6-month consequences of COVID-19 in patients discharged from hospital: a cohort study
- PMID: 33428867
- PMCID: PMC7833295
- DOI: 10.1016/S0140-6736(20)32656-8
6-month consequences of COVID-19 in patients discharged from hospital: a cohort study
Retracted and republished in
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Retraction and republication: 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study.Lancet. 2023 Jun 17;401(10393):2025. doi: 10.1016/S0140-6736(23)01175-3. Epub 2023 Jun 9. Lancet. 2023. Retracted and republished in: Lancet. 2023 Jun 17;401(10393):e21-e33. doi: 10.1016/S0140-6736(23)00810-3. PMID: 37307841 Free PMC article. Retracted and republished. No abstract available.
Expression of concern in
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Expression of concern: 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study.Lancet. 2023 Jan 14;401(10371):90. doi: 10.1016/S0140-6736(22)02370-4. Epub 2022 Nov 24. Lancet. 2023. PMID: 36436530 Free PMC article. No abstract available.
Abstract
Background: The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity.
Methods: We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020. Patients who died before follow-up, patients for whom follow-up would be difficult because of psychotic disorders, dementia, or re-admission to hospital, those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism, those who declined to participate, those who could not be contacted, and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5-6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received severe acute respiratory syndrome coronavirus 2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences.
Findings: In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 (IQR 47·0-65·0) years and 897 (52%) were men. The follow-up study was done from June 16, to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 (175·0-199·0) days. Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients. The proportions of median 6-min walking distance less than the lower limit of the normal range were 24% for those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5-6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5-6, and median CT scores were 3·0 (IQR 2·0-5·0) for severity scale 3, 4·0 (3·0-5·0) for scale 4, and 5·0 (4·0-6·0) for scale 5-6. After multivariable adjustment, patients showed an odds ratio (OR) 1·61 (95% CI 0·80-3·25) for scale 4 versus scale 3 and 4·60 (1·85-11·48) for scale 5-6 versus scale 3 for diffusion impairment; OR 0·88 (0·66-1·17) for scale 4 versus scale 3 and OR 1·77 (1·05-2·97) for scale 5-6 versus scale 3 for anxiety or depression, and OR 0·74 (0·58-0·96) for scale 4 versus scale 3 and 2·69 (1·46-4·96) for scale 5-6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with estimated glomerular filtration rate (eGFR) 90 mL/min per 1·73 m2 or more at acute phase had eGFR less than 90 mL/min per 1·73 m2 at follow-up.
Interpretation: At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery.
Funding: National Natural Science Foundation of China, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, National Key Research and Development Program of China, Major Projects of National Science and Technology on New Drug Creation and Development of Pulmonary Tuberculosis, and Peking Union Medical College Foundation.
Copyright © 2021 Elsevier Ltd. All rights reserved.
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Comment in
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Long-term follow-up of recovered patients with COVID-19.Lancet. 2021 Jan 16;397(10270):173-175. doi: 10.1016/S0140-6736(21)00039-8. Epub 2021 Jan 8. Lancet. 2021. PMID: 33428868 Free PMC article. No abstract available.
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Long-haul COVID: heed the lessons from other infection-triggered illnesses.Lancet. 2021 Mar 13;397(10278):967-968. doi: 10.1016/S0140-6736(21)00446-3. Epub 2021 Mar 5. Lancet. 2021. PMID: 33684352 Free PMC article. No abstract available.
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Anesthesia and the "post-COVID syndrome": Perioperative considerations for patients with prior SARS-CoV-2 infection.J Clin Anesth. 2021 Sep;72:110283. doi: 10.1016/j.jclinane.2021.110283. Epub 2021 Apr 8. J Clin Anesth. 2021. PMID: 33857843 Free PMC article. No abstract available.
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Six-month respiratory outcomes and exercise capacity of COVID-19 acute respiratory failure patients treated with continuous positive airway pressure.Intern Med J. 2021 Nov;51(11):1810-1815. doi: 10.1111/imj.15345. Intern Med J. 2021. PMID: 33961728 Free PMC article.
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Long-term effects of COVID-19 on kidney function.Lancet. 2021 May 15;397(10287):1806-1807. doi: 10.1016/S0140-6736(21)00880-1. Lancet. 2021. PMID: 33992141 Free PMC article. No abstract available.
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Long-term effects of COVID-19 on kidney function.Lancet. 2021 May 15;397(10287):1807. doi: 10.1016/S0140-6736(21)00881-3. Lancet. 2021. PMID: 33992143 Free PMC article. No abstract available.
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