Comprehensive Health Assessment 3 Months After Recovery From Acute Coronavirus Disease 2019 (COVID-19)

Abstract Background Long-term health sequelae of coronavirus disease 2019 (COVID-19) may be multiple but have thus far not been systematically studied. Methods All patients discharged after COVID-19 from the Radboud University Medical Center, Nijmegen, the Netherlands, were consecutively invited to a multidisciplinary outpatient facility. Also, nonadmitted patients with mild disease but with symptoms persisting >6 weeks could be referred by general practitioners. Patients underwent a standardized assessment including measurements of lung function, chest computed tomography (CT)/X-ray, 6-minute walking test, body composition, and questionnaires on mental, cognitive, health status, and quality of life (QoL). Results 124 patients (59 ± 14 years, 60% male) were included: 27 with mild, 51 with moderate, 26 with severe, and 20 with critical disease. Lung diffusion capacity was below the lower limit of normal in 42% of discharged patients. 99% of discharged patients had reduced ground-glass opacification on repeat CT imaging, and normal chest X-rays were found in 93% of patients with mild disease. Residual pulmonary parenchymal abnormalities were present in 91% of discharged patients and correlated with reduced lung diffusion capacity. Twenty-two percent had low exercise capacity, 19% low fat-free mass index, and problems in mental and/or cognitive function were found in 36% of patients. Health status was generally poor, particularly in the domains functional impairment (64%), fatigue (69%), and QoL (72%). Conclusions This comprehensive health assessment revealed severe problems in several health domains in a substantial number of ex–COVID-19 patients. Longer follow-up studies are warranted to elucidate natural trajectories and to find predictors of complicated long-term trajectories of recovery.

[1]  B. Balbi,et al.  Low physical functioning and impaired performance of activities of daily life in COVID-19 patients who survived hospitalisation , 2020, European Respiratory Journal.

[2]  H. Prescott,et al.  Recovery From Severe COVID-19: Leveraging the Lessons of Survival From Sepsis. , 2020, JAMA.

[3]  F. Benedetti,et al.  Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors , 2020, Brain, Behavior, and Immunity.

[4]  Cuiyun Yuan,et al.  Chest Computed Tomography and Clinical Follow-Up of Discharged Patients with COVID-19 in Wenzhou City, Zhejiang, China , 2020, Annals of the American Thoracic Society.

[5]  Yanfeng Gao,et al.  Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery , 2020, EClinicalMedicine.

[6]  X. Tang,et al.  Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections , 2020, Nature Medicine.

[7]  G. Keser,et al.  Cytokine storm in COVID-19: pathogenesis and overview of anti-inflammatory agents used in treatment , 2020, Clinical Rheumatology.

[8]  H. Shan,et al.  Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase , 2020, Respiratory Research.

[9]  George M. Varghese,et al.  Clinical management of COVID-19 , 2020, The Indian journal of medical research.

[10]  Fergus Gleeson,et al.  COVID-19 patients and the radiology department – advice from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI) , 2020, European Radiology.

[11]  G. Singhania,et al.  An Atypical Presentation of Novel Coronavirus Disease 2019 (COVID-19) , 2020, The American Journal of Medicine.

[12]  Kevin McCarthy,et al.  Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement , 2019, American journal of respiratory and critical care medicine.

[13]  V. Brusasco,et al.  2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung , 2017, European Respiratory Journal.

[14]  C. A. Groot,et al.  Persistence of impaired health status of Q fever patients 4 years after the first Dutch outbreak , 2015, Epidemiology and Infection.

[15]  E. Wouters,et al.  New reference values for body composition by bioelectrical impedance analysis in the general population: results from the UK Biobank. , 2014, Journal of the American Medical Directors Association.

[16]  G. Biessels,et al.  The Telephone Interview for Cognitive Status (Modified): Relation with a comprehensive neuropsychological assessment , 2012, Journal of clinical and experimental neuropsychology.

[17]  D. Needham,et al.  Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders' conference* , 2012, Critical care medicine.

[18]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[19]  J. Molema,et al.  Development of a battery of instruments for detailed measurement of health status in patients with COPD in routine care: the Nijmegen Clinical Screening Instrument , 2009, Quality of Life Research.

[20]  G. Viegi,et al.  Standardisation of the measurement of lung volumes , 2005, European Respiratory Journal.

[21]  I. McDowell,et al.  A global clinical measure of fitness and frailty in elderly people , 2005, Canadian Medical Association Journal.

[22]  J. Sung,et al.  Impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors , 2005, Thorax.

[23]  L. Poon,et al.  Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia : a prospective study , 2003 .

[24]  M. Poulain,et al.  6-minute walk testing is more sensitive than maximal incremental cycle testing for detecting oxygen desaturation in patients with COPD. , 2003, Chest.

[25]  Arthur S Slutsky,et al.  One-year outcomes in survivors of the acute respiratory distress syndrome. , 2003, The New England journal of medicine.

[26]  G. Serban Assessing Psychological Trauma and PTSD , 1999 .

[27]  N. Aaronson,et al.  Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. , 1998, Journal of clinical epidemiology.

[28]  A. Beck,et al.  Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care. , 1997, Behaviour research and therapy.

[29]  J. Dijkman,et al.  The development of the 'Quality-of-life for Respiratory Illness Questionnaire (QOL-RIQ)': a disease-specific quality-of-life questionnaire for patients with mild to moderate chronic non-specific lung disease. , 1997, Respiratory medicine.

[30]  G. Bleijenberg,et al.  Dimensional assessment of chronic fatigue syndrome. , 1994, Journal of psychosomatic research.

[31]  C K Wells,et al.  Evaluation of clinical methods for rating dyspnea. , 1988, Chest.

[32]  R. Larsen,et al.  The Satisfaction with Life Scale , 1985, Journal of personality assessment.

[33]  R. Snaith,et al.  The Hospital Anxiety And Depression Scale , 2003, Health and quality of life outcomes.

[34]  D. Broadbent,et al.  The Cognitive Failures Questionnaire (CFQ) and its correlates. , 1982, The British journal of clinical psychology.

[35]  M. Bergner,et al.  The Sickness Impact Profile: Development and Final Revision of a Health Status Measure , 1981, Medical care.

[36]  C. E. WHO Coronavirus Disease (COVID-19) Dashboard , 2020 .

[37]  Cuiyun Yuan,et al.  Chest CT and Clinical Follow-up of Discharged Patients with COVID-19 in Wenzhou City, Zhejiang, China , 2020 .

[38]  Jesse B. Hall,et al.  ICU-acquired weakness and recovery from critical illness. , 2014, The New England journal of medicine.

[39]  Helena Motlagh,et al.  Impact of Event Scale-revised. , 2010, Journal of physiotherapy.

[40]  H. Folgering,et al.  An integral assessment framework of health status in chronic obstructive pulmonary disease (COPD) , 2008, International journal of behavioral medicine.

[41]  ATS Statement , 2002 .