The phenotype and prediction of long-term physical, mental and cognitive COVID-19 sequelae 20 months after recovery, a community-based cohort study in China

Abstract

Long-term sequelae clustering phenotypes are important for precise health care management in COVID-19 survivors. We reported findings for 1000 survivors 20 months after diagnosis of COVID-19 in a community-based cohort in China. Sequelae symptoms were collected from a validated questionnaire covering 27 symptoms involved in five organ systems including self-reported physical condition, dyspnea, cognitive function and mental health. The generalized symptoms were reported with the highest rate (60.7%), followed by the mental (48.3%), cardiopulmonary (39.8%), neurological (37.1%; cognitive impairment, 15.6%), and digestive symptoms (19.1%). Four clusters were identified by latent class analysis: 44.9% no or mild group (cluster 1), 29.2% moderate group with mainly physical impairment (cluster 2), 9.6% moderate group with mainly cognitive and mental health impairment (cluster 3), and 16.3% severe group (cluster 4). Physical comorbidities or history of mental disorders, longer hospitalization periods and severe acute illness predicted severe group. For moderate group, adults less than 60 years, with physical comorbidities and severe acute illness were more likely to have physical symptoms, while adult women with longer hospitalization stays had increased risk of cognitive and mental health impairment. Overall, among more than half of community COVID-19 survivors who presented moderate or severe sequelae 20 months after recovery, three-tenth had physical vulnerability that may require physical therapy aiming to improve functioning, one-tenth mental or cognitive vulnerable cases need psychotherapy and cognitive rehabilitation, and one-sixth severe group needs multidisciplinary clinical management. The remaining half is free to clinical intervention. Our findings introduced an important framework to map numerous symptoms to precise classification of the clinical sequelae phenotype and provide information to guide future stratified recovery interventions.

Fig. 1. Flow chart of the study.

*1791 COVID-19 survivors invited in our survey, with 1002 survivors willing to participate in survey and 789 not participating in survey. ^†1783 COVID-19 survivors eligible for survey with the exclusion of 8 survivors under 15 years (1000 eligible survivors included in analysis and 783 eligible survivors not included). The response rate: 1000 eligible survivors included in analysis / 1783 eligible survivors invited = 56.1%. The effective rate: 1000 eligible questionnaires/1023 completed questionnaires = 97.8%.

Fig. 2. Sequelae symptoms stratified by sex, age, severity of acute illness and sequelae clusters.

*means the p-value of subgroup test less than 0.05.

Fig. 3. The rate of sequelae symptoms by four sequelae clusters.

A The rate of sequelae symptoms by four sequelae clusters. B The rate of five organ systems by four sequelae clusters. Cluster 1: no or mild group (no or mild physical, cognitive and mental health impairment) (44.9%). Cluster 2: moderate group with mainly physical impairment (29.2%). Cluster 3: moderate group with mainly cognitive and mental health impairment (9.6%). Cluster 4: severe group (severe physical, cognitive and mental health impairment) (16.3%).