Three-month outcomes of recovered COVID-19 patients: prospective observational study

Abstract

Aims: A novel coronavirus SARS-CoV-2 has resulted in an ongoing global pandemic of Coronavirus disease 2019 (COVID-19). However, the outcomes of recovered patients have not been well defined. Methods: This is a prospective observational follow-up study of survivors with COVID-19 from a designated tertiary center in Hefei, China. We examined chest computed tomography (CT) scanning, pulmonary function, 6-min walk distance (6MWD), and 36 item Short Form General Health Survey (SF-36). Results: Among 81 enrolled patients, 62 (77%) patients and 61 (75%) patients, respectively, completed 1-month and 3-month follow-ups. Abnormal CT findings were still present in 73% of patients at 1 month and 54% at 3 months, whereas chest CT scan scores improved progressively at 1-month (5.0 ± 5.1) and 3-month follow up (3.0 ± 4.5) compared with that during hospitalization (11 ± 6.8). Mild restrictive pulmonary impairment was detected in 11% and 10% of patients at 1-month and 3-month follow up, respectively. The 6MWD was 523 ± 77 m in male patients and 484 ± 58 m in female patients, which was significantly lower than in healthy controls (606 ± 68 m, 568 ± 78 m, p < 0.001). SF-36 scores were significantly impaired in the domains of role physical (RP), role emotional (RE), and social functioning (SF) compared with the normal age-matched population. RP was improved at 3-month compared with 1-month follow up in the 41–64 years group ( p < 0.01). Multivariable analysis showed that older age (over 40 years) and steroid administration during hospitalization were independently associated with worse chest CT scores at 3-month follow up. Conclusions: At 3 months, chest CT abnormalities were present in one half of COVID-19 survivors and worse chest CT scores were independently associated with older age and steroid administration during hospitalization. Residual pulmonary function impairments were modest, whereas exercise capacity and SF-36 scores were significantly lower than the general population. Support program and further follow-up evaluations may be needed. The reviews of this paper are available via the supplemental material section.

Long-Term Impact of COVID-19: A Systematic Review of the Literature and Meta-Analysis

“…However, high prevalence of chest CT abnormalities was not well reflected on PFT and only weak to moderate correlations were found [31,32]. Presence of GGO, commonly identified at follow-up [28][29][30][31][32][33][34]36,37,40,41,43,45], can be a manifestation of a wide variety of clinical features including focal interstitial fibrosis, and inflammation [53]. Residual pulmonary parenchymal abnormalities were correlated with lower DLCO [45], and pulmonary function abnormalities occurred frequently in patients with fibrotic-like changes [28].…”

“…Decreased functional capacity was identified in an average of 36% (95% CI 22-49, I 2 = 97%) of the patients at a mean of 4.2 (SD 1.3) months follow-up using data from five studies which presented a proportion of decreased functionality assessed with the work productivity and impairment questionnaire (WPAI) [49] and with performance-based tests (Table 2) including the short physical performance battery (SPPB) [27,48], the one minute sit to stand test (1-MSTST) [48], the 2 min walking test [27,48], and the 6 minute walking test (6MWT) [29,45] (Supplementary Table S5 and Figure S4). Cao et al also stated that performance in the 6MWT was significantly lower in post COVID-19 patients than in health controls but did not report the proportion of patients under the threshold [43]. Lower performance in the 6MWT was reported in patients with severe/critical COVID-19 compared to patients with mild/moderate disease at baseline [29,34,47,49], however, another study reports no difference between groups [30].…”

“…Thirteen articles report the results of chest CT scans in post COVID-19 patients at a mean of 3.8 (SD 1.3) months follow-up [28][29][30][31][32][33][34]36,37,40,41,43,45] (Supplementary Table S2 and Figure S1). Persistent chest CT abnormalities attributable to COVID-19 were identified in 59% of the patients (95% CI 44-73, I 2 = 96%) (Table 2).…”

“…Thirteen articles explored the effect of COVID-19 on lung function at follow-up [27][28][29][30][31][32]36,37,40,41,43,45,46] (Supplementary Table S3 and Figure S2). Abnormal pulmonary function tests (PFT) were identified in 39% (95% CI 24-55, I 2 = 94%) of the patients (Table 2).…”

“…Fifteen studies explored persistent post COVID-19 fatigue [29,31,32,35,36,39-41,43-47, 49,50] and eighteen studies [27][28][29][30][31][32][33]35,36,[40][41][42][43][44]46,47,49,50] report on one or more persistent respiratory symptoms at follow-up (Supplementary Table S4 and Figure S3). Pooled analysis indicates that fatigue was reported by 38% of the patients (95% CI 27-49, I 2 = 98%) (Table 2), dyspnea by 32% (95% CI 24-40, I 2 = 9%), chest pain or tightness by 16% (95% CI 12-21, I 2 = 94%), cough by 13%, (95% CI 9-17, I 2 = 94%), sputum by 12% (95% CI 3-21, I 2 = 94%), and sore throat by 4% (95% CI 2-7, I 2 = 66%).…”