Hospitalized Patients With COVID-19 May Experience Long-term Physical and Psychological Symptoms

Patients hospitalized with severe COVID-19 may continue to experience long-term respiratory, physical, and psychological symptoms 4 months after being discharged, according to a study published in JAMA Network Open.

The results showed that many recovered patients experienced lingering symptoms of posttraumatic stress (PTS), a significant decrease in diffusing lung capacity for carbon monoxide (D_LCO), some degree of lung impairment, and limited mobility that persisted 4 months post-hospitalization.

“Midterm sequelae of COVID-19, such as respiratory and physical functional impairment, may impact psychological health. Residual lung injury may be associated with reduced quality of life in survivors of COVID-19,” wrote the investigators.

When the COVID-19 pandemic began, researchers globally focused their attention on the clinical features and prognosis of infection with SARS-CoV-2, the virus that causes COVID-19. As a result, less is known about the type and severity of long-term respiratory and functional sequela for COVID-19.

COVID-19 can impact the lungs in a number of ways and commonly results in altered D_LCO, leading to impairments in exercise capacity similar to patients who have recovered from SARS pneumonia. Additionally, it is possible that functional impairments associated with COVID-19 could result in adverse psychological outcomes.

The investigators set out to investigate the prevalence and clinical associations of functional and psychological impairment in patients who have recovered from severe acute COVID-19 by using a prospective cohort design. They contacted 767 patients who were discharged after being hospitalized with COVID-19 from the Azienda Ospedaliero-Unoversitaria Maggiore della Carità in Novara, Italy, between March 1, 2020, and June 29, 2020.

Of those patients, 494 declined to participate, 35 died after discharge, and 238 agreed to participate. The median age of participating patients was 61 years, 59.7% were men, and the mean number of comorbidities was 2. Of the patients who agreed to participate, 219 completed both pulmonary function and D_LCO measurement tests.

At the 4-month follow-up, D_LCO was less than 80% of the expected value in 51.6% (n = 113) of patients and more severe impairment (D_CLO < 60% of expected) was observed in 15.5% (n = 34) of patients.

The risk factors associated with D_CLO less than 80% of expected were female sex (odds ratio [OR], 4.33; 95% CI, 2.25-8.33; P < .001) and modality of oxygen delivery during hospitalization (OR, 1.68; 95% CI, 1.08-2.61; P = .02). Female sex (OR, 2.70; 95% CI, 1.11-6.55; P = .03), chronic obstructive pulmonary disease (COPD) (OR, 5.52; 95% CI, 1.32-23.08; P = .02), and intensive care unit admission (OR, 5.76; 95% CI, 1.37-24.25; P = .02) were identified as risk factors associated with D_CLO less than 60% of expected.

Overall, 53.8% (n = 128) of patients were identified to have some degree of functional impairment at follow-up. Limited mobility was identified in 53 patients (22.3%) based on Short Physical Performance Battery scores. All of the other patients underwent a 2-minute walk test, which revealed that an additional 75 (31.5%) patients had a smaller degree of impairment in exercise capacity.

COPD had an association with increase physical impairment risk (OR, 12.70; 95% CI, 1.41-114.85; P = .02) and higher D_CLO was associated with a decrease physical impairment risk (OR, 0.96; 95% CI, 0.94-0.98; P < .001).

Further, 21% (n = 50) reported that their exercise tolerance had worsened after COVID-19.

Additionally, 17% of the overall study population had some degree of clinically relevant PTS symptoms, as determined by results from the Impact of Event Scale-Revised questionnaire. However, 25.6% (n = 61) of patients had mild PTS symptoms, 11.3% (n = 27) had moderate symptoms, and 5.9% (n = 14) had severe symptoms. Male sex was the only independent factor associated with moderate to severe PTS symptom incidence.

The investigators noted that contacting only hospitalized patients with COVID-19 may be a limitation. The high proportion of discharged patients who declined to participate may have generated a selection bias and distorted the real proportion of patients still experiencing functional or psychological sequela. Also, the psychological evaluation was limited to PTS symptoms and may not have captured the full extent of the psychological COVID-19 impact.

Reference

Bellan M, Soddu D, Balbo PE, et al. Respiratory and psychophysical sequelae among patients with COVID-19 four months after hospital discharge. JAMA Netw Open. Published online January 27, 2021. Accessed March 16, 2021. doi:10.1001/jamanetworkopen.2020.36142