Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct 24;8(4):00355-2022.
doi: 10.1183/23120541.00355-2022. eCollection 2022 Oct.

Symptoms persisting after hospitalisation for COVID-19: 12 months interim results of the CO-FLOW study

L Martine Bek  1   2 , Julia C Berentschot  3   2 , Majanka H Heijenbrok-Kal  1   4 , Susanne Huijts  3 , Michel E van Genderen  5 , J Hans Vlake  5 , Jasper van Bommel  5 , Joachim G J V Aerts  3 , Gerard M Ribbers  1   4 , Rita J G van den Berg-Emons  1   6 , Merel E Hellemons  3   6
Affiliations

Symptoms persisting after hospitalisation for COVID-19: 12 months interim results of the CO-FLOW study

L Martine Bek et al. ERJ Open Res. .

Abstract

Introduction: A large proportion of patients experience a wide range of sequelae after acute COVID-19, especially after severe illness. The long-term health sequelae need to be assessed. Our objective was to longitudinally assess persistence of symptoms and clusters of symptoms up to 12 months after hospitalisation for COVID-19 and to assess determinants of the main persistent symptoms.

Methods: In this multicenter prospective cohort study patients with COVID-19 are followed up for 2 years with measurements at 3, 6, 12 and 24 months after hospital discharge. Here, we present interim results regarding persistent symptoms up to 12 months.

Results: We included 492 patients; mean±sd age was 60.2±10.7 years, 335 (68.1%) were males, median length of hospital stay was 11 (6.0-27.0) days. At 3 months after discharge 97.0% of the patients had at least one persisting symptom, this declined to 95.5% and 92.0% at 6 and 12 months, respectively (p=0.010). Muscle weakness, exertional dyspnoea, fatigue, and memory and concentration problems were the most prevalent symptoms with rates over 50% during follow-up. Over time, muscle weakness, hair loss and exertional dyspnoea decreased significantly (p<0.001), while other symptoms such as fatigue, concentration and memory problems, anosmia and ageusia persisted. Symptoms from the physical and respiratory cluster declined significantly over time, in contrast to the fatigue and cognitive symptom clusters.

Conclusion: The majority of patients experienced COVID-19 sequelae up to 12 months after severe infection. Whereas physical and respiratory symptoms showed slow gradual decline, fatigue and cognitive symptoms did not evidently resolve over time.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: L.M. Bek, J.C. Berentschot and M.H. Heijenbrok-Kal have received support for the present manuscript from ZonMw COVID-19 program, Rijndam Rehabilitation and Laurens. M.E. van Genderen has received a research grant from stichting Theia and stichting SGS, outside the submitted work. R.J.G. van den Berg-Emons has received a grant from ZonMw (Dutch organisation for health research) outside the submitted work. M.E. Hellemons has received a grant from ZonMw outside the submitted work and is an associate editor of this journal. The remaining authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Flowchart of the patients in the CO-FLOW study during the interim analysis.
FIGURE 2
FIGURE 2
Symptom prevalence over time. Prevalence of COVID-19-related symptoms at 3-, 6- and 12-month follow-up in patients after hospitalisation for COVID-19, sorted by symptoms cluster and from most to least frequently reported. Data are presented as percentage of patients with symptoms. Symptoms marked with ◊ declined significantly over time based on generalised estimating equation analyses, with follow-up visit as fixed factor and symptom (yes/no) at each follow-up visit as dependent variable.
FIGURE 3
FIGURE 3
Venn diagrams showing overlap between the symptom clusters (physical symptoms, cognitive symptoms, fatigue symptoms and respiratory symptoms) for the entire cohort, males and females. Data are presented as n (%) indicating the number of patients with symptoms.
FIGURE 4
FIGURE 4
Forest plot of the patient and admission characteristics associated with the most prevalent symptoms for the a) physical, b) fatigue and c) cognitive symptoms clusters obtained by multivariable logistic regression analyses. LOS: length of stay.
See this image and copyright information in PMC

References

    1. Wiersinga WJ, Rhodes A, Cheng AC, et al. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19). JAMA 2020; 324: 782–793. doi: 10.1001/jama.2020.12839 - DOI - PubMed
    1. Greenhalgh T, Knight M, A'Court C, et al. Management of post-acute covid-19 in primary care. BMJ 2020, 370: m3026. doi: 10.1136/bmj.m3026 - DOI - PubMed
    1. Shah W, Hillman T, Playford ED, et al. Managing the long term effects of covid-19: summary of NICE, SIGN, and RCGP rapid guideline. BMJ 2021; 372: n136. doi: 10.1136/bmj.n136 - DOI - PubMed
    1. WHO . A clinical case definition of post COVID-19 condition by a Delphi consensus. www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Cl... - PMC - PubMed
    1. Sudre CH, Murray BA-OX, Varsavsky T, et al. Attributes and predictors of long COVID. Nat Med 2021; 27: 626–631. - PMC - PubMed

LinkOut - more resources