Luc Morin1, Laurent Savale2, Tài Pham3, Romain Colle4, Samy Figueiredo5, Anatole Harrois5, Matthieu Gasnier4, Anne-Lise Lecoq6, Olivier Meyrignac7, Nicolas Noel8, Elodie Baudry9, Marie-France Bellin7, Antoine Beurnier10, Walid Choucha4, Emmanuelle Corruble4, Laurent Dortet11, Isabelle Hardy-Leger8, François Radiguer5, Sabine Sportouch3, Christiane Verny9, Benjamin Wyplosz12, Mohamad Zaidan13, Laurent Becquemont6, David Montani2, Xavier Monnet3. 1. Université Paris-Saclay, AP-HP, Service de Réanimation Pédiatrique et Médecine Néonatale, Hôpital de Bicêtre, Santé de l'Enfant et de l'Adolescent, Le Kremlin-Bicêtre, France. 2. Université Paris-Saclay, AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, DMU 5, Thorinno, Inserm UMR_S999, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France. 3. Université Paris-Saclay, AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, FHU Sepsis, Le Kremlin-Bicêtre, France. 4. Université Paris-Saclay, AP-HP, Service de Psychiatrie, Hôpital de Bicêtre, DMU 11 Psychiatrie, Santé Mentale, Addictologie et Nutrition, Équipe MOODS, INSERM U1178, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Le Kremlin-Bicêtre, France. 5. Université Paris-Saclay, AP-HP, Service de Réanimation Chirurgicale, Hôpital de Bicêtre, DMU 12 Anesthésie, Réanimation, Douleur, Le Kremlin-Bicêtre, France. 6. Université Paris-Saclay, AP-HP, Centre de Recherche Clinique Paris-Saclay, DMU 13 Santé Publique, Information Médicale, Appui à la Recherche Clinique, INSERM U1018, CESP, Le Kremlin-Bicêtre, France. 7. Université Paris-Saclay, AP-HP, Service de Radiologie Diagnostique et Interventionnelle, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France. 8. Université Paris-Saclay, AP-HP, Service de Médecine Interne et Immunologie Clinique, Hôpital de Bicêtre, DMU 7 Endocrinologie-Immunités-Inflammations Cancer-Urgences, Le Kremlin-Bicêtre, France. 9. Université Paris-Saclay, AP-HP, Service de Gériatrie Aiguë, Hôpital de Bicêtre, DMU 1 Médecine Territoire Gériatrie, Le Kremlin-Bicêtre, France. 10. Université Paris-Saclay, AP-HP, Service de Physiologie et d'Explorations Fonctionnelles Respiratoires, Hôpital de Bicêtre, DMU 5 Thorinno, Inserm UMR_S999, Le Kremlin-Bicêtre, France. 11. Université Paris-Saclay, AP-HP, Service de Microbiologie, Hôpital de Bicêtre, DMU 15 Biologie-Génétique-PUI, INSERM 1193, Le Kremlin-Bicêtre, France. 12. Université Paris-Saclay, AP-HP, Service des Maladies Infectieuses et Tropicales, Hôpital de Bicêtre, DMU 7 Endocrinologie-Immunités-Inflammations Cancer-Urgences, INSERM U1018, CESP, Le Kremlin-Bicêtre, France. 13. Université Paris-Saclay, AP-HP, Service de Néphrologie Transplantation, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Le Kremlin-Bicêtre, France.
Abstract
Importance: Little is known about long-term sequelae of COVID-19. Objective: To describe the consequences at 4 months in patients hospitalized for COVID-19. Design, Setting, and Participants: In a prospective uncontrolled cohort study, survivors of COVID-19 who had been hospitalized in a university hospital in France between March 1 and May 29, 2020, underwent a telephone assessment 4 months after discharge, between July 15 and September 18, 2020. Patients with relevant symptoms and all patients hospitalized in an intensive care unit (ICU) were invited for further assessment at an ambulatory care visit. Exposures: Survival of hospitalization for COVID-19. Main Outcomes and Measures: Respiratory, cognitive, and functional symptoms were assessed by telephone with the Q3PC cognitive screening questionnaire and a checklist of symptoms. At the ambulatory care visit, patients underwent pulmonary function tests, lung computed tomographic scan, psychometric and cognitive tests (including the 36-Item Short-Form Health Survey and 20-item Multidimensional Fatigue Inventory), and, for patients who had been hospitalized in the ICU or reported ongoing symptoms, echocardiography. Results: Among 834 eligible patients, 478 were evaluated by telephone (mean age, 61 years [SD, 16 years]; 201 men, 277 women). During the telephone interview, 244 patients (51%) declared at least 1 symptom that did not exist before COVID-19: fatigue in 31%, cognitive symptoms in 21%, and new-onset dyspnea in 16%. There was further evaluation in 177 patients (37%), including 97 of 142 former ICU patients. The median 20-item Multidimensional Fatigue Inventory score (n = 130) was 4.5 (interquartile range, 3.0-5.0) for reduced motivation and 3.7 (interquartile range, 3.0-4.5) for mental fatigue (possible range, 1 [best] to 5 [worst]). The median 36-Item Short-Form Health Survey score (n = 145) was 25 (interquartile range, 25.0-75.0) for the subscale "role limited owing to physical problems" (possible range, 0 [best] to 100 [worst]). Computed tomographic lung-scan abnormalities were found in 108 of 171 patients (63%), mainly subtle ground-glass opacities. Fibrotic lesions were observed in 33 of 171 patients (19%), involving less than 25% of parenchyma in all but 1 patient. Fibrotic lesions were observed in 19 of 49 survivors (39%) with acute respiratory distress syndrome. Among 94 former ICU patients, anxiety, depression, and posttraumatic symptoms were observed in 23%, 18%, and 7%, respectively. The left ventricular ejection fraction was less than 50% in 8 of 83 ICU patients (10%). New-onset chronic kidney disease was observed in 2 ICU patients. Serology was positive in 172 of 177 outpatients (97%). Conclusions and Relevance: Four months after hospitalization for COVID-19, a cohort of patients frequently reported symptoms not previously present, and lung-scan abnormalities were common among those who were tested. These findings are limited by the absence of a control group and of pre-COVID assessments in this cohort. Further research is needed to understand longer-term outcomes and whether these findings reflect associations with the disease.
