Follow-up study on long-term prognosis of COVID-19 discharged patients in Xinyang city of Henan province_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Mengdie ¹ , HU Bing ² , ZHAN Weiqiang ¹ , LUO Ning ¹ , XU Ming ¹ , SHI Chuanchuan ¹ ,  LU Yibin ¹

1. Xinyang Central Hospital Intensive care unit, Xinyang, Henan 464000, P. R. China;
2. Xinyang Vocational and Technical College Cardiology Department , Xinyang, Henan 464000, P. R. China;

Corresponding author：

LU Yibin, Email: luyb6810@163.com

Keywords：

Coronavirus disease 2019; long COVID-19; post-COVID-19 condition; risk factors

DOI：

10.7507/1671-6205.202308048

Video：

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Objective To describe the development trend of clinical symptoms, pulmonary function and chest imaging examination of COVID-19 discharged from Xinyang from January 2020 to June 2020, and analyze the related risk factors. Methods This study was a prospective, longitudinal and cohort study. The survivors of COVID-19 hospitalized in Xinyang Fifth People's Hospital and Xinyang Central Hospital from January to June, 2020 were prospectively followed up 12 months and 24 months after discharge. Patients who refused to participate in the study and suffered from cancer and chronic respiratory diseases, including asthma or chronic obstructive pulmonary disease, were excluded. During the follow-up period, the patients who meet the research conditions were asked about clinical symptoms, routine and biochemical blood tests, pulmonary function and chest high-resolution CT (HRCT) and 6-minute walking distance test, and were evaluated with the Dyspnea Scale (mMRC). Results It was found that from January to June, 2020, among 207 eligible patients, 169 patients participated in this study, including 126 cases of mild and ordinary type (74.6%) and 43 cases of severe and critical type (25.4%). There were 100 males (59.2%) and 69 females (40.8%), aged 20 - 78 years old (50±15). It was found that more than half of COVID-19 patients had one or more symptoms at the end of 12 months after rehabilitation, including fatigue (90 cases, 53.3%), insomnia (43 cases, 25.4%), anxiety (24 cases, 14.2%), chest tightness (29 cases, 17.2%) and alopecia (35 cases, 20.7%). Two years after discharge, 52 patients (30.8%) still had at least one clinical symptom. The quality of life, cardiopulmonary function and exercise ability of COVID-19 patients in rehabilitation period decreased to varying degrees. Most patients' lung function and CT results returned to normal, but a few patients still had persistent lung function and imaging abnormalities 12 months and 24 months after discharge. Pulmonary function was mainly manifested as diffuse function injury, and the predicted value of carbon monoxide diffusion capacity (D_LCO) was less than 80% in 44 cases (26.0%). Pulmonary HRCT mainly showed chronic inflammation in one lung/both lungs (28 cases, 41.2%), multiple nodules in one lung/both lungs (23 cases, 33.8%) and ground glass shadow (10 cases, 14.7%), etc. Multivariate logistic regression analysis showed that female COVID-19 patients with old age were more likely to have anxiety symptoms after discharge, which had nothing to do with the severity of acute disease. Older female patients with severe COVID-19 were more likely to have symptoms of D_LCO damage during the recovery period, and their lung function gradually recovered with time. Conclusions Most of COVID-19 patients in Xinyang recovered well during the rehabilitation period, but some patients still had clinical symptoms such as fatigue, insomnia, anxiety, etc. The absorption of lung lesions was slow and some patients were accompanied by impaired pulmonary diffusion function. With the extension of rehabilitation time, the above symptoms have been significantly improved.

Citation： LI Mengdie, HU Bing, ZHAN Weiqiang, LUO Ning, XU Ming, SHI Chuanchuan, LU Yibin. Follow-up study on long-term prognosis of COVID-19 discharged patients in Xinyang city of Henan province. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(2): 86-94. doi: 10.7507/1671-6205.202308048 Copy

