Long-term outcomes of patients following hospitalization for coronavirus disease 2019: a prospective observational study

Abstract

Objectives: Few data are available regarding follow up of patients with coronavirus disease 2019 (COVID-19) after their discharge. We aim to describe the long-term outcomes of survivors of hospitalization for COVID-19 followed up first at an outpatient facility and subsequently by telephone.

Methods: Observational prospective study conducted at a tertiary general hospital. Clinical and radiological progression was assessed and data were recorded on a standardized reporting form. Patients were divided into three groups according to Pao₂/Fio₂ at hospitalization: Pao₂/Fio₂ >300, Pao₂/Fio₂ 300-200 and Pao₂/Fio₂ <200. A logistic multivariate regression model was performed to identify factors associated with persistence of symptoms.

Results: For facility follow up, 302 individuals were enrolled. Median follow up was 45 days after discharge; 78% (228/294) of patients had COVID-19-related symptoms (53% asthenia, 56% respiratory symptoms) and 40% (122/302) had residual pulmonary radiographic lesions. Pao₂/Fio₂ <200 was an independent predictor of persistent dyspnoea (OR 1.87, 95% CI 1.38-2.52, p < 0.0001). Pao₂/Fio₂ >300 was associated with resolution of chest radiographic lesions (OR 0.56, 95% CI 0.42-0.74, p < 0.0001). Fifty per cent of patients required specific medical follow up after the first consultation and were transferred to another physician. A total of 294 patients were contacted for telephone follow up after a median follow-up time of 7 months. Fifty per cent of patients (147/294) still presented symptoms and 49% (145/294) had psychological disorders. Asthenia was identified in 27% (78/294) and dyspnoea in 10% (28/294) of patients independently of Pao₂/Fio₂.

Conclusions: Patients with COVID-19 require long-term follow up because of the persistence of symptoms; patients with low Pao₂/Fio₂ during the acute illness require special attention.

Keywords: Aftermath; Coronavirus disease 2019; Follow up; Outpatient facility; Pao(2)/Fio(2); Sequelae.

Graphical abstract

Fig. 1

Patient selection flow chart. ∗Re-admitted to hospital: five for respiratory insufficiency related to COVID-19, two for bacterial pneumonia, one for diarrhoea, one for pulmonary embolism, one for ovarian neoplasia, one for acute pyelonephritis. ∗∗Death after discharge: seven at home, three at hospital (two due to respiratory insufficiency related to COVID-19, one due to cerebral stroke). ∗∗∗Death: two at home, two at hospital (one due to septic shock, one due to pancreatic neoplasia).