What are the 2-year health outcomes for patients hospitalized with COVID-19 in China?

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 in the world. The emergence of SARS-CoV-2 variants due to genomic mutations prolonged the pandemic. Some variants of SARS-CoV-2, such as Omicron and Delta, are more transmissible and virulent than the ancestral strain.

Study: Two-year health outcomes among hospitalized COVID-19 survivors in China. Image Credit: Hananeko_Studio/Shutterstock

Background

Even though most COVID-19 patients recover from an acute infection, some suffer from prolonged health problems associated with cognitive, physical and psychological problems, significantly affecting their quality of life. Therefore, it is important to carry out regular follow-ups of COVID-19 patients discharged from hospitals. These studies will help understand the trajectory of symptom burden as well as the long-term health outcomes associated with SARS-CoV-2 infection.

Previous research found that COVID-19 patients who required intensive care unit (ICU) treatment continued to experience physical, mental, or cognitive symptoms even after a year after discharge from hospital. It is imperative to understand how long COVID-19 symptoms last.

A recent Open JAMA Network The study assessed the dynamic trajectory of COVID-19 symptom burden as well as symptom persistence in those who survived SARS-CoV-2 infection for two years after discharge from hospital.

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 years of discharge from hospital. 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 as well as a chronic obstructive pulmonary disease (COPD) assessment test (CAT). Participants’ symptoms were recorded as no problems, mild problems, moderate problems, or severe problems. Patients with at least one persistent symptom of COVID-19 represented long COVID.

Study results

A total of 370 patients, or 19.8% of the study cohort, had symptoms of COVID-19 two years after discharge from hospital. 12.0% of the study cohort reported persistent symptoms, while 7.8% of patients experienced new or worsening symptoms from a reported level of mild symptoms in the first year of follow-up.

Some common symptoms experienced by participants were chest tightness, fatigue, dyspnea, myalgia, and anxiety. The majority of symptoms disappeared over time. Although the dyspnea persisted longer, it subsided after one year. The finding of this study was consistent with previous studies that found a trend of decreasing symptoms over time.

In this study, a higher risk of symptom persistence was related to ICU admission. Moreover, COVID-19 infection in patients with cerebrovascular diseases was associated with the manifestation of the onset of new symptoms. 6.2% of participants had CAT scores of at least 10. The current study observed a higher risk of symptom persistence in recovered COVID-19 patients who required intensive care during their stay at hospital or who suffered from chronic liver disease.

Chronic liver disease has been identified as an important factor associated with the risk of symptom persistence. Additionally, a CAT score of 10 and above also indicated a higher possibility of experiencing prolonged symptoms of COVID-19.

Study limitations

The authors pointed out several limitations, including the lack of an age- and comorbidity-matched control group. Due to this limitation, the long-term symptoms of patients with acute illness could not be determined. Another shortcoming of the current study was the loss of participants, especially older patients, during follow-up. Age distribution is an important aspect as it is considered an effect modifier of post-COVID-19 symptoms.

The current study also used a self-report symptom questionnaire instead of diagnostic tools, which increases the risk of bias due to participant subjectivity. The number of symptoms considered in this study was low, considering that over a hundred symptoms related to COVID-19 were reported. The emergence of SARS-CoV-2 variants has been rampant, which may have altered virulence and long-term sequelae compared to the data analyzed in the present study.

conclusion

The current longitudinal cohort study, which included COVID-19 survivors after two years of discharge from hospitals, found that common symptoms that persisted for an extended period were fatigue, anxiety, chest tightness, dyspnea and myalgia. Although most of these symptoms resolved, the dyspnea persisted at a reduced level over time. Patients with severe COVID-19 infection who needed to be admitted to intensive care had a higher risk of symptoms persisting. This study provided insights into the dynamic trajectory of health outcomes of COVID-19 survivors.

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