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December 30, 2020

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Long-term Outcomes in Patients Hospitalized with COVID-19

Reviewed by Milana Bogorodskaya, M.D.

As the COVID-19 pandemic continues, it has become apparent that many patients suffer long-term sequelae. Two recent brief articles describe the long-term (6-8 weeks) patient outcomes after discharge from the hospital. Both observational cohorts had a mean age in early 60s, with around 60% requiring supplemental oxygen and a median length of hospital stay of 5-7 days.

In Annals of Internal Medicine, Chopra et al. describe an observational cohort of 1,648 patients (62.7% non-white) with COVID-19 discharged from 38 hospitals in Michigan. The in-hospital mortality rate was 24.2%, and the 60-day mortality rate was 29.2%; 78% were discharged home. At 60-day follow-up from discharge, 15.1% were readmitted. The study was able to reach 488 (41.8%) patients who remained alive at 60 days of follow-up. They found that 159 (32.6%) reported persistent symptoms, with the most common being breathlessness walking up stairs (70.4%) followed by shortness of breath, chest tightness, or wheezing (50.9%), and cough (47.2%), and 38.5% reported not being able to return to normal activity. Of 195 individuals who were employed prior to their infection, 117 (60%) were able to return to work, with 30 (25.6%) of those reporting reduced hours or modified duties due to health reasons.

Mandal et al., reporting in Thorax, describe an observational cohort of 479 patients (45.1% non-white) with COVID-19 discharged from three different hospitals in London, U.K. The study was able to reach 92% of those they contacted with 2.8% refusing to participate. At a median of 54 days of follow-up, patients reported a median overall recovery health grade of 90%, and 276 (71.9%) reported persistence of at least one symptom, with the most common being fatigue, followed by poor sleep quality and breathlessness. Of those who had follow-up blood test results, 7.3% of patients had persistent lymphopenia, 30.1% had elevated D-dimer, and 9.5% had elevated C-reactive protein. Of those who had a follow-up chest X-ray, 89% were normal or improved, 2% were unchanged, and 9% showed significant deterioration.

These two studies suggest that symptoms can persist long after patients are discharged from the hospital and that there is a need for close follow-up in the few months after an infection.

(Chopra et al. Ann Intern Med. Published online: Nov. 11, 2020.)

(Mandal at al. Thorax. Published online: Nov. 10, 2020.)

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