Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 151 No. 4142 (2021)

Long COVID 1 year after hospitalisation for COVID-19: a prospective bicentric cohort study

  • Christoph Becker
  • Katharina Beck
  • Samuel Zumbrunn
  • Valentina Memma
  • Naemi Herzog
  • Benjamin Bissmann
  • Sebastian Gross
  • Nina Loretz
  • Jonas Mueller
  • Simon A. Amacher
  • Chantal Bohren
  • Rainer Schaefert
  • Stefano Bassetti
  • Christoph Fux
  • Beat Mueller
  • Philipp Schuetz
  • Sabina Hunziker
DOI
https://doi.org/10.4414/SMW.2021.w30091
Cite this as:
Swiss Med Wkly. 2021;151:w30091
Published
22.10.2021

Abstract

AIMS OF THE STUDY: There is increasing interest in better understanding of long COVID, a condition characterised by long-term sequelae — appearing or persisting after the typical convalescence period — of coronavirus disease 2019 (COVID-19). Herein, we describe long-term outcomes regarding residual symptoms and psychological distress in hospitalised patients 1 year after COVID-19.

METHODS: This prospective cohort study included consecutive adult patients hospitalised for confirmed COVID-19 in two Swiss tertiary-care hospitals between March and June 2020. The primary endpoint was evidence of long COVID 1 year after discharge, defined as ≥1 persisting or new symptom related to COVID-19, from a predefined list of symptoms. Secondary endpoints included psychological distress and symptoms of post-traumatic stress disorder (PTSD).

RESULTS: Among 90 patients included in the study, 63 (70%) had symptoms of long COVID 1 year after hospitalisation, particularly fatigue (46%), concentration difficulties (31%), shortness of breath (21%) and post-exertion malaise (20%). Three predictors, namely duration of hospitalisation (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.00–1.22; p = 0.041), severity of illness (OR 1.19, 95% CI 1.04–1.37; p = 0.013), and self-perceived overall health status 30 days after hospitalisation (OR 0.97, 95% CI 0.94–1.00; p = 0.027) were associated with long COVID. Regarding secondary endpoints, 16 (18%) experienced psychological distress and 3 (3.3%) patients had symptoms of PTSD.

CONCLUSION: A high proportion of COVID-19 patients report symptoms of long COVID 1 year after hospitalisation, which negatively affects their quality of life. The most important risk factors were severe initial presentation of COVID-19 with long hospital stays.

