Health outcomes of COVID-19 patients from Wuhan, China 3-year after hospital discharge: a cohort study

Abstract

Objectives: To evaluate changes in health outcomes between years 2 and 3 after discharge following COVID-19 and to identify risk factors for poor health 3-year post-discharge.

Design: This is a multicentre observational cohort study.

Setting: This study was conducted in two centres from Wuhan, China.

Participants: Eligibility screening has been performed in 3988 discharged laboratory-confirmed adult COVID-19 patients. Exclusion criteria were refusal to participate, inability to contact and death before follow-up. The WHO COVID-19 guidelines on defining disease severity were adopted.

Results: 1594 patients participated in the 1-year, 2-year and 3-year follow-ups, including 796 (49.9%) male patients, and 422 (26.5%) patients were classified in the severe disease group. 3 years after discharge, 182 (11.4%) patients still complained of at least one symptom. The most common symptoms were fatigue, myalgia, chest tightness, cough, anxiety, shortness of breath and expectoration. Fatigue or myalgia, the most common symptom cluster, frequently coexisted with chest symptoms and anxiety. Symptom persistence between years 2 and 3 was reported in 70 patients (4.4%) for which intensive care unit (ICU) admission was a risk factor (p=0.038). Of the 1586 patients who completed the chronic obstructive pulmonary disease assessment test (CAT), 97 (6.1%) scored ≥10, with older age being associated with CAT ≥10 (p=0.007).

Conclusions: Between years 2 and 3 after SARS-CoV-2 infection, most patients returned to an asymptomatic state, and only a few were still symptomatic. ICU admission was a risk factor for symptom persistence.

Keywords: COVID-19; Public health; Risk Factors.

Figure 1. Study flowchart.

Figure 2. Symptoms of COVID-19 survivors during 3-year follow-up. (A) Percentage of patients presenting with COVID-19-related symptoms at 1-year, 2-year and 3-year follow-up. (B) Co-occurrence network of symptom clusters 3 years after hospital discharge. Outer circles represent individual symptoms. The outer circle area represents the proportion of participants with that symptom. These are linked to inner circles, which represent symptom clusters. The width of the link lines also represents the proportion of patients with that symptom. The circle area for clusters represents the proportion of participants with at least one symptom from that cluster. Central link lines between symptom clusters represent the co-occurrence of symptom clusters. Line width represents the degree of co-occurrence. (C, D) Proportion of different symptoms in the symptoms persist group and new-onset symptoms group at 3-year follow-up. (E) Factors associated with sequelae at 3-year follow-up. (F) Factors associated with sequelae of respiratory system at 3-year follow-up.

Figure 3. Total and item chronic obstructive pulmonary disease (COPD) assessment test (CAT) scores in patients at 3-year follow-up. (A) Total CAT score at 3 years after patient discharge; lines within bars denote means, and error bars denote 95% CIs. (B) Percentage of patients with CAT score 10 or higher and less than 10. (C) Histogram of responses to individual CAT items; confidence refers to a CAT item concerning confidence leaving the home.