Patient outcomes after hospitalisation with COVID-19 and implications for follow-up; results from a prospective UK cohort

• DOI: 10.1101/2020.08.12.20173526
• Publication Date: 2020-08-14T23:41:19Z
• Authors: DT Arnold; FW Hamilton; A Milne; A Morley; J Viner; M Attwood; A Noel; S Gunning; J Hatrick; S Hamilton; KT Elvers; C Hyams; A Bibby; E Moran; H Adamali; J Dodd; NA Maskell; S Barratt
• Keywords: Pulmonary and Respiratory Medicine; Adult; Male; 610; Brief Communication; name=Academic Respiratory Unit; 03 medical and health sciences; 0302 clinical medicine; 616; Humans; Prospective Studies; Pandemics; Aged; SARS-CoV-2; /dk/atira/pure/core/keywords/FHS/academic_respiratory_unit; /dk/atira/pure/core/keywords/FHS/academic_respiratory_unit; name=Academic Respiratory Unit; COVID-19; Middle Aged; United Kingdom; 3. Good health; Hospitalization; /dk/atira/pure/core/keywords/uob_covid19; /dk/atira/pure/core/keywords/uob_covid19; name=Covid19; name=Covid19; Female; Follow-Up Studies

ABSTRACTBackgroundCOVID-19 causes a wide spectrum of disease. The incidence and severity of sequelae after the acute infection is uncertain. Data measuring the longer-term impact of COVID-19 on symptoms, radiology and pulmonary function are urgently needed to plan follow-up services.MethodsConsecutive patients hospitalised with COVID-19 were prospectively recruited to this observational study with outcomes recorded at 28-days. All were invited to a systematic follow up at 8-12 weeks, including chest radiograph, spirometry, exercise test, bloods, and health-related quality of life (HRQoL) questionnaires.FindingsBetween 30th March and 3rd June 2020, 163 patients with COVID-19 were recruited. Median hospital length of stay was 5 days (IQR 2-8) and 19 patients died. At 8-12 weeks post admission, 134 patients were available for follow up and 110 attended. Most (74%) had persistent symptoms (notably breathlessness and excessive fatigue) with reduced HRQoL.Only patients who required oxygen therapy in hospital had abnormal radiology, clinical examination or spirometry at follow up. Thirteen (12%) patients had an abnormal chest X-ray with improvement in all but 2 from admission. Eleven (10%) had restrictive spirometry. Blood test abnormalities had returned to baseline in the majority (104/110).InterpretationPatients with COVID-19 remain highly symptomatic at 8-12 weeks, however, clinical abnormalities requiring action are infrequent, especially in those without a supplementary oxygen requirement during their acute illness. This has significant implications for physicians assessing patients with persistent symptoms, suggesting that a more holistic approach focussing on rehabilitation and general wellbeing is paramount.FundingSouthmead Hospital Charity