Persistent Health Problems beyond Pulmonary Recovery up to 6 Months after Hospitalization for COVID-19: A Longitudinal Study of Respiratory, Physical, and Psychological Outcomes

Abstract

Rationale: Data on longitudinal recovery after hospitalization for coronavirus disease (COVID-19) currently remain scarce, just as outcomes beyond 3 months of follow-up do. Objectives: To evaluate the sequelae up to 6 months after hospitalization for COVID-19 by considering 1) recovery as it relates to pulmonary function, radiological abnormalities, physical and mental health status, and health-related quality of life (HR-QoL) and 2) the predictors of the most clinically relevant sequelae. Methods: Patients were evaluated at 6 weeks, 3 months, and 6 months after hospitalization by using pulmonary function testing, radiological evaluation, and online questionnaires on the physical and mental health status and HR-QoL. Outcomes were analyzed using repeated-measurement analyses. Results: Ninety-two patients were included (mean age, 58.2 ± 12.3 yr; 58 [63.0%] men). The estimated percentage of patients with impaired forced vital capacity improved from 25% at 6 weeks to 11% at 6 months; for impaired diffusion capacity, this percentage improved from 63% to 46%. Radiologically, ground-glass opacity decreased but fibrosis persisted. The majority of patients (89.1%) still reported one or more symptoms 6 months after discharge. Fatigue decreased significantly over time (P = 0.006). Nonetheless, fatigue remained in 51% of the patients at 6 months. HR-QoL (nearly) normalized in most domains at 6 months, except for physical role functioning, with persistent fatigue and the length of hospitalization being the most important predictors. Conclusions: During the first 6 months after hospitalization for COVID-19, most patients demonstrated continuing recovery across all health domains, but persistent sequelae were frequent. Fatigue was the most frequent residual and persistent symptom up to 6 months after hospitalization, importantly impacting HR-QoL.

Keywords: coronavirus disease; fatigue; patient-reported outcomes; pulmonary function; trajectories of recovery.

Figure 1.

Pulmonary function at 6 weeks, 3 months, and 6 months. (A) FVC and FEV₁ values in liters (scale on the left side, dashed lines) and the percent-predicted values (scale on the right side, solid lines) are shown. (B) Dl_COc values in mmol/min ⋅ kPa/L (scale on the left side, dashed line) and the percent-predicted values (scale on the right side, solid line) are shown. Dl_COc = diffusing capacity of the lung for carbon monoxide adjusted for hemoglobin; FEV₁ = forced expiratory volume in 1 second; FVC = forced vital capacity.

Figure 2.

Fatigue, post-traumatic stress, anxiety, and depression at 6 weeks, 3 months, and 6 months. For each domain the cutoff score is shown. FAS = Fatigue Assessment Scale; HADS = Hospital Anxiety and Depression Scale; IES-R = Impact of Event Scale–Revised.

Figure 3.

Scores for the SF-36 health-related quality of life domains at 6 weeks, 3 months, and 6 months compared with the Dutch norm population. SF-36 = 36-item Short Form Health Survey.