Symptoms and Health Outcomes Among Survivors of COVID-19 Infection 1 Year After Hospital Discharge | Chronic Obstructive Pulmonary Disease | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Symptoms and Health Outcomes Among Survivors of COVID-19 Infection 1 Year After Discharge From Hospitals in Wuhan, China

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are the long-term health outcomes associated with COVID-19 infection 1 year after hospital discharge?

Findings  In this cohort study of 2433 patients who had been hospitalized with COVID-19, the most common symptoms at 1 year after discharge were fatigue, sweating, chest tightness, anxiety, and myalgia. Patients with severe disease had more postinfection symptoms and higher chronic obstructive pulmonary disease assessment test scores.

Meaning  This study reported prolonged symptoms of COVID-19 and found that severe disease during hospitalization was a risk factor for more symptoms and higher chronic obstructive pulmonary disease assessment test scores.

Abstract

Importance  The long-term health outcomes and symptom burden of COVID-19 remain largely unclear.

Objective  To evaluate health outcomes of COVID-19 survivors 1 year after hospital discharge and to identify associated risk factors.

Design, Setting, and Participants  This retrospective, multicenter cohort study was conducted at 2 designated hospitals, Huoshenshan Hospital and Taikang Tongji Hospital, both in Wuhan, China. All adult patients with COVID-19 discharged between February 12 and April 10, 2020, were screened for eligibility. Of a consecutive sample of 3988 discharged patients, 1555 were excluded (796 declined to participate and 759 were unable to be contacted) and the remaining 2433 patients were enrolled. All patients were interviewed via telephone from March 1 to March 20, 2021. Statistical analysis was performed from March 28 to April 18, 2021.

Exposures  COVID-19.

Main Outcomes and Measures  All patients participated in telephone interviews using a series of questionnaires for evaluation of symptoms, along with a chronic obstructive pulmonary disease (COPD) assessment test (CAT). Logistic regression models were used to evaluate risk factors for fatigue, dyspnea, symptom burden, or higher CAT scores.

Results  Of 2433 patients at 1-year follow-up, 1205 (49.5%) were men and 680 (27.9%) were categorized into the severe disease group as defined by the World Health Organization guideline; the median (IQR) age was 60.0 (49.0-68.0) years. In total, 1095 patients (45.0%) reported at least 1 symptom. The most common symptoms included fatigue, sweating, chest tightness, anxiety, and myalgia. Older age (odds ratio [OR], 1.02; 95% CI, 1.01-1.02; P < .001), female sex (OR, 1.27; 95% CI, 1.06-1.52; P = .008), and severe disease during hospital stay (OR, 1.43; 95% CI, 1.18-1.74; P < .001) were associated with higher risks of fatigue. Older age (OR, 1.02; 95% CI, 1.01-1.03; P < .001) and severe disease (OR, 1.51; 95% CI, 1.14-1.99; P = .004) were associated with higher risks of having at least 3 symptoms. The median (IQR) CAT score was 2 (0-4), and a total of 161 patients (6.6%) had a CAT score of at least 10. Severe disease (OR, 1.84; 95% CI, 1.31-2.58; P < .001) and coexisting cerebrovascular diseases (OR, 1.95; 95% CI, 1.07-3.54; P = .03) were independent risk factors for CAT scores of at least 10.

Conclusions and Relevance  This study found that patients with COVID-19 with severe disease during hospitalization had more postinfection symptoms and higher CAT scores.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Accepted for Publication: July 17, 2021.

Published: September 29, 2021. doi:10.1001/jamanetworkopen.2021.27403

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Zhang X et al. JAMA Network Open.

Corresponding Authors: Li Li, MD, Professor, Department of Respiratory Medicine (dpyyhxlili@tmmu.edu.cn), and Lixia Cheng, MS, Department of Medical Quality Management (clx109@tmmu.edu.cn), Daping Hospital, Army Medical University, Chongqing 400042, China.

Author Contributions: Dr Li and L. Cheng had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Mss Zhang and F. Wang and Dr Shen contributed equally to this work.

Concept and design: Shen, Liu, He, Cao, Cheng, Li.

Acquisition, analysis, or interpretation of data: Xue Zhang, F. Wang, Shen, Xiao-Hua Zhang, Cen, B. Wang, Zhao, Zhou, Hu, M. Wang, Miao, Jones, Ma, Cao, Cheng, Li.

Drafting of the manuscript: Xue Zhang, F. Wang, Shen, Xiao-Hua Zhang, Cen, B. Wang, Zhou, Hu, M. Wang, He, Cao, Cheng, Li.

Critical revision of the manuscript for important intellectual content: Shen, Zhao, Liu, Miao, Jones, Ma, Li.

Statistical analysis: F. Wang, Shen, Zhao, Ma.

Obtained funding: Ma, Cheng, Li.

Administrative, technical, or material support: Shen, Liu.

Supervision: Shen.

