Health status and exercise capacity of patients who survived COVID-19 one year after hospital discharge

A wide range of clinical signs, asymptomatic, mild and severe, have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. SARS-CoV-2 is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic.

Background

Prognosis of acute illness was related to the need for intensive care unit (ICU) care, length of hospital stay (LOS), severe respiratory distress, previous comorbidities, and inflammatory markers. In addition, transcriptomic studies have shown that a small set of regulatory genes can be a strong predictor of clinical outcomes in patients with COVID-19. Genomic research has shed light on why a particular individual may be affected by the aftermath of COVID-19 while others are not.

Several definitions have been proposed for long-term COVID. Overall, long-lasting COVID includes a broad spectrum of persistent or new-onset symptoms within one month of SARS-CoV-2 infection. However, the duration of long-term COVID and its health impacts are still unclear.

Although several studies have determined 12-month outcomes of COVID-19, they have been based on telephone interviews. Evidence-based studies are therefore rare to determine the extent of sequelae after infection. Recent PLoS ONE study evaluated the health status and mobility capacity of patients recovered from COVID-19 one year after hospital discharge.

About studying

This multicenter prospective cohort study included 1,904 patients infected with SARS-CoV-2 from three acute care hospitals in Barcelona, ​​Spain. Among them, fifty patients from each center were randomly selected, which included 58% males and 42% females.

All selected participants were adults with PCR-confirmed SARS-CoV-2 infection, required hospital admission, and had COVID-19 pneumonia between 28 February and 15 April 2020. Epidemiological and demographic details of the study cohort were obtained, along with their economic status , details of ICU admission, comorbidities, radiological findings and laboratory test reports.

During the follow-up visit after one year, between February 2021 and May 2021, a comprehensive medical evaluation focused on persistent symptoms was performed and a complete physical examination was also performed. During the physical assessment, all participants who could walk unaided completed a 6-minute walk test (6MWT). In this test, mean peripheral oxygen saturation (Sp02) was recorded before and after the 6MWT. The level of dyspnea was measured after completion of the 6MWT based on the Borg Perceived Exertion Scale.

Study results

Among the randomly selected patients, 50% were retired and 70% had never smoked. Median LOS was nine days and 7% of patients required mechanical ventilation. Baseline peripheral oxygen saturation (Sp02) of the cohort was ≤ 94%. During the acute phase of the disease, around 23% of patients suffered from acute respiratory distress syndrome.

Follow-up visits revealed that about 80% of patients complained of at least one persistent symptom, mostly dyspnea, followed by arthromyalgia, paresthesia, subjective memory loss, and asthenia. The findings of this study were consistent with previous studies that reported persistent dyspnea after one year of recovery from severe COVID-19 illness requiring hospitalization. Despite a higher percentage of persistent dyspnea, no significant abnormalities were found on chest radiographs.

Due to the presence of interstitial infiltrates, 14% of patients showed abnormal X-rays. It was observed that only 7% of the study cohort required hospitalization during the follow-up period.

Multivariate regression analysis showed that female gender, chronic obstructive pulmonary disease (COPD) and smoking were independent risk factors for persistent dyspnea. Previous studies have shown that women were more susceptible to long-term COVID. This may be due to hormones that could influence the hyperinflammatory state of the acute phase, even after recovery.

Approximately 50% of patients failed to reach the theoretical reference values ​​for the 6MWT test. Only 5% of patients had a decrease in saturation after completing the 6MWT. Pulmonary diffusion disorders and extrapulmonary causes such as cytokine disorders, viral myositis, muscle wasting, corticosteroid-induced myopathy, and deconditioning could account for the loss of locomotor capacity in patients who have recovered from COVID-19.

Conclusions

A key strength of this study was its large multicenter cohort containing severely infected COVID-19 patients alive at least one year after hospital discharge. However, due to the lack of data regarding the patients’ baseline situation before hospital admission, the authors were unable to determine whether some of the symptoms were already prevalent before the infection with COVID-19.

Furthermore, only a small number of patients were followed and no control group was evaluated. Another limitation of this study was that patients included in the cohort were infected during the first wave of COVID-19. Therefore, the findings may not exactly correspond to the current situation with the prevalence of vaccines and the occurrence of SARS-CoV-2 variants.

Taken together, a large number of patients from the first wave of the pandemic cured of COVID-19 showed persistent symptomatology and poor exercise capacity, even one year after hospital discharge.