The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by the rapid outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has claimed more than 6.52 million lives worldwide. The emergence of SARS-CoV-2 variants due to genomic mutations has prolonged the pandemic. Some SARS-CoV-2 variants, such as Omicron and Delta, are more transmissible and virulent than the ancestral strain.
Study: Two-year health outcomes in hospitalized survivors of COVID-19 in China. Image credit: Hananeko_Studio/Shutterstock
Background
Although most patients with COVID-19 recover from the acute infection, some experience prolonged health conditions associated with cognitive, physical and psychological issues, significantly affecting their quality of life. Therefore, conducting regular follow-ups of patients with COVID-19 discharged from hospitals is important. These studies will help to understand the trajectory of symptom burden as well as long-term health outcomes associated with SARS-CoV-2 infection.
Previous research found that patients with COVID-19 who required treatment in the intensive care unit (ICU) continued to experience physical, mental or cognitive symptoms a year after discharge. Understanding the ongoing duration of symptoms associated with COVID-19 is imperative.
One last one JAMA Network Open The study assessed the dynamic trajectory of the burden of COVID-19 symptoms as well as the persistence of symptoms in those who survived SARS-CoV-2 infection for two years after leaving hospitals.
About the study
In this longitudinal cohort study, scientists collected data on COVID-19 survivors who were discharged from Taikang Tongji and Huoshenshan hospitals. Both hospitals are located in Wuhan, China.
All participants were interviewed by telephone after the first and second year of hospital discharge. The second year follow-up study was conducted between March 1, 2022 and April 6, 2022.
In addition to the telephone interview, all participants also provided a self-reported symptom questionnaire along with a chronic obstructive pulmonary disease (COPD) assessment test (CAT). Participants’ symptoms were recorded as no problems, mild problems, moderate problems, or severe problems. Patients who had at least one persistent symptom of COVID-19 represented prolonged COVID-19.
Study findings
A total of 370 patients, ie 19.8% of the study group, were found to experience Symptoms of covid-19 two years after discharge from the hospital. 12.0% of the study group reported persistent symptoms, while 7.8% of patients experienced new symptoms or worsening from a reported level of mild symptoms at the first year follow-up.
Some common symptoms experienced by participants were chest tightness, fatigue, dyspnea, myalgia, and anxiety. Most symptoms disappeared over time. Although the dyspnea persisted for longer, it subsided after one year. This study’s finding was consistent with previous studies that found a downward trend in symptoms over time.
In this study, a higher risk of symptom persistence was associated with ICU admission. In addition, COVID-19 infection in patients with cerebrovascular disease was associated with the emergence of new symptoms. 6.2% of participants exhibited CAT scores of at least 10. The present study observed a higher risk of symptom persistence in recovered patients with COVID-19 who required ICU care during their hospital stay or had chronic liver disease.
Chronic liver disease was identified as an important factor associated with the risk of continued symptoms. Additionally, a CAT score of 10 and higher also indicated a higher likelihood of experiencing prolonged symptoms of COVID-19.
Limitations of the study
The authors noted several limitations, including the lack of an age- and comorbidity-matched control group. Because of this limitation, the long-term symptoms of the patients’ acute illness could not be determined. Another shortcoming of the present study was the loss of participants, especially elderly patients, to follow-up. Age distribution is an important aspect because it is considered a modifier of the effect of symptoms after COVID-19.
The current study also used a self-report symptom questionnaire rather than diagnostic tools, which increases the risk of bias due to participant subjectivity. The number of symptoms examined in this study was small, considering the fact that more than a hundred symptoms associated with COVID-19 have been reported. The emergence of SARS-CoV-2 variants has been endemic, which could have altered the virulence and long-term consequences compared to the data analyzed in the present study.
conclusions
The current longitudinal cohort study, which included COVID-19 survivors two years after discharge from hospitals, found common symptoms that persisted over an extended period were fatigue, anxiety, chest tightness, dyspnea and myalgia. Although most of these symptoms resolved, dyspnea persisted at a reduced level over time. Patients severely infected with COVID-19 who required ICU admission were at a higher risk of symptom persistence. This study provided insights into the dynamic trajectory of health outcomes of COVID-19 survivors.
