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Two-Year Health Outcomes in Hospitalized COVID-19 Survivors in China

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

Question  What are the 2-year health outcomes among patients hospitalized for COVID-19 in China?

Findings  In this longitudinal cohort study that included 1864 patients, the most common symptoms at 2 years after SARS-CoV-2 infection were fatigue, chest tightness, anxiety, dyspnea, and myalgia, and most symptoms resolved from 1-year to 2-year follow-up, although the incidence of dyspnea showed no significant change. Patients with severe disease during hospitalization, especially those who required intensive care unit admission, had higher risks of persistent symptoms and higher chronic obstructive pulmonary disease assessment test scores.

Meaning  These findings suggest that prolonged symptoms may persist in a proportion of COVID-19 survivors for 2 years after SARS-CoV-2 infection.


Importance  Relatively little is known about the persistence of symptoms in patients with COVID-19 for more than 1 year after their acute illness.

Objective  To assess the health outcomes among hospitalized COVID-19 survivors over 2 years and to identify factors associated with increased risk of persistent symptoms.

Design, Setting, and Participants  This was a longitudinal cohort study of patients who survived COVID-19 at 2 COVID-19–designated hospitals in Wuhan, China, from February 12 to April 10, 2020. All patients were interviewed via telephone at 1 year and 2 years after discharge. The 2-year follow-up study was conducted from March 1 to April 6, 2022. Statistical analysis was conducted from April 20 to May 5, 2022. The severity of disease was defined by World Health Organization guideline for COVID-19.

Exposures  COVID-19.

Main Outcomes and Measures  The main outcome was symptom changes over 2 years after hospital discharge. All patients completed a symptom questionnaire for evaluation of symptoms, along with a chronic obstructive pulmonary disease assessment test (CAT) at 1-year and 2-year follow-up visits.

Results  Of 3988 COVID-19 survivors, a total of 1864 patients (median [IQR] age, 58.5 [49.0-68.0] years; 926 male patients [49.7%]) were available for both 1-year and 2-year follow-up visits. The median (IQR) time from discharge to follow-up at 2 years was 730 (719-743) days. At 2 years after hospital discharge, 370 patients (19.8%) still had symptoms, including 224 (12.0%) with persisting symptoms and 146 (7.8%) with new-onset or worsening of symptoms. The most common symptoms were fatigue, chest tightness, anxiety, dyspnea, and myalgia. Most symptoms resolved over time, but the incidence of dyspnea showed no significant change (1-year vs 2-year, 2.6% [49 patients] vs 2.0% [37 patients]). A total of 116 patients (6.2%) had CAT total scores of at least 10 at 2 years after discharge. Patients who had been admitted to the intensive care unit had higher risks of persistent symptoms (odds ratio, 2.69; 95% CI, 1.02-7.06; P = .04) and CAT scores of 10 or higher (odds ratio, 2.83; 95% CI, 1.21-6.66; P = .02).

Conclusions and Relevance  In this cohort study, 2 years after hospital discharge, COVID-19 survivors had a progressive decrease in their symptom burden, but those with severe disease during hospitalization, especially those who required intensive care unit admission, had higher risks of persistent symptoms. These results are related to the original strain of the virus, and their relevance to infections with the Omicron variant is not known.

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Article Information

Accepted for Publication: July 27, 2022.

Published: September 15, 2022. doi:10.1001/jamanetworkopen.2022.31790

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Yang X et al. JAMA Network Open.

Corresponding Authors: Li Li, MD, Department of Respiratory Medicine, Daping Hospital, Third Military Medical University Army Medical University, Chongqing 400042, China (dpyyhxlili@tmmu.edu.cn); Bin Cao, MD, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China (caobin_ben@163.com).

Author Contributions: Dr Li had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Ms Yang, Mr Hou, Ms Shen, Mr M. Zhang, Ms K. Zhang, and Ms F. Wang contributed equally to this work.

Concept and design: Ma, He, G. Cao, Jiang, B. Cao, Li.

Acquisition, analysis, or interpretation of data: Yang, Hou, Shen, M. Zhang, K. Zhang, F. Wang, Liu, Ma, Cheng, Kang, Hu, M. Wang, Zeng, Y. Wang, Jones, Li.

Drafting of the manuscript: Yang, Hou, Shen, M. Zhang, G. Cao, Jiang, Li.

Critical revision of the manuscript for important intellectual content: Yang, K. Zhang, F. Wang, Liu, Ma, Cheng, Kang, Hu, M. Wang, Zeng, Y. Wang, He, G. Cao, Jiang, Jones, B. Cao, Li.

Statistical analysis: Shen, Ma, Zeng.

Obtained funding: Ma, Cheng, Li.

Administrative, technical, or material support: Liu, Y. Wang, He, B. Cao.

Supervision: G. Cao, Li.

Conflict of Interest Disclosures: None 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), Chongqing Special Project for Academicians (cstc2020yszx-jcyjX0004), and 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.

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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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