Descriptive analysis of long COVID sequelae identified in a multidisciplinary clinic serving hospitalised and non-hospitalised patients

Abstract

Background: There are emerging data of long-term effects of coronavirus disease 2019 (COVID-19) comprising a diversity of symptoms. The aim of this study was to systematically describe and measure pulmonary and extra-pulmonary post-COVID-19 complications in relation to acute COVID-19 severity.

Methods: Patients attending a standard of care 3 months post-hospitalisation follow-up visit and those referred by their general practitioner because of persistent post-COVID-19 symptoms were included. Patients underwent symptomatic, quality of life, pulmonary (lung function and high-resolution computed tomography (HRCT)), cardiac (high-resolution ECG), physical (1-min sit and stand test (1-MSTST), handgrip strength, cardiopulmonary exercise testing (CPET)) and cognitive evaluations.

Results: All 34 hospitalised and 22 out of 23 non-hospitalised patients had ≥1 complaint or abnormal finding at follow-up. Overall, 67% of patients were symptomatic (Medical Research Council (MRC) ≥2 or COPD assessment test (CAT) ≥10), with no difference between hospitalised versus non-hospitalised patients. Pulmonary function (forced expiratory volume in 1 s (FEV₁) or diffusing capacity of the lung for carbon monoxide (D _LCO)) <80% of predicted) was impaired in 68% of patients. D _LCO was significantly lower in those hospitalised compared to non-hospitalised (70.1±18.0 versus 80.2±11.2% predicted, p=0.02). Overall, 53% had an abnormal HRCT (predominantly ground-glass opacities) with higher composite computed tomography (CT) scores in hospitalised versus non-hospitalised patients (2.3 (0.1-4.8) and 0.0 (0.0-0.3), p<0.001). 1-MSTST was below the 25th percentile in almost half of patients, but no signs of cardiac dysfunction were found. Cognitive impairments were present in 59-66% of hospitalised and 31-44% of non-hospitalised patients (p=0.08).

Conclusion: Three months after COVID-19 infection, patients were still symptomatic and demonstrated objective respiratory, functional, radiological and cognitive abnormalities, which were more prominent in hospitalised patients. Our study underlines the importance of multidimensional management strategies in these patients.

FIGURE 1

Flowchart for participants recruited between March 15 and August 31 2020. *: number of Covid-positive individuals in the community unknown. **: all patients were offered standard of care, which included LFU, DCO, high-resolution computed tomography (HRCT), clinical evaluation, multidisciplinary team and follow-up visit with follow-up plan including any additional visit. ***: only patients with dyspnoea or significant symptoms were referred from their general practitioner (GP).

FIGURE 2

Long-term impact of coronavirus disease 2019 (COVID-19). a) Number of patients that presented with an impairment in the individual domains shown for all patients, hospitalised patients and non-hospitalised patients. b) Percentage distribution of number of impaired domains. DC: deceleration capacity; PRD: periodic repolarisation dynamics; 1-MSTST; 1-min sit and stand test; CPET: cardiopulmonary exercise testing; FEV₁: forced expiratory volume in 1 s; D_LCO: diffusing capacity of the lung for carbon monoxide; PCFS: post-COVID functional scale; SCIP: Screen for cognitive impairment in psychiatry; CAT: COPD Assessment Test; MRC: Medical Research Council Dyspnoea Score; CFQ: Cognitive Failures Questionnaire; CT: computed tomography; WPAI: Work Productivity and Activity Impairment Questionnaire; EQ-5D: 5 Dimension 5 Level Quality of Life Questionnaire; EQ-5D VAS: 5 Dimension 5 Level Quality of Life Questionnaire visual analog score.

FIGURE 3

High-resolution computed tomography (HRCT) findings in non-hospitalised and hospitalised. Median computed tomography (CT) scores for the different radiological entities with comparison between non-hospitalised and hospitalised patients (a) or non-hospitalised, hospitalised without necessity for oxygen treatment and hospitalised with oxygen treatment (b), respectively. Ground-glass: ground-glass opacities; Consolidation: airspace consolidation; Reticular: reticular pattern; Parench.Bands: pleuraparenchymal bands; Airtrap: air trapping; Sep.Thicken: interlobular septal thickening; Bronchiec: traction bronchiectasis and traction bronchiolectasies. **: p<0.01; ***: p<0.001; ****: p<0.0001.

FIGURE 4

Correlations between intitial covid, lung function, patient-reported outcomes, symptoms, cognitive measures, functional tests, cardiac tests and cognitive measures. Pearson correlations for coronavirus disease 2019 (COVID-19), lung function, patient-reported outcomes (PRO), symptoms, cognition (Cogn.), cardiac and functional. Only correlation coefficients with p<0.05 are shown. * p<0.05; ** p<0.01; *** p<0.001. CRP: C-reactive protein; FEV₁: forced expiratory volume in 1 s; D_LCO: diffusing capacity of the lung for carbon monoxide; K_CO: carbon monoxide transfer coefficient; PCFS: post-COVID functional scale; CAT: COPD Assessment Test; MRC: Medical Research Council dyspnoea score; CFQ: Cognitive Failures Questionnaire; SCIP: screen for cognitive impairment in psychiatry; EQ-5D: 5 Dimension 5 Level Quality of Life Questionnaire; EQ-5D Health/VAS: 5 Dimension 5 Level Quality of Life Questionnaire visual analog scale; CT: computed tomography; PRD: periodic repolarisation dynamics; DC: deceleration capacity; V′O₂max: maximal oxygen uptake; 1-MSTST: 1-min sit and stand test.