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12th October 2021
The presence of continued symptoms after resolution of an acute infection with COVID-19 has become recognised and termed “Long-COVID“. For example, in one study, symptoms including fatigue or muscle weakness and sleep difficulties were the most common symptoms 6 months after the initial infection. Moreover, one small study with 83 patients, found that even after 12 months, radiological lung changes persisted in a quarter of patients. However, to date, there are no specific tools for an assessment of the ongoing symptom burden of COVID-19 although some evidence suggests that the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) may be of value. The CAT has been shown to provide some insight into the severity of symptom burden for patients following a hospitalisation for COVID-19 and might be of use in the assessment of ongoing symptoms following COVID-19.
In an attempt to determine the outcomes and symptom burden of patients with Long-COVID, a team from the Department of Respiratory Medicine, Daping Hospital, Chongqing, China, invited all adult patients with COVID-19 discharged from two hospitals in Wuhan, between February and April 2020, to participate in the follow-up study. Enrolled participants were interviewed by telephone and asked a series of questions on persistent symptoms as well as the CAT questionnaire, for which a score of 10 or more indicates a medium disease impact. Clinical and demographic data on each of the patients was obtained from electronic hospital records.
A total of 2,433 patients with a median age of 60 years (49.5% male), of whom, 27.9% had severe COVID-19 infection, were included in the analysis. At the one-year follow-up, 1338 (55%) of patients were completely symptom-free, with the remaining 45%, reporting at least one symptom. In addition, a patients hospitalised with more severe disease were more likely to report persistent symptoms (odds ratio, OR = 1.31, 95% CI 1.04 – 1.65, p = 0.02). The most common one-year follow-up symptoms were fatigue (27.7%), sweating (16.9%) and chest tightness (13%). The presence of fatigue was also more likely in those with a higher initial disease severity (OR = 1.36, 95% CI 1.10 – 1.68).
Among the 2,433 participants, the median CAT score was 2 although 6.6% had a CAT score greater than 10. As with persistent symptoms, more patients with severe infection had a CAT score > 10 (11.6% vs 4.7%, p < 0.01, severe vs non-severe infection). Furthermore, higher disease severity and co-existing cerebrovascular disease, were independent predictors of a CAT score > 10 (OR = 1.95, 95% CI 1.07 – 3.54, p = 0.03).
The authors concluded that their findings provided valuable information about the long-term health outcomes of COVID-19 survivors and risk factors for sustained symptoms and poor respiratory health status.
Zhang X et al. Symptoms and Health Outcomes Among Survivors of COVID-19 Infection 1 Year After Discharge From Hospitals in Wuhan, China. JAMA Netw Open 2021.