Symptoms persisting after hospitalisation for COVID-19: 12 months interim results of the CO-FLOW study
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Abstract
A large proportion of patients experience a wide range of sequelae after acute COVID-19, especially after severe illness. The long-term health sequelae need to be assessed. Our objective was to longitudinally assess persistence of symptoms and clusters of symptoms up to 12 months after hospitalisation for COVID-19 and to assess determinants of the main persistent symptoms.
Methods
In this multicenter prospective cohort study patients with COVID-19 are followed up for 2 years with measurements at 3, 6, 12 and 24 months after hospital discharge. Here, we present interim results regarding persistent symptoms up to 12 months.
Results
We included 492 patients; mean± sd age was 60.2±10.7 years, 335 (68.1%) were males, median length of hospital stay was 11 (6.0–27.0) days. At 3 months after discharge 97.0% of the patients had at least one persisting symptom, this declined to 95.5% and 92.0% at 6 and 12 months, respectively (p=0.010). Muscle weakness, exertional dyspnoea, fatigue, and memory and concentration problems were the most prevalent symptoms with rates over 50% during follow-up. Over time, muscle weakness, hair loss and exertional dyspnoea decreased significantly (p<0.001), while other symptoms such as fatigue, concentration and memory problems, anosmia and ageusia persisted. Symptoms from the physical and respiratory cluster declined significantly over time, in contrast to the fatigue and cognitive symptom clusters.
Conclusion
The majority of patients experienced COVID-19 sequelae up to 12 months after severe infection. Whereas physical and respiratory symptoms showed slow gradual decline, fatigue and cognitive symptoms did not evidently resolve over time.
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SciScore for 10.1101/2021.12.11.21267652: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The Medical Ethics Committee of the Erasmus Medical Center (MC) approved this study (MEC-2020-0487).
Consent: All patients provided written informed consent before the start of the measurements.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All analyses were performed using Statistical Package for Social Sciences (SPSS) version 25 (IBM SPSS statistics, SPSS Inc, Chicago, IL, USA) and STATA version 8SE SPSSsuggested: (SPSS, RRID:SCR_002865)STATAsuggested: (Stata, RRID:SCR_012763)E (StataCorp LLC, Texas, USA) and R version 4.1.1 (R-Foundation) were used for graphs. …SciScore for 10.1101/2021.12.11.21267652: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The Medical Ethics Committee of the Erasmus Medical Center (MC) approved this study (MEC-2020-0487).
Consent: All patients provided written informed consent before the start of the measurements.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All analyses were performed using Statistical Package for Social Sciences (SPSS) version 25 (IBM SPSS statistics, SPSS Inc, Chicago, IL, USA) and STATA version 8SE SPSSsuggested: (SPSS, RRID:SCR_002865)STATAsuggested: (Stata, RRID:SCR_012763)E (StataCorp LLC, Texas, USA) and R version 4.1.1 (R-Foundation) were used for graphs. StataCorpsuggested: (Stata, RRID:SCR_012763)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:Our study has several strengths and limitations. We followed a large cohort of patients in a longitudinal design at 3, 6, and 12 months after hospital discharge. Currently, long-term follow-up data are scarce. As the study is still ongoing, data were not complete for the entire cohort; also, the initial patients were generally recruited between 3 and 6 months after hospital discharge, resulting in unequal groups at different time points. We therefore included only participants with data of at least two study measurements, and used GEE models to make maximal use of all data and to investigate how symptoms developed over time. One inclusion criterium was that patients or their relatives had to be able to communicate in Dutch or English. Therefore, there is underrepresentation of individuals with a migration background in this study compared to the community where this cohort was established. Nonetheless, 24% of the participants in this cohort had a migration background; migration background was not a predictor of residual symptoms in this study. Another limitation is that our results are only generalizable to hospitalized patients. Also, we did not have patient scores on the severity of complaints. Even though symptoms may persist for considerable time, the severity may very well decrease over time, as was also shown in other studies (16). To summarize, a large number of post COVID-19 patients experienced persistent symptoms up to 12 months after hospitalization for COVID-19. W...
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.
Results from scite Reference Check: We found no unreliable references.
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