Symptoms persisting after hospitalisation for COVID-19: 12 months interim results of the CO-FLOW study

Abstract

IntroductionA large proportion of patients experiences a wide range of sequelae after acute COVID-19, especially after severe illness. The long-term health sequelae need to be assessed. Our objective was to longitudinally assess persistence of symptoms and clusters of symptoms up to 12 months after hospitalization for COVID-19, and to assess determinants of the main persistent symptoms.MethodsIn this multicenter prospective cohort study patients with COVID-19 are followed up for 2 years with measurements at 3, 6, 12, and 24 months after hospital discharge. Here, we present interim results regarding persistent symptoms up to 12 months.ResultsWe included 492 patients; mean age was 60.2±10.7 years, 335 (68.1%) males, median length of hospital stay 11 (6.0–27.0) days. At 3 months after discharge 97.0% of the patients had at least 1 persisting symptom, this declined to 95.5% and 92.0% at 6 and 12 months, respectively (p=0.010).Muscle weakness, exertional dyspnea, fatigue, and memory and concentration problems were the most prevalent symptoms with rates over 50% during follow-up. Over time, muscle weakness, hair loss, and exertional dyspnea decreased significantly (p<0.001), while other symptoms, such as fatigue, concentration and memory problems, anosmia, and ageusia persisted. Symptoms from the physical and respiratory cluster declined significantly over time, in contrast to the fatigue and cognitive symptomclusters.ConclusionThe majority of patients experienced COVID-19 sequelae up to 12 months after severe infection. Whereas physical and respiratory symptoms showed slow gradual decline, fatigue and cognitive symptoms did not evidently resolve over time.

Severe fatigue as symptom of long COVID is characterized by increased expression of inflammatory genes in monocytes, increased serum pro-inflammatory cytokines, and increased CD8+ T-lymphocytes: A putative dysregulation of the immune-brain axis, the coagulation process, and auto-inflammation to explain the diversity of long COVID symptoms

“…Several symptoms (such as chest pain, sensory overload, and headache) could not be taken into account as they were added to this questionnaire in a later stage and contain incomplete data. 5 Dyspnea was assessed with the Modified Medical Research Council (mMRC) Dyspnea Scale, 32 the questionnaire scales the severity of dyspnea from 0 (no dyspnea) to 4 (severe dyspnea); scores ≥2 were considered representative for the presence of dyspnea symptom. The severity of fatigue was assessed using the FAS (score range 0-50) with a score ≥22 indicating substantial fatigue.…”

“…Frequently reported symptoms are fatigue, impaired fitness, dyspnea, and cognitive impairment. 3-5 Numerous studies showed the presence of these symptoms beyond 3 months after acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with evidence of persistence even two years after the acute illness. 6 As patients with long COVID differ substantially regarding symptoms, severity, and recovery profile, attempts have been made to discern different clinical phenotypes of long COVID, without reaching consensus to date.…”

“…Among patients who had been hospitalized for acute COVID-19, proportions of up to 41% to 60% have been reported for patients that still suffer from fatigue one year after hospital discharge, without evident improvement beyond 6 months. 5, 10, 11 Furthermore, the fatigue has been shown to negatively affect quality of life. 12 This troubling problem thus requires in-depth evaluation regarding its pathogenesis, facilitating future interventions.…”

Treatments of COVID-19-Associated Taste and Saliva Secretory Disorders

“…A significant number of COVID-19 survivors report persistent taste disorders when followed up 1-12 months after symptom onset, disease diagnosis, or hospitalization [13,14]. The prevalence is 39% for dysgeusia at 8-month follow-up [11], 19% for ageusia at 12-month follow-up [15], and 22% for taste or smell impairment at 12month follow-up [16]. According to follow-up studies [11,17,18] and comprehensive symptom reviews [13,19], xerostomia, dry mouth, and hyposalivation persist in COVID-19 survivors with prevalence of 9-29% at 1-8 months follow-ups.…”

Long-term outcomes of different rehabilitation programs in patients with long COVID syndrome: a cohort prospective study

“…In addition, aquatic exercise carried out in mineral-rich water seemed to add a protective effect on the microcirculatory system, in the lymph flow and in tissue metabolism. 14 Nevertheless, the lack of data in the literature on the effects of rehabilitation programs on medium-and long-term long COVID symptoms, 18,19 and the heterogeneity in durations and contents of the few existing studies, [20][21][22][23] determined the need for further investigations. Therefore, with this further analysis we aim to increasing knowledge on rehabilitation programs in patients with long COVID syndrome, evaluating also clinical outcomes in the long-term.…”