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1. Huang LX, Yao Q, Gu XY, et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet, 2021, 398: 747-758.
2. Wu XJ, Liu XF, Zhou YL, et al. 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. Lancet Respir Med, 2021, 9(7): 747-754.
3. Garg M, Maralakunte M, Garg S, et al. The conundrum of 'long-COVID-19': a narrative review. Int J Gen Med, 2021, 14: 2491-2506.
4. Cabrera Martimbianco AL, Pacheco RL, Bagattini ÂM, et al. Frequency, signs and symptoms, and criteria adopted for long COVID-19: a systematic review. Int J Clin Pract, 2021, 75: e14357.
5. 张庆丰, 胡克. 新型冠状病毒肺炎患者的肺部后遗症. 中国呼吸与危重监护杂志, 2022, 21(7): 516-521.
6. 中华人民共和国国家卫生健康委员会办公厅. 新型冠状病毒感染的肺炎诊疗方案(试行第八版)[EB/OL]. http://www.nhc.gov.cn/yzygj/s7653p/202104/7de0b3837c8b4606a0594aeb0105232b/files/f192ac6e5567469db4f0a8691ca18907.pdf.
7. 中华医学会. 常规肺功能检查基层指南(2018年). 中华全科医师杂志, 2019, 18(6): 511-518.
8. Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med, 2003, 348(20): 1986-1994.
9. Hsu HH, Tzao C, Wu CP, et al. Correlation of high-resolution CT, symptoms, and pulmonary function in patients during recovery from severe acute respiratory syndrome. Chest, 2004, 126(1): 149-158.
10. Lam MH, Wing YK, Yu MW, et al. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. Arch Intern Med, 2009, 169(22): 2142-2147.
11. Beretta S, Cristillo V, Camera G, et al. Incidence and long-term functional outcome of neurologic disorders in hospitalized COVID-19 patients infected with Pre-Omicron variants. Neurology, 2023, 29,101(9): e892-e903.
12. Jackson C, Stewart ID, Plekhanova T, et al. Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study. Lancet Respir Med, 2023, 11(8): 673-684.
13. Peter RS, Nieters A, Kräusslich HG, et al. Post-acute sequelae of covid-19 six to 12 months after infection: population based study. BMJ, 2022, 379: e071050.
14. Xie Y, Xu E, Bowe B, et al. Long-term cardiovascular outcomes of COVID-19. Nat Med, 2022, 28(3): 583-590.
15. Paul BD, Lemle MD, Komaroff AL et al. Redox imbalance links COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome. Proc Natl Acad Sci U S A, 2021, 118(34): e2024358118.
16. Taquet M, Sillett R, Zhu L, et al. Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1284437 patients. Lancet Psychiatry, 2022, 9(10): 815-827.
17. Balcom EF, Nath A, Power C. Acute and chronic neurological disorders in COVID-19: potential mechanisms of disease. Brain, 2021, 144(12): 3576-3588.
18. Ferrucci R, Dini M, Groppo E, et al. Long-lasting cognitive abnormalities after COVID-19. Brain Sci, 2021, 11(2): 235.
19. Beretta S, Iannuzzi F, Diamanti S, et al. Neurovascular and infectious disease phenotype of acute stroke patients with and without COVID-19. Neurol Sci, 2022, 43(8): 4619-4625.
20. Ballouz T, Menges D, Anagnostopoulos A, et al. Recovery and symptom trajectories up to two years after SARS-CoV-2 infection: population based, longitudinal cohort study. BMJ, 2023, 381: e074425.
21. Carfì A, Bernabei R, Landi F, et al. Persistent symptoms in patients after acute COVID-19. JAMA, 2020, 324: 603-605.
22. 耿茜, 郑劲平, 梁晓林, 等. 新型冠状病毒肺炎患者康复初期肺功能及心肺运动功能评价. 中国呼吸与危重监护杂志, 2021, 20(5): 320-324.
23. Aly Z, Xie Y, Bowe B. High-dimensional characterization of post-acute sequelae of COVID-19. Nature, 2021, 594(7862): 259-264.
24. Ong KC, Ng AW, Lee LS, et al. 1-year pulmonary function and health status in survivors of severe acute respiratory syndrome. Chest, 2005, 128: 1393-1400.
25. 刘羽翔, 叶艳平, 张萍, 等. SARS患者3年康复期肺功能变化的临床研究. 中国危重病急救医学, 2007, 19(9): 536-538.
26. Yan ZP, Yang M, Lai CL. Long COVID-19 syndrome: a comprehensive review of its effect on various organ systems and recommendation on rehabilitation plans. Biomedicines, 2021, 9(8): 966.
27. Wiemken TL, McGrath LJ, Andersen KM, et al. Coronavirus disease 2019 severity and risk of subsequent cardiovascular events. Clin Infect Dis, 2023, 76(3): e42-e50.
28. Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol, 2020, 5(11): 1265-1273.
29. Huang L, Zhao PJ, Tang DZ, et al. Cardiac involvement in patients recovered from COVID-2019 identified using magnetic resonance imaging. JACC Cardiovasc Imaging, 2020, 13(11): 2330-2339.
30. Wu YJ, Guo C, Tang LT, et al. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. Lancet Gastroenterol Hepatol, 2020, 5(5): 434-435.
31. Kariyawasam JC, Jayarajah U, Riza R, et al. Gastrointestinal manifestations in COVID-19. Trans R Soc Trop Med Hyg, 2021, 115: 1362-1388.
32. Cheung KS, Hung IFN, Chan PPY, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: Systematic Review and Meta-analysis. Gastroenterology, 2020, 159(1): 81-95.

Chinese Journal of Respiratory and Critical Care Medicine

Follow-up study on long-term prognosis of COVID-19 discharged patients in Xinyang city of Henan province

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