Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection

Laurie G Jacobs, Elli Gourna Paleoudis, Dineen Lesky-Di Bari, Themba Nyirenda, Tamara Friedman, Anjali Gupta, Lily Rasouli, Marygrace Zetkulic, Bindu Balani, Chinwe Ogedegbe, Harinder Bawa, Lauren Berrol, Nabiha Qureshi, Judy L Aschner, Laurie G Jacobs, Elli Gourna Paleoudis, Dineen Lesky-Di Bari, Themba Nyirenda, Tamara Friedman, Anjali Gupta, Lily Rasouli, Marygrace Zetkulic, Bindu Balani, Chinwe Ogedegbe, Harinder Bawa, Lauren Berrol, Nabiha Qureshi, Judy L Aschner

Abstract

Background: Characterizing the prevalence and persistence of symptoms associated with COVID-19 infection following hospitalization and their impact is essential to planning post-acute community-based clinical services. This study seeks to identify persistent COVID-19 symptoms in patients 35 days post-hospitalization and their impact on quality of life, health, physical, mental, and psychosocial function.

Methods and findings: This prospective cohort study used the PROMIS® Instruments to identify symptoms and quality of life parameters in consecutively enrolled patients between March 22 and April 16, 2020, in New Jersey. The 183 patients (median age 57 years; 61.5% male, 54.1% white) reported persistent symptoms at 35 days, including fatigue (55.0%), dyspnea (45.3%), muscular pain (51%), associated with a lower odds rating general health (41.5%, OR 0.093 [95% CI: 0.026, 0.329], p = 0.0002), quality of life (39.8%; OR 0.116 [95% CI: 0.038, 0.364], p = 0.0002), physical health (38.7%, OR 0.055 [95% CI: 0.016, 0.193], p <0.0001), mental health (43.7%, OR 0.093 [95% CI: 0.021, 0.418], p = 0.0019) and social active role (38.7%, OR 0.095 [95% CI: 0.031, 0.291], p<0.0001), as very good/excellent, particularly adults aged 65 to 75 years (OR 8·666 [95% CI: 2·216, 33·884], p = 0·0019).

Conclusions: COVID-19 symptoms commonly persist to 35 days, impacting quality of life, health, physical and mental function. Early post-acute evaluation of symptoms and their impact on function is necessary to plan community-based services.

Conflict of interest statement

Laurie G. Jacobs -no conflicts of interest, no financial relationships Elli Gourna Paleoudis -no conflicts of interest, no financial relationships Dineen Lesky-DiBari - no conflicts of interest, no financial relationships Anjali Gupta -no conflicts of interest, no financial relationships Lily Rasoulli - no conflicts of interest, no financial relationships Themba Nyrirenda - no conflicts of interest, no financial relationships Tamara Friedman - no conflicts of interest, no financial relationships Marygrace Zetkulic -no conflicts of interest, no financial relationships Bindu Balani - Financial relationships: Gilead- PI, Remdisivir clinical trial, 2020, personal fees; Merck advisory committee; Abbvie speaker, personal fees Chinwe Ogedegbe -no conflicts of interest, no financial relationships Harinder Bawa -no conflicts of interest, no financial relationships Nabiha Qureshi -no conflicts of interest, no financial relationships Lauren Berrol -no conflicts of interest, no financial relationships Judy Aschner -Gilead Science, stock owner" We confirm that the competing interests and financial relationships statement above is correct and that this does not alter our adherence to PLOS ONE policies on sharing data and materials.

