6-month consequences of COVID-19 in patients discharged from hospital: a cohort study

Background The long-term health consequences of COVID-19 remain largely unclear. We aimed to describe the long-term health consequences of patients with COVID-19 who had been discharged from hospital and investigate associated risk factors, particularly disease severity. Methods We conducted an ambidirectional cohort study of laboratory-confirmed COVID-19 patients discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7 and May 29, 2020. Exclusions included deaths before follow-up; difficulty with follow-up due to psychotic disorders, dementia, or readmission; immobility; refusal; inability to contact; and residence outside Wuhan or in nursing/welfare homes. Participants completed questionnaires (symptoms, mMRC dyspnoea, EQ-5D-5L, EQ-VAS), physical examination, 6-minute walk test, and blood tests. Stratified sampling by peak seven-category severity scale (3, 4, 5–6) selected subsets for pulmonary function testing, high-resolution chest CT, and ultrasonography. Participants in the LOTUS trial received SARS-CoV-2 antibody tests. Multivariable linear and logistic regressions assessed associations between disease severity and long-term consequences. Findings Of 2469 discharged patients, 1733 were enrolled (median age 57 years; 52% male). Follow-up occurred June 16–Sept 3, 2020; median 186 days after symptom onset. Fatigue or muscle weakness (52%) and sleep difficulties (26%) were most common; 23% reported anxiety or depression. Proportions with 6-minute walk distance below the lower limit of normal were 17% (severity 3), 13% (severity 4), and 28% (severity 5–6). Among 94 with antibody testing, neutralising antibody seropositivity (96.2% acute vs 58.5% follow-up) and median titres (19.0 vs 10.0) declined significantly. Of 822 without AKI and with normal eGFR at acute phase, 107 had eGFR <90 mL/min/1.73 m² at follow-up. Interpretation At 6 months after acute infection, COVID-19 survivors were mainly troubled by fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients more severely ill during hospitalisation had more impaired pulmonary diffusion capacities and abnormal chest imaging and are priority targets for interventions supporting long-term recovery. Declining neutralising antibodies raise concern for reinfection risk.

Chaolin Huang, Lixue Huang, Yeming Wang, Xia Li, Lili Ren, Xiaoying Gu, Liang Kang, Li Guo, Min Liu, Xing Zhou, Jianfeng Luo, Zhenghui Huang, Shengjin Tu, Yue Zhao, Li Chen, Decui Xu, Yanping Li, Caihong Li, Lu Peng, Yong Li, Wuxiang Xie, Dan Cui, Lianhan Shang, Guohui Fan, Jiuyang Xu, Geng Wang, Ying Wang, Jingchuan Zhong, Chen Wang, Jianwei Wang, Dingyu Zhang, Bin Cao