Identifying patients at risk of post-discharge complications related to COVID-19 infection

Abstract

SARS-CoV-2 infection is a multisystem disease with post-discharge sequelae. We report early follow-up data from one UK hospital of the initial 200 hospital inpatients with slow recovery from the condition. At 4 weeks post-discharge, 321/957 survivors (34%) had persistent symptoms. A structured outpatient clinical assessment protocol was designed, and outcomes from the first 200 patients seen 4–6 weeks post-discharge are presented here. In 80/200 (40%), we identified at follow-up a cardiorespiratory cause of breathlessness, including persistent parenchymal abnormality (64 patients), pulmonary embolism (four patients) and cardiac complications (eight patients). These findings occurred both in patients who had intensive care unit (ICU) admissions and those who had been managed on the ward, although patients requiring ICU admissions were more likely to have a significant cardiorespiratory cause found for their breathlessness, risk ratio 2.8 (95% CI 1.5 to 5.1).

Post-COVID-19 Syndrome: The Persistent Symptoms at the Post-viral Stage of the Disease. A Systematic Review of the Current Data

“…While SARS-CoV-2 was detected in many organ systems, the lungs seem to be the main organs affected by the virus ( 105 – 107 ). Abnormal lung functions and structural changes were reported up to 6 months after hospitalization in mild-to-critical COVID-19 patients ( 25 , 27 , 28 , 32 , 34 , 36 , 39 , 41 ), also with diffuse alveolar damage, desquamation of alveolar epithelial type II cells, fibrine exudation, hyaline membranes, scattered interstitial inflammation, monocytes, and macrophages ( 23 , 24 , 34 ). Several authors reported that these persistent lung symptoms and dysfunctions correlated with prior COVID-19 severity ( 19 , 20 , 24 , 25 , 27 , 36 , 38 , 41 ).…”

COVID-19 and what comes after?

“…In this edition of Thorax, four Brief Communications from the UK and Canada report the short-term to medium-term post-discharge outcome of hospitalised COVID-19 patients, identifying a pattern of five key persisting symptoms: breathlessness, cough, fatigue, muscle and joint pain and poor sleep quality. [6][7][8][9] Mandal and colleagues recruited 384 patients from three large London hospitals. 6 A median 54 days after discharge, approximately half of the patients reported persistent breathlessness with a third reporting an ongoing cough.…”

“…In a third study by Hall and colleagues in London, 7 the investigators screened patients by telephone prior to clinic and reported that one third of patients had returned to baseline functional level and declined clinic attendance, one third were unsuitable for clinic due to their clinical status or were uncontactable and one third had persistent symptoms. Although breathlessness was a prominent feature in the 200 individuals with persistent symptoms who were reviewed, with a median MRC Score of 2.6±1.2, 31% of patients had not required oxygen on admission during the acute illness.…”

“…Long-term studies should also investigate the effect of disruption of the brain-heart-lung-kidney-skeletal muscle axis with the development of physiological imaging and include both physical and psychological impacts so that we can develop clinical strategies to manage posttraumatic stress disorder and other psychological morbidities. Interestingly, the only study reporting on cognitive impairment 7 determined that the test used was inappropriate for this cohort of patients. It will be important to ensure that appropriate tools are used for this crucial area of assessment.…”

Symptomatic, biochemical and radiographic recovery in patients with COVID-19

“…The studies of recovered patients that are available have described a prolonged burden of symptoms following hospital discharge. [3][4][5][6][7][8][9] However, some features of recovery which are less well characterised include the rate of recovery of symptoms, recovery in nonhospitalised patients and patients without a positive PCR swab, biochemical and haematological recovery and healthcare utilisation.…”