References

  1. Logue JK, Franko NM, McCulloch DJ, McDonald D, Magedson A, Wolf CR, et al. Sequelae in Adults at 6 Months After COVID-19 Infection. JAMA Netw Open. 2021;4(2):e210830. Epub 2021/02/20. doi: https://doi.org/10.1001/jamanetworkopen.2021.0830. PubMed PMID: 33606031; PubMed Central PMCID: PMCPMC7896197.
  2. 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 Aug;324(6):603–5. https://doi.org/10.1001/jama.2020.12603
  3. Nasserie T, Hittle M, Goodman SN. Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19: A Systematic Review. JAMA network open. 2021;4(5):e2111417. Epub 2021/05/27. doi: https://doi.org/10.1001/jamanetworkopen.2021.11417. PubMed PMID: 34037731; PubMed Central PMCID: PMCPMC8155823.
  4. Nehme M, Braillard O, Alcoba G, Aebischer Perone S, Courvoisier D, Chappuis F, et al. COVID-19 Symptoms: Longitudinal Evolution and Persistence in Outpatient Settings. Ann Intern Med. 2021;174(5):723-5. doi: https://doi.org/10.7326/M20-5926. PubMed PMID: 33284676; PubMed Central PMCID: PMCPMC7741180.
  5. Al-Aly Z, Xie Y, Bowe B. High-dimensional characterization of post-acute sequelae of COVID-19. Nature. 2021 Jun;594(7862):259–64. https://doi.org/10.1038/s41586-021-03553-9
  6. Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med. 2021 Apr;27(4):601–15. https://doi.org/10.1038/s41591-021-01283-z
  7. Maltezou HC, Pavli A, Tsakris A. Post-COVID Syndrome: An Insight on Its Pathogenesis. Vaccines (Basel). 2021;9(5). Epub 2021/06/03. doi: https://doi.org/10.3390/vaccines9050497. PubMed PMID: 34066007; PubMed Central PMCID: PMCPMC8151752.
  8. Ortelli P, Ferrazzoli D, Sebastianelli L, Engl M, Romanello R, Nardone R, et al. Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: Insights into a challenging symptom. J Neurol Sci. 2021;420:117271. Epub 2020/12/29. doi: https://doi.org/10.1016/j.jns.2020.117271. PubMed PMID: 33359928; PubMed Central PMCID: PMCPMC7834526.
  9. Stratton CW, Tang YW, Lu H. Pathogenesis-directed therapy of 2019 novel coronavirus disease. J Med Virol. 2021 Mar;93(3):1320–42. https://doi.org/10.1002/jmv.26610
  10. Carvalho-Schneider C, Laurent E, Lemaignen A, Beaufils E, Bourbao-Tournois C, Laribi S, et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect. 2021;27(2):258-63. Epub 2020/10/09. doi: https://doi.org/10.1016/j.cmi.2020.09.052. PubMed PMID: 33031948; PubMed Central PMCID: PMCPMC7534895.
  11. Goertz YMJ, Van Herck M, Delbressine JM, Vaes AW, Meys R, Machado FVC, et al. Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome? ERJ Open Res. 2020;6(4). Epub 2020/12/02. doi: https://doi.org/10.1183/23120541.00542-2020. PubMed PMID: 33257910; PubMed Central PMCID: PMCPMC7491255
  12. Stavem K, Ghanima W, Olsen MK, Gilboe HM, Einvik G. Prevalence and Determinants of Fatigue after COVID-19 in Non-Hospitalized Subjects: A Population-Based Study. Int J Environ Res Public Health. 2021;18(4). Epub 2021/03/07. doi: https://doi.org/10.3390/ijerph18042030. PubMed PMID: 33669714; PubMed Central PMCID: PMCPMC7921928.
  13. Lee SH, Shin HS, Park HY, Kim JL, Lee JJ, Lee H, et al. Depression as a Mediator of Chronic Fatigue and Post-Traumatic Stress Symptoms in Middle East Respiratory Syndrome Survivors. Psychiatry Investig. 2019;16(1):59-64. Epub 2019/01/05. doi: https://doi.org/10.30773/pi.2018.10.22.3. PubMed PMID: 30605995; PubMed Central PMCID: PMCPMC6354037.
  14. Moldofsky H, Patcai J. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC Neurol. 2011;11:37. Epub 2011/03/26. doi: https://doi.org/10.1186/1471-2377-11-37. PubMed PMID: 21435231; PubMed Central PMCID: PMCPMC3071317.
  15. Lam MH, Wing YK, Yu MW, Leung CM, Ma RC, Kong AP, et al. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. Arch Intern Med. 2009 Dec;169(22):2142–7. https://doi.org/10.1001/archinternmed.2009.384
  16. Chau SWH, Wong OWH, Ramakrishnan R, Chan SSM, Wong EKY, Li PYT, et al. History for some or lesson for all? A systematic review and meta-analysis on the immediate and long-term mental health impact of the 2002-2003 Severe Acute Respiratory Syndrome (SARS) outbreak. BMC Public Health. 2021;21(1):670. Epub 2021/04/09. doi: https://doi.org/10.1186/s12889-021-10701-3. PubMed PMID: 33827499; PubMed Central PMCID: PMCPMC8025448.
  17. Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020 Jul;7(7):611–27. https://doi.org/10.1016/s2215-0366(20)30203-0 https://doi.org/10.1016/S2215-0366(20)30203-0
  18. Dong F, Liu HL, Dai N, Yang M, Liu JP. A living systematic review of the psychological problems in people suffering from COVID-19. J Affect Disord. 2021;292:172-88. Epub 2021/06/15. doi: https://doi.org/10.1016/j.jad.2021.05.060. PubMed PMID: 34126309; PubMed Central PMCID: PMCPMC8169237.
  19. Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry. 2021 Feb;8(2):130–40. https://doi.org/10.1016/s2215-0366(20)30462-4 https://doi.org/10.1016/S2215-0366(20)30462-4
  20. Menges D, Ballouz T, Anagnostopoulos A, Aschmann HE, Domenghino A, Fehr JS, et al. Burden of post-COVID-19 syndrome and implications for healthcare service planning: A population-based cohort study. PLoS One. 2021;16(7):e0254523. Epub 2021/07/13. doi: https://doi.org/10.1371/journal.pone.0254523. PubMed PMID: 34252157; PubMed Central PMCID: PMCPMC8274847.
