Severity of self-reported symptoms and psychological burden 6-months after hospital admission for COVID-19: a prospective cohort study

Abstract

Objectives: Few studies have reported clinical COVID-19 sequelae six months (M6) after hospital discharge, but none has studied symptom severity.

Methods: Prevalence and severity of 7 symptoms were estimated until M6 using the self-administered influenza severity scale in COVID-19 hospitalized patients enrolled in the French COVID cohort. Factors associated with severity were assessed by logistic regression. Anxiety, depression and health-related quality of life (HRQL) were also assessed.

Results: At M6, among the 324 patients (median age 61 years, 63% men, 19% admitted to intensive care during the acute phase), 187/324 (58%) reported at least one symptom, mostly fatigue (47%) and myalgia (23%). Symptom severity was scored, at most, mild in 125 (67%), moderate in 44 (23%) and severe in 18 (10%). Female gender was the sole factor associated with moderate/severe symptom reporting (OR = 1.98, 95%CI=1.13-3.47). Among the 225 patients with psychological assessment, 24 (11%) had anxiety, 18 (8%) depressive symptoms, and their physical HRQL was significantly poorer than the general population (p=0.0005).

Conclusion: Even if 58% of patients reported ≥1 symptom at M6, less than 7% rated any symptom as severe. Assessing symptoms severity could be helpful to identify patients requiring appropriate medical care. Women may require special attention.

Keywords: COVID-19; Persistent symptoms; Risk factors; Sequelae.

Figure 1

Frequency and severity of self-reported symptoms in patients from the French COVID cohort at 3 and 6 months (M3 and M6) after hospital admission. Barplot representing each symptom severity for the N = 324 patients who fully completed their 7-symptoms questionnaire at 3 and 6 months after diagnostic confirmation. The score for each symptom is given on a four-degree scale going from 0 to 3 (i.e. none, mild, moderate, severe). The corresponding percentages are given in each colored bar. Of note, patients presenting no symptom at all are not represented on this graph.

Figure 2

Evolution of 7-symptoms over time in patients from the French COVID cohort. a. Heatmap of the 7 self-reported symptoms. For a given symptom at a given time-point, the box is colored according to the proportion of patients reporting this symptom, and the percentage is displayed in each box. P-values of McNemar test for paired samples comparing proportions of patients reporting symptoms at 3 and 6 months (M3 and M6) after hospital admission are: Fatigue, p=0.5; Myalgia, p=0.2; Headache, p=0.06; Cough, p=0.8; Nasal obstruction, p=1; Sore throat, p=0.3; Feverishness, p=0.2 b. Boxplots of the total score obtained by adding the scores obtained for each of the 7 self-reported symptoms. The score for each symptom is given on a four-degree scale going from 0 to 3, the total score is thus between 0 and 21. The red dots represent the mean values.