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. 2021 Sep 1;4(9):e2127403.
doi: 10.1001/jamanetworkopen.2021.27403.

Symptoms and Health Outcomes Among Survivors of COVID-19 Infection 1 Year After Discharge From Hospitals in Wuhan, China

Xue Zhang  1 , Fang Wang  1 , Ye Shen  1 , Xiaohua Zhang  2   3 , Yuan Cen  3   4 , Bin Wang  3   5 , Songtao Zhao  3   6 , Yi Zhou  3   7 , Baoman Hu  1 , Man Wang  1 , Yuhui Liu  8 , Hongming Miao  9 , Paul Jones  10 , Xiangyu Ma  11 , Yong He  1 , Guoqiang Cao  1   3 , Lixia Cheng  12   13 , Li Li  1   3
Affiliations

Symptoms and Health Outcomes Among Survivors of COVID-19 Infection 1 Year After Discharge From Hospitals in Wuhan, China

Xue Zhang et al. JAMA Netw Open. .

Abstract

Importance: The long-term health outcomes and symptom burden of COVID-19 remain largely unclear.

Objective: To evaluate health outcomes of COVID-19 survivors 1 year after hospital discharge and to identify associated risk factors.

Design, setting, and participants: This retrospective, multicenter cohort study was conducted at 2 designated hospitals, Huoshenshan Hospital and Taikang Tongji Hospital, both in Wuhan, China. All adult patients with COVID-19 discharged between February 12 and April 10, 2020, were screened for eligibility. Of a consecutive sample of 3988 discharged patients, 1555 were excluded (796 declined to participate and 759 were unable to be contacted) and the remaining 2433 patients were enrolled. All patients were interviewed via telephone from March 1 to March 20, 2021. Statistical analysis was performed from March 28 to April 18, 2021.

Exposures: COVID-19.

Main outcomes and measures: All patients participated in telephone interviews using a series of questionnaires for evaluation of symptoms, along with a chronic obstructive pulmonary disease (COPD) assessment test (CAT). Logistic regression models were used to evaluate risk factors for fatigue, dyspnea, symptom burden, or higher CAT scores.

Results: Of 2433 patients at 1-year follow-up, 1205 (49.5%) were men and 680 (27.9%) were categorized into the severe disease group as defined by the World Health Organization guideline; the median (IQR) age was 60.0 (49.0-68.0) years. In total, 1095 patients (45.0%) reported at least 1 symptom. The most common symptoms included fatigue, sweating, chest tightness, anxiety, and myalgia. Older age (odds ratio [OR], 1.02; 95% CI, 1.01-1.02; P < .001), female sex (OR, 1.27; 95% CI, 1.06-1.52; P = .008), and severe disease during hospital stay (OR, 1.43; 95% CI, 1.18-1.74; P < .001) were associated with higher risks of fatigue. Older age (OR, 1.02; 95% CI, 1.01-1.03; P < .001) and severe disease (OR, 1.51; 95% CI, 1.14-1.99; P = .004) were associated with higher risks of having at least 3 symptoms. The median (IQR) CAT score was 2 (0-4), and a total of 161 patients (6.6%) had a CAT score of at least 10. Severe disease (OR, 1.84; 95% CI, 1.31-2.58; P < .001) and coexisting cerebrovascular diseases (OR, 1.95; 95% CI, 1.07-3.54; P = .03) were independent risk factors for CAT scores of at least 10.

Conclusions and relevance: This study found that patients with COVID-19 with severe disease during hospitalization had more postinfection symptoms and higher CAT scores.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Jones reported personal fees from GlaxoSmithKline Employee and stocks and shares from GlaxoSmithKline outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flowchart
Figure 2.
Figure 2.. Total and Item CAT Scores in Patients at 1-Year Follow-up
ADL indicates activities of daily living; CAT, COPD assessment test; COPD, chronic obstructive pulmonary disease.
See this image and copyright information in PMC

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