  21. Frontera JA, Yang D, Lewis A, Patel P, Medicherla C, Arena V, et al. A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications. J Neurol Sci. 2021;426:117486. Epub 2021/05/18. doi: https://doi.org/10.1016/j.jns.2021.117486. PubMed PMID: 34000678; PubMed Central PMCID: PMCPMC8113108.
  22. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP ; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61(4):344–9. https://doi.org/10.1016/j.jclinepi.2007.11.008
  23. Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013 Apr;84(4):465–70. https://doi.org/10.1016/j.resuscitation.2012.12.016
  24. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. https://doi.org/10.1016/0021-9681(87)90171-8
  25. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
  26. Dolan P. Modeling valuations for EuroQol health states. Med Care. 1997 Nov;35(11):1095–108. https://doi.org/10.1097/00005650-199711000-00002
  27. EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990 Dec;16(3):199–208. https://doi.org/10.1016/0168-8510(90)90421-9
  28. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82. https://doi.org/10.1002/da.10113
  29. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983 Dec;24(4):385–96. https://doi.org/10.2307/2136404
  30. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002 Feb;52(2):69–77. https://doi.org/10.1016/s0022-3999(01)00296-3 https://doi.org/10.1016/S0022-3999(01)00296-3
  31. Maercker A, Schützwohl M. Erfassung von psychischen Belastungsfolgen: Die Impact of Event Skala-revidierte Version (IES-R). Diagnostica. 1998;(44(3)):130–41.
  32. Creamer M, Bell R, Failla S. Psychometric properties of the impact of event scale—revised. Behav Res Ther. 2003 Dec;41(12):1489–96. https://doi.org/10.1016/j.brat.2003.07.010
  33. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220-32. Epub 2021/01/12. doi: https://doi.org/10.1016/S0140-6736(20)32656-8. PubMed PMID: 33428867; PubMed Central PMCID: PMCPMC7833295.
  34. Nehme M, Braillard O, Chappuis F, Courvoisier DS, Guessous I. Prevalence of Symptoms More Than Seven Months After Diagnosis of Symptomatic COVID-19 in an Outpatient Setting. Ann Intern Med. 2021. Epub 2021/07/06. doi: https://doi.org/10.7326/M21-0878. PubMed PMID: 34224254; PubMed Central PMCID: PMCPMC8280535.
  35. Boscolo-Rizzo P, Guida F, Polesel J, Marcuzzo AV, Capriotti V, D’Alessandro A, et al. Sequelae in adults at 12 months after mild-to-moderate coronavirus disease 2019 (COVID-19). Int Forum Allergy Rhinol. 2021 Jun; :alr.22832. https://doi.org/10.1002/alr.22832
  36. Sudre CH, Murray B, Varsavsky T, Graham MS, Penfold RS, Bowyer RC, et al. Attributes and predictors of long COVID. Nat Med. 2021;27(4):626-31. doi: https://doi.org/10.1038/s41591-021-01292-y
  37. Blomberg B, Mohn KG, Brokstad KA, Zhou F, Linchausen DW, Hansen BA, et al.; Bergen COVID-19 Research Group. Long COVID in a prospective cohort of home-isolated patients. Nat Med. 2021 Sep;27(9):1607–13. https://doi.org/10.1038/s41591-021-01433-3
  38. Havervall S, Rosell A, Phillipson M, Mangsbo SM, Nilsson P, Hober S, et al. Symptoms and Functional Impairment Assessed 8 Months After Mild COVID-19 Among Health Care Workers. JAMA. 2021;325(19):2015-6. Epub 2021/04/08. doi: https://doi.org/10.1001/jama.2021.5612. PubMed PMID: 33825846; PubMed Central PMCID: PMCPMC8027932.
  39. Frontera JA, Yang DO, Lewis A, Patel P, Medicherla C, Arena V, et al. A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications. J Neurol Sci. 2021;426. doi: ARTN 117486.
  40. Schuler D, Tuch A, Peter C. Psychische Gesundheit in der Schweiz. Monitoring 2020. (Obsan Bericht 15/2020). Neuchâtel: Schweizerisches Gesundheitsobservatorium, 2020.
  41. Robert Koch-Institut. Depressive Symptomatik im europäischen Vergleich – Ergebnisse des European Health Interview Survey (EHIS) 2. Journal of Health Monitoring. 2019;4(4):62–70. https://doi.org/10.25646/6221
  42. Vincent A, Beck K, Becker C, Zumbrunn S, Ramin-Wright M, Urben T, et al. Psychological burden in patients with COVID-19 and their relatives 90 days after hospitalization: A prospective observational cohort study. J Psychosom Res. 2021;147:110526. Epub 2021/05/30. doi: https://doi.org/10.1016/j.jpsychores.2021.110526. PubMed PMID: 34051515; PubMed Central PMCID: PMCPMC8132501.
  43. Beck K, Vincent A, Becker C, Keller A, Cam H, Schaefert R, et al. Prevalence and factors associated with psychological burden in COVID-19 patients and their relatives: A prospective observational cohort study. PLoS One. 2021 May;16(5):e0250590. https://doi.org/10.1371/journal.pone.0250590
  44. Lara-Cinisomo S, Akinbode TD, Wood J. A Systematic Review of Somatic Symptoms in Women with Depression or Depressive Symptoms: Do Race or Ethnicity Matter? Journal of women's health (2002). 2020;29(10):1273-82. doi: https://doi.org/10.1089/jwh.2019.7975. PubMed PMID: 32397866.
  45. McKnight-Eily LR, Okoro CA, Strine TW, Verlenden J, Hollis ND, Njai R, et al. Racial and Ethnic Disparities in the Prevalence of Stress and Worry, Mental Health Conditions, and Increased Substance Use Among Adults During the COVID-19 Pandemic - United States, April and May 2020. MMWR Morb Mortal Wkly Rep. 2021;70(5):162-6. doi: https://doi.org/10.15585/mmwr.mm7005a3. PubMed PMID: 33539336; PubMed Central PMCID: PMCPMC7861483 Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Most read articles by the same author(s)

1 2 3 4 > >>