Incidence and risk factors for persistent symptoms in adults previously hospitalized for COVID‐19
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Abstract
Background
The long‐term sequalae of COVID‐19 remain poorly characterized. We assessed persistent symptoms in previously hospitalized patients with COVID‐19 and assessed potential risk factors.
Methods
Data were collected from patients discharged from 4 hospitals in Moscow, Russia between 8 April and 10 July 2020. Participants were interviewed via telephone using an ISARIC Long‐term Follow‐up Study questionnaire.
Results
2,649 of 4755 (56%) discharged patients were successfully evaluated, at median 218 (IQR 200, 236) days post‐discharge. COVID‐19 diagnosis was clinical in 1291 and molecular in 1358. Most cases were mild, but 902 (34%) required supplemental oxygen and 68 (2.6%) needed ventilatory support. Median age was 56 years (IQR 46, 66) and 1,353 (51.1%) were women. Persistent symptoms were reported by 1247 (47.1%) participants, with fatigue (21.2%), shortness of breath (14.5%) and forgetfulness (9.1%) the most common symptoms and chronic fatigue (25%) and respiratory (17.2%) the most common symptom categories. Female sex was associated with any persistent symptom category OR 1.83 (95% CI 1.55 to 2.17) with association being strongest for dermatological (3.26, 2.36 to 4.57) symptoms. Asthma and chronic pulmonary disease were not associated with persistent symptoms overall, but asthma was associated with neurological (1.95, 1.25 to 2.98) and mood and behavioural changes (2.02, 1.24 to 3.18), and chronic pulmonary disease was associated with chronic fatigue (1.68, 1.21 to 2.32).
Conclusions
Almost half of adults admitted to hospital due to COVID‐19 reported persistent symptoms 6 to 8 months after discharge. Fatigue and respiratory symptoms were most common, and female sex was associated with persistent symptoms.
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SciScore for 10.1101/2021.02.17.21251895: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study was approved by the Sechenov University Local Ethics Committee on April 22, 2020 (protocol number 08–20).
Consent: If available by telephone, the patients were asked to provide their verbal consent to the interview.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Cell Line Authentication not detected. Table 2: Resources
Experimental Models: Cell Lines Sentences Resources The study was registered with EuroQoL as part of the ISARIC collaborative effort (EuroQoL ID 37035). EuroQoL ID 37035suggested: NoneSoftware and Algorithms Sentences Resources Data collection and entry were performed by a … SciScore for 10.1101/2021.02.17.21251895: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study was approved by the Sechenov University Local Ethics Committee on April 22, 2020 (protocol number 08–20).
Consent: If available by telephone, the patients were asked to provide their verbal consent to the interview.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Cell Line Authentication not detected. Table 2: Resources
Experimental Models: Cell Lines Sentences Resources The study was registered with EuroQoL as part of the ISARIC collaborative effort (EuroQoL ID 37035). EuroQoL ID 37035suggested: NoneSoftware and Algorithms Sentences Resources Data collection and entry were performed by a team of medical students who signed confidentiality agreements, underwent training in basic data entry into REDCap and telephone interviews. REDCapsuggested: (REDCap, RRID:SCR_003445)Data management: We used REDCap electronic data capture tools (Vanderbilt University, Nashville, TN, USA) hosted at Sechenov University and Microsoft Excel (Microsoft Corp, Redmond, WA, USA) for data collection, storage and management 11,12. Microsoft Excelsuggested: (Microsoft Excel, RRID:SCR_016137)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:At the same time, this cohort study has some limitations. First, the study population only included patients within Moscow, although regional clustering is common to all major cohort studies published during the COVID-19 pandemic. Second, acute data were collected from the electronic medical records with no access to additional information that could be potentially retrieved from the medical notes. Third, almost half of the patients in our cohort did not have RT-PCR confirmed COVID-19 infection, although our previous work 3 showed that clinical features of COVID-19 and in-hospital mortality were the same in COVID-19 clinically diagnosed and laboratory-confirmed cases. We also performed sensitivity analyses using data from the laboratory-confirmed COVID-19 patients only to ensure consistency and robustness of the findings. Fifth, some patients may have developed additional comorbidities or complications since the hospital discharge, which were not appropriately captured and could potentially affect the QoL and symptom prevalence and persistence. There is also a risk of recall bias in reporting quality of life and dyspnoea preceding COVID-19. At 6-8 months follow-up, many patients experienced symptoms from the time of hospital discharge, with chronic fatigue and respiratory problems being the most common sequelae. Most patients reported symptoms at 6-8 months from the time of discharge, although a subgroup reported symptoms limited to a few weeks and/or months after the acute p...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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