Conflict of Interest Disclosures: Dr Jones reported personal fees from GlaxoSmithKline Employee and stocks and shares from GlaxoSmithKline outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported by the National Natural Science Foundation of China (81672287), the Joint Scientific Research Project of the Chongqing Health Commission and the Science and Technology Commission (2020FYYX213),the Outstanding Youth Science Fund of Chongqing (cstc2020jcyjjqX0014), Chongqing Talent Fund (CQYC202005003) and by the Science Foundation for Outstanding Young People of the Army Medical University.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Wiersinga  WJ , Rhodes  A , Cheng  AC , Peacock  SJ , Prescott  HC .  Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review.   JAMA. 2020;324(8):782-793. doi:10.1001/jama.2020.12839PubMedGoogle Scholar
2.
Huang  Y , Tan  C , Wu  J ,  et al.  Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase.   Respir Res. 2020;21(1):163. doi:10.1186/s12931-020-01429-6PubMedGoogle Scholar
3.
Wang  F , Kream  RM , Stefano  GB .  Long-term respiratory and neurological sequelae of COVID-19.   Med Sci Monit. 2020;26:e928996. doi:10.12659/MSM.928996PubMedGoogle Scholar
4.
Liu  J , Deswal  A , Khalid  U .  COVID-19 myocarditis and long-term heart failure sequelae.   Curr Opin Cardiol. 2021;36(2):234-240. doi:10.1097/HCO.0000000000000832PubMedGoogle Scholar
5.
Carfì  A , Bernabei  R , Landi  F ; Gemelli Against COVID-19 Post-Acute Care Study Group.  Persistent symptoms in patients after acute COVID-19.   JAMA. 2020;324(6):603-605. doi:10.1001/jama.2020.12603PubMedGoogle Scholar
6.
Yelin  D , Wirtheim  E , Vetter  P ,  et al.  Long-term consequences of COVID-19: research needs.   Lancet Infect Dis. 2020;20(10):1115-1117. doi:10.1016/S1473-3099(20)30701-5PubMedGoogle Scholar
7.
Liu  C , Ye  L , Xia  R ,  et al.  Chest computed tomography and clinical follow-up of discharged patients with COVID-19 in Wenzhou City, Zhejiang, China.   Ann Am Thorac Soc. 2020;17(10):1231-1237. doi:10.1513/AnnalsATS.202004-324OCPubMedGoogle Scholar
8.
Xiong  Q , Xu  M , Li  J ,  et al.  Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study.   Clin Microbiol Infect. 2021;27(1):89-95. doi:10.1016/j.cmi.2020.09.023PubMedGoogle Scholar
9.
Zhao  YM , Shang  YM , Song  WB ,  et al.  Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery.   EClinicalMedicine. 2020;25:100463. doi:10.1016/j.eclinm.2020.100463PubMedGoogle Scholar
10.
Huang  C , Huang  L , Wang  Y ,  et al.  6-month consequences of COVID-19 in patients discharged from hospital: a cohort study.   Lancet. 2021;397(10270):220-232. doi:10.1016/S0140-6736(20)32656-8PubMedGoogle Scholar
11.
Wu  X , Liu  X , Zhou  Y ,  et al.  3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study.   Lancet Respir Med. 2021;9(7):747-754. doi:10.1016/S2213-2600(21)00174-0PubMedGoogle Scholar
12.
Fernández-de-Las-Peñas  C , Guijarro  C , Plaza-Canteli  S , Hernández-Barrera  V , Torres-Macho  J .  Prevalence of post-COVID-19 cough one year after SARS-CoV-2 Infection: a multicenter study.   Lung. 2021;199(3):249-253. doi:10.1007/s00408-021-00450-wPubMedGoogle Scholar
13.
Jones  PW , Harding  G , Berry  P , Wiklund  I , Chen  WH , Kline Leidy  N .  Development and first validation of the COPD assessment test.   Eur Respir J. 2009;34(3):648-654. doi:10.1183/09031936.00102509PubMedGoogle Scholar
14.
Daynes  E , Gerlis  C , Briggs-Price  S , Jones  P , Singh  SJ .  COPD assessment test for the evaluation of COVID-19 symptoms.   Thorax. 2021;76(2):185-187. doi:10.1136/thoraxjnl-2020-215916PubMedGoogle Scholar
15.
China National Health Commission. Chinese clinical guidance for COVID-19 pneumonia diagnosis and treatment. Accessed December 10, 2020. http://kjfy.meetingchina.org/msite/news/show/cn/3337.html
16.
Vogelmeier  CF , Criner  GJ , Martinez  FJ ,  et al.  Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD executive summary.   Respirology. 2017;22(3):575-601. doi:10.1111/resp.13012PubMedGoogle Scholar
17.
Jones  PW , Tabberer  M , Chen  WH .  Creating scenarios of the impact of COPD and their relationship to COPD Assessment Test (CAT™) scores.   BMC Pulm Med. 2011;11:42. doi:10.1186/1471-2466-11-42PubMedGoogle Scholar