References

    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. 10.1016/S0140-6736(20)30183-5
    1. World Health Organization. Coronavirus disease (COVID-19) Situation Report– 159. Available from: . Accessed June 27, 2020.
    1. Centers for Disease Control and Prevention. 2020. Coronavirus Disease 2019 (COVID-19), Cases, Data, & Surveillance. Available from: . Accessed June, 27, 2020.
    1. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052–59. 10.1001/jama.2020.6775
    1. Potere N, Valeriani E, Candeloro M, et al. Acute complications and mortality in hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis. Crit Care 2020;24:389 Published 2020 Jul 2. 10.1186/s13054-020-03022-1
    1. Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–20. 10.1056/NEJMoa2002032
    1. Keeley P, Buchanan D, Carolan C, Pivodic L, Tavabie S, Noble S. Symptom burden and clinical profile of COVID-19 deaths: a rapid systematic review and evidence summary [published online ahead of print, 2020 May 28]. BMJ Support Palliat Care. 2020; bmjspcare-2020-002368. 10.1136.
    1. Hendren NS, Drazner MH, Bozkurt B, Cooper L. Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome. Circulation. 2020;141:1903–14. 10.1161/CIRCULATIONAHA.120.047349
    1. Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up. JACC State-of-the-Art Review. JACC. 2020;75:2950–73. 10.1016/j.jacc.2020.04.031
    1. Park SY, Yun SG, Shin JW, et al. Persistent severe acute respiratory syndrome coronavirus 2 detection after resolution of coronavirus disease 2019-associated symptoms/signs [published online ahead of print, 2020 Jun 19]. Korean J Intern Med. 2020;10.3904/kjim.2020.203. 10.3904/kjim.2020.203
    1. Carfì A, Bernabei R, Landi F, for the Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA. 2020. Published Online: July 9, 2020. 10.1001/jama.2020.12603
    1. PROMIS Scale v1.2—Global Health 13Apr2018. Available from: . Accessed April 1, 2020.
    1. PROMIS Short Form v1.0—Dyspnea Functional Limitations - 10a 02Sept2016. Available from: . Accessed: April 1, 2020.
    1. WHO R&D Blueprint novel Coronavirus COVID-19 Therapeutic Trial Synopsis. Page 6. February 18, 2020. Available from: . Accessed June 28, 2020.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81. 10.1016/j.jbi.2008.08.010
    1. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208 10.1016/j.jbi.2019.103208
    1. DeSalvo KB, Fan VS, McDonell MD, Fihn SD. Predicting mortality and healthcare utilization with a single question. Health Serv Res. 2005;40:1234–46. 10.1111/j.1475-6773.2005.00404.x
    1. Centers for Disease Control and Prevention. Healthy Weight. Assessing your weight. About BMI. Available from: (accessed June 28, 2020).
    1. Simmons RK, Alberti KGMM, Gale EAM, et al. The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation. Diabetologia. 2010;53,600–605. 10.1007/s00125-009-1620-4
    1. CMS Learning Network. MLN booklet. Home Oxygen Therapy. Page 3. October 2017. Available from: . Accessed July 10, 2020.
    1. Jin J-M, Bai P, He W, et al. Gender Differences in Patients With COVID-19: Focus on Severity and Mortality. Front. Public Health. 2020,8:152 10.3389/fpubh.2020.00152 April. 10.3389/fpubh.2020.00152.
    1. Gebhard C, Regitz-Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ. 2020;11:29 Published 2020 May 25. 10.1186/s13293-020-00304-9
    1. Barsky AJ, Peekna HM, Borus JF. Somatic Symptom Reporting in Women and Men. J Gen Intern Med. 2001;16:266–75. 10.1046/j.1525-1497.2001.00229.x
    1. Cydulka RK, Emerman CL, Rowe BH, et al. Differences between men and women in reporting of symptoms during an asthma exacerbation. Ann of Emerg Med. 2001;38:123–28. 10.1067/mem.2001.114305
    1. Gonzalez-Reiche AS, Hernandez MM, Sullivan MJ, et al. Introductions and early spread of SARS-CoV-2 in the New York City area [published online ahead of print, 2020 May 29]. Science. 2020; eabc1917 10.1126/science.abc1917
    1. Ahmed H, Patel K, Greenwood DC. Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and meta-analysis. J Rehabil Med. 2020. May 31;52:jrm00063 10.2340/16501977-2694
    1. Ngai JC, Ko FW, Ng SS, To KW, Tong M, Hui DS. The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status. Respirology. 2010;15:543–50. 10.1111/j.1440-1843.2010.01720.x
    1. Iannaccone S, Alemanno F, Houdayer E, et al. COVID-19 rehabilitation units are twice as expensive as regular rehabilitation units. J Rehabil Med. 2020;52: jrm00073 Published 2020 Jun 30. 10.2340/16501977-2704
    1. Lam M H-B, Wing Y-K, Yu M W-M, et al. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors. Long-term follow-up. Arch Intern Med. 2009;169:2142–47. 10.1001/archinternmed.2009.384

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe