infection with COVID-19. Additionally, worsened quality of life was dichotomized, which results in information loss. The analyses were descriptive, and it is unclear whether there is an association between severity of initial illness or among hospitalized patients (i.e. oxygen therapy, ventilation), duration of hospitalization, or pharmacological treatments and symptom persistence.

Value added

This is the one of the first studies to date to characterize symptom persistence among patients who recovered after hospitalization with COVID-19.

This review was posted on: 15 July 2020