Importance: Little is known about long-term sequelae of COVID-19. Objective: To describe the consequences at 4 months in patients hospitalized for COVID-19. Design, Setting, and Participants: In a prospective uncontrolled cohort study, survivors of COVID-19 who had been hospitalized in a university hospital in France between March 1 and May 29, 2020, underwent a telephone assessment 4 months after discharge, between July 15 and September 18, 2020. Patients with relevant symptoms and all patients hospitalized in an intensive care unit (ICU) were invited for further assessment at an ambulatory care visit. Exposures: Survival of hospitalization for COVID-19. Main Outcomes and Measures: Respiratory, cognitive, and functional symptoms were assessed by telephone with the Q3PC cognitive screening questionnaire and a checklist of symptoms. At the ambulatory care visit, patients underwent pulmonary function tests, lung computed tomographic scan, psychometric and cognitive tests (including the 36-Item Short-Form Health Survey and 20-item Multidimensional Fatigue Inventory), and, for patients who had been hospitalized in the ICU or reported ongoing symptoms, echocardiography. Results: Among 834 eligible patients, 478 were evaluated by telephone (mean age, 61 years [SD, 16 years]; 201 men, 277 women). During the telephone interview, 244 patients (51%) declared at least 1 symptom that did not exist before COVID-19: fatigue in 31%, cognitive symptoms in 21%, and new-onset dyspnea in 16%. There was further evaluation in 177 patients (37%), including 97 of 142 former ICU patients. The median 20-item Multidimensional Fatigue Inventory score (n = 130) was 4.5 (interquartile range, 3.0-5.0) for reduced motivation and 3.7 (interquartile range, 3.0-4.5) for mental fatigue (possible range, 1 [best] to 5 [worst]). The median 36-Item Short-Form Health Survey score (n = 145) was 25 (interquartile range, 25.0-75.0) for the subscale "role limited owing to physical problems" (possible range, 0 [best] to 100 [worst]). Computed tomographic lung-scan abnormalities were found in 108 of 171 patients (63%), mainly subtle ground-glass opacities. Fibrotic lesions were observed in 33 of 171 patients (19%), involving less than 25% of parenchyma in all but 1 patient. Fibrotic lesions were observed in 19 of 49 survivors (39%) with acute respiratory distress syndrome. Among 94 former ICU patients, anxiety, depression, and posttraumatic symptoms were observed in 23%, 18%, and 7%, respectively. The left ventricular ejection fraction was less than 50% in 8 of 83 ICU patients (10%). New-onset chronic kidney disease was observed in 2 ICU patients. Serology was positive in 172 of 177 outpatients (97%). Conclusions and Relevance: Four months after hospitalization for COVID-19, a cohort of patients frequently reported symptoms not previously present, and lung-scan abnormalities were common among those who were tested. These findings are limited by the absence of a control group and of pre-COVID assessments in this cohort. Further research is needed to understand longer-term outcomes and whether these findings reflect associations with the disease.
Authors: Susanne Rabady; Johann Altenberger; Markus Brose; Doris-Maria Denk-Linnert; Elisabeth Fertl; Florian Götzinger; Maria de la Cruz Gomez Pellin; Benedikt Hofbaur; Kathryn Hoffmann; Renate Hoffmann-Dorninger; Rembert Koczulla; Oliver Lammel; Bernd Lamprecht; Judith Löffler-Ragg; Christian A Müller; Stefanie Poggenburg; Hans Rittmannsberger; Paul Sator; Volker Strenger; Karin Vonbank; Johannes Wancata; Thomas Weber; Jörg Weber; Günter Weiss; Maria Wendler; Ralf-Harun Zwick Journal: Wien Klin Wochenschr Date: 2021-12-01 Impact factor: 1.704
Authors: Sherif M Shoucri; Lawrence Purpura; Clare DeLaurentis; Matthew A Adan; Deborah A Theodore; Alexandria Lauren Irace; Shelief Y Robbins-Juarez; Apurva M Khedagi; Daniel Letchford; Amro A Harb; Lillian M Zerihun; Kate E Lee; Karen Gambina; Max C Lauring; Noah Chen; Colin P Sperring; Sanket S Mehta; Ellen L Myers; Hueyjong Shih; Michael G Argenziano; Samuel L Bruce; Cody L Slater; Jonathan R Tiao; Karthik Natarajan; George Hripcsak; Ruijun Chen; Michael T Yin; Magdalena E Sobieszczyk; Delivette Castor; Jason E Zucker Journal: BMJ Open Date: 2021-06-02 Impact factor: 2.692
Authors: Sophie A Clarke; Maria Phylactou; Bijal Patel; Edouard G Mills; Beatrice Muzi; Chioma Izzi-Engbeaya; Sirazum Choudhury; Bernard Khoo; Karim Meeran; Alexander N Comninos; Ali Abbara; Tricia Tan; Waljit S Dhillo Journal: J Clin Endocrinol Metab Date: 2021-07-13 Impact factor: 5.958
Authors: Matteo Parotto; Sheila Nainan Myatra; Daniel Munblit; Alyaa Elhazmi; Otavio T Ranzani; Margaret S Herridge Journal: Lancet Respir Med Date: 2021-07-14 Impact factor: 30.700