18.
Li  L , Fang  X , Cheng  L ,  et al.  Development and validation of a prognostic nomogram for predicting in-hospital mortality of COVID-19: a multicenter retrospective cohort study of 4086 cases in China.   Aging (Albany NY). 2021;13(3):3176-3189. doi:10.18632/aging.202605PubMedGoogle Scholar
19.
Organization  WH .  Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. Interim guidance.   Pediatr Med Rodz. 2020;16(1):9-26. doi:10.15557/PiMR.2020.0003Google Scholar
20.
Bourgonje  AR , Abdulle  AE , Timens  W ,  et al.  Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19).   J Pathol. 2020;251(3):228-248. doi:10.1002/path.5471PubMedGoogle Scholar
21.
Logue  JK , Franko  NM , McCulloch  DJ ,  et al.  Sequelae in adults at 6 months after COVID-19 infection.   JAMA Netw Open. 2021;4(2):e210830. doi:10.1001/jamanetworkopen.2021.0830PubMedGoogle Scholar
22.
Fan  E , Dowdy  DW , Colantuoni  E ,  et al.  Physical complications in acute lung injury survivors: a two-year longitudinal prospective study.   Crit Care Med. 2014;42(4):849-859. doi:10.1097/CCM.0000000000000040PubMedGoogle Scholar
23.
Garrigues  E , Janvier  P , Kherabi  Y ,  et al.  Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19.   J Infect. 2020;81(6):e4-e6. doi:10.1016/j.jinf.2020.08.029PubMedGoogle Scholar
24.
Tenforde  MW , Billig Rose  E , Lindsell  CJ ,  et al; CDC COVID-19 Response Team.  Characteristics of adult outpatients and inpatients with COVID-19 - 11 Academic Medical Centers, United States, March-May 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(26):841-846. doi:10.15585/mmwr.mm6926e3PubMedGoogle Scholar
25.
Lee  AM , Wong  JG , McAlonan  GM ,  et al.  Stress and psychological distress among SARS survivors 1 year after the outbreak.   Can J Psychiatry. 2007;52(4):233-240. doi:10.1177/070674370705200405PubMedGoogle Scholar
26.
Fried  JA , Ramasubbu  K , Bhatt  R ,  et al.  The variety of cardiovascular presentations of COVID-19.   Circulation. 2020;141(23):1930-1936. doi:10.1161/CIRCULATIONAHA.120.047164PubMedGoogle Scholar
27.
Lai  PH , Lancet  EA , Weiden  MD ,  et al.  Characteristics associated with out-of-hospital cardiac arrests and resuscitations during the novel coronavirus disease 2019 pandemic in New York City.   JAMA Cardiol. 2020;5(10):1154-1163. doi:10.1001/jamacardio.2020.2488PubMedGoogle Scholar
28.
Shi  S , Qin  M , Shen  B ,  et al.  Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China.   JAMA Cardiol. 2020;5(7):802-810. doi:10.1001/jamacardio.2020.0950PubMedGoogle Scholar
29.
Baldi  E , Sechi  GM , Mare  C ,  et al; Lombardia CARe Researchers.  Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy.   N Engl J Med. 2020;383(5):496-498. doi:10.1056/NEJMc2010418PubMedGoogle Scholar
30.
Parma  V , Ohla  K , Veldhuizen  MG ,  et al; GCCR Group Author.  More than smell-COVID-19 Is associated with severe impairment of smell, taste, and chemesthesis.   Chem Senses. 2020;45(7):609-622. doi:10.1093/chemse/bjaa041PubMedGoogle Scholar
31.
Horvath  L , Lim  JWJ , Taylor  JW ,  et al.  Smell and taste loss in COVID-19 patients: assessment outcomes in a Victorian population.   Acta Otolaryngol. 2021;141(3):299-302. doi:10.1080/00016489.2020.1855366PubMedGoogle Scholar
32.
Boscolo-Rizzo  P , Guida  F , Polesel  J ,  et al.  Self-reported smell and taste recovery in coronavirus disease 2019 patients: a one-year prospective study.   Eur Arch Otorhinolaryngol. 2021. doi:10.1007/s00405-021-06839-wPubMedGoogle Scholar
33.
da Silva  GF , Morano  MT , Sales  MP , Olegário  NB , Cavalcante  AG , Pereira  ED .  Comparison of face-to-face interview and telephone interview administration of COPD assessment test: a randomized study.   Qual Life Res. 2014;23(4):1193-1197. doi:10.1007/s11136-013-0563-xPubMedGoogle Scholar
34.
Raghavan  N , Lam  YM , Webb  KA ,  et al.  Components of the COPD Assessment Test (CAT) associated with a diagnosis of COPD in a random population sample.   COPD. 2012;9(2):175-183. doi:10.3109/15412555.2011.650802PubMedGoogle Scholar
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close