Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge

Key Points

Question

What respiratory, functional, and psychological sequalae are associated with recovery from coronavirus disease 2019 (COVID-19)?

Findings

In this cohort study of 238 patients with COVID-19 hospitalized in an academic hospital in Northern Italy, more than half of participants had a significant reduction of diffusing lung capacity for carbon monoxide or measurable functional impairment and approximately one-fifth of patients had symptoms of posttraumatic stress 4 months after discharge.

Meaning

These findings suggest that despite virological recovery, a sizable proportion of patients with COVID-19 experienced respiratory, functional, or psychological sequelae months after hospital discharge.

Abstract

This cohort study examines prevalence and risk factors associated with lung function or physical impairment or posttraumatic stress symptoms among survivors of severe coronavirus disease 2019 (COVID-19).

Abstract

Importance

Although plenty of data exist regarding clinical manifestations, course, case fatality rate, and risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19), long-term respiratory and functional sequelae in survivors of COVID-19 are unknown.

Objective

To evaluate the prevalence of lung function anomalies, exercise function impairment, and psychological sequelae among patients hospitalized for COVID-19, 4 months after discharge.

Design, Setting, and Participants

This prospective cohort study at an academic hospital in Northern Italy was conducted among a consecutive series of patients aged 18 years and older (or their caregivers) who had received a confirmed diagnosis of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection severe enough to require hospital admission from March 1 to June 29, 2020. SARS-CoV-2 infection was confirmed via reverse transcription–polymerase chain reaction testing, bronchial swab, serological testing, or suggestive computed tomography results.

Exposure

Severe COVID-19 requiring hospitalization.

Main Outcomes and Measures

The primary outcome of the study was to describe the proportion of patients with a diffusing lung capacity for carbon monoxide (D _lco ) less than 80% of expected value. Secondary outcomes included proportion of patients with severe lung function impairment (defined as D _lco <60% expected value); proportion of patients with posttraumatic stress symptoms (measured using the Impact of Event Scale–Revised total score); proportion of patients with functional impairment (assessed using the Short Physical Performance Battery [SPPB] score and 2-minute walking test); and identification of factors associated with D _lco reduction and psychological or functional sequelae.

Results

Among 767 patients hospitalized for severe COVID-19, 494 (64.4%) refused to participate, and 35 (4.6%) died during follow-up. A total of 238 patients (31.0%) (median [interquartile range] age, 61 [50-71] years; 142 [59.7%] men; median [interquartile range] comorbidities, 2 [1-3]) consented to participate to the study. Of these, 219 patients were able to complete both pulmonary function tests and D _lco measurement. D _lco was reduced to less than 80% of the estimated value in 113 patients (51.6%) and less than 60% in 34 patients (15.5%). The SPPB score was suggested limited mobility (score <11) in 53 patients (22.3%). Patients with SPPB scores within reference range underwent a 2-minute walk test, which was outside reference ranges of expected performance for age and sex in 75 patients (40.5%); thus, a total of 128 patients (53.8%) had functional impairment. Posttraumatic stress symptoms were reported in a total of 41 patients (17.2%).

Conclusions and Relevance

These findings suggest that at 4 months after discharge, respiratory, physical, and psychological sequelae were common among patients who had been hospitalized for COVID-19.