Comprehensive Health Assessment 3 Months After Recovery From Acute Coronavirus Disease 2019 (COVID-19)

Abstract

Background: Long-term health sequelae of coronavirus disease 2019 (COVID-19) may be multiple but have thus far not been systematically studied.

Methods: All patients discharged after COVID-19 from the Radboud University Medical Center, Nijmegen, the Netherlands, were consecutively invited to a multidisciplinary outpatient facility. Also, nonadmitted patients with mild disease but with symptoms persisting >6 weeks could be referred by general practitioners. Patients underwent a standardized assessment including measurements of lung function, chest computed tomography (CT)/X-ray, 6-minute walking test, body composition, and questionnaires on mental, cognitive, health status, and quality of life (QoL).

Results: 124 patients (59 ± 14 years, 60% male) were included: 27 with mild, 51 with moderate, 26 with severe, and 20 with critical disease. Lung diffusion capacity was below the lower limit of normal in 42% of discharged patients. 99% of discharged patients had reduced ground-glass opacification on repeat CT imaging, and normal chest X-rays were found in 93% of patients with mild disease. Residual pulmonary parenchymal abnormalities were present in 91% of discharged patients and correlated with reduced lung diffusion capacity. Twenty-two percent had low exercise capacity, 19% low fat-free mass index, and problems in mental and/or cognitive function were found in 36% of patients. Health status was generally poor, particularly in the domains functional impairment (64%), fatigue (69%), and QoL (72%).

Conclusions: This comprehensive health assessment revealed severe problems in several health domains in a substantial number of ex-COVID-19 patients. Longer follow-up studies are warranted to elucidate natural trajectories and to find predictors of complicated long-term trajectories of recovery.

Keywords: COVID-19; fatigue; health status; multidisciplinary; post-acute; sequelae of COVID-19.

Figure 1.

Flow chart of patient inclusion. Abbreviations: COVID-19, coronavirus disease 2019; GP, general practitioner.

Figure 2.

A–D, Extent and type of residual pulmonary parenchyma abnormalities 3 months after recovery from acute COVID-19 and association with DLCO. Abbreviations: COVID-19, coronavirus disease 2019; CT, computed tomography; DLCO, lung diffusion capacity of carbon monoxide. *P < .05.

Figure 3.

Health status on domains of the SF-36 (A) and on subdomains of the Nijmegen Clinical Screening Instrument (B) 3 months after recovery from acute COVID-19. *P < .05. Abbreviations: COVID-19, coronavirus disease 2019; QoL, quality of life; HrQoL, health-related quality of life; SF-36, Short Form-36.