Long-Term Outcomes of COVID-19 Survivors and an Exploratory Analysis of Factors Associated with Sequela-Free Survival of Patients Treated at Leishenshan Hospital in Wuhan, China (preprint)

Objective: To determine key factors associated with sequela-free survival of patients with COVID-19.Design: Retrospective–prospective observational study.Setting: Leishenshan Hospital in Wuhan, China.Participants: Patients with COVID-19 admitted at Leishenshan Hospital in Wuhan, China between 15 February 2020 and 1 April 2020 and discharged.Main Outcomes: MeasuresSequela-free survival is defined as having none of the long-term sequelae measured with the Activity of Daily Living (ADL) Scale, Modified Medical Research Council (mMRC) Dyspnoea Scale, New York Heart Association (NYHA) classification, Self-rating Depression Scale (SDS), Carcinologic Handicap Index (CHI) and Modified Telephone Interview for Cognitive Status (TICS-M). Multivariable logistic regression was used to examine the key factors of sequela-free survival.ResultsThe follow-up period for the 464 patients was 10 August to 30 September 2020. Of these, 424 patients completed the assessment of all scales. 30.2% (128 of 424) were categorised as sequela-free at follow-up. The most common sequelae were psychosocial problems (254 [57.7%]), respiratory function abnormality (149 [32.6%]) and cardiac function abnormality (98 [21.5%]). Risk factors associated with COVID-19 sequelae were anaemia on admission, longer duration from the onset of symptoms to admission and advanced age, whereas anti-anaemia treatment was a protective factor against sequelae. A haemoglobin level of <113 g/l for female patients or <92 g/l for male patients at admission discriminated a higher risk of any COVID-19 sequelae.Conclusions: Only one third COVID-19 survivors were sequela-free. Anaemia on admission, longer duration from the onset of symptoms to admission and advanced age were the risk factors of any long-term sequela. Anti-anaemia treatment was associated with beneficial outcomes in COVID-19 survivors.Funding: This study was funded by grants to DSS from the National Natural Science Foundation of China (Nos.81771133, 81970995) (DSD grants), Shanghai Shenkang Hospital Development Center Founding (SHDC12017X11), Renji Hospital Clinical Innovation Foundation (PYMDT-007), Shanghai municipal Education Commission-Gaofeng Clinical Medicine Support (20191903), State Key Laboratory of Neuroscience(SKLN－201803), the National Natural Science Foundation of China (No.81701358) (DH grants), the Shanghai Municipal Commission of Health and Family Planning Funding (20184Y0205) (CYC grants) and Renji Hospital founding (RJZZ18-019) (LLH grants).Declaration of Interest: None to declare. Ethical Approval: This study was approved by the Institutional Research Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiaotong University (ethics committee approval No. KY2020-34).

Long-Term Outcomes and Sequelae for 464 COVID-19 Patients Discharged from Leishenshan Hospital in Wuhan, China (preprint)

Background: While coronavirus disease 2019 (COVID-19) has emerged as a global pandemic, millions of COVID-19 patients have recovered and returned to their families and work, although the long-term outcomes remain unknown.Methods: This retrospective–prospective study analysed data for COVID-19 patients discharged from Leishenshan Hospital in Wuhan, China. Long-term outcomes were measured by Activity of Daily Living (ADL) Scale, Modified Medical Research Council (mMRC) Dyspnoea Scale, New York Heart Association (NYHA) classification, Self-rating Depression Scale (SDS), Carcinologic Handicap Index (CHI), and Modified Telephone Interview for Cognitive Status (TICS-M). Multivariable logistic regression was used to examine the risk factors of long-term outcomes.Findings: The follow-up period for the 464 patients was August 10–September 30, 2020. The most common sequelae were psychosocial problems (254 [57·7%]), respiratory function abnormality (149 [32·6%]), and cardiac function abnormality (98 [21·5%]). Rare sequelae were ADL disability (61 [13·3%]); pain (55 [12·5%]); feeding difficulties (54 [12·2%]); dysphonia (46 [10·4%]); and hyposmia (27 [6·1%]), as well as impairment in hearing (40 [9·1%]), vison (37 [8·4%]), swallowing (30 [6·8%]), and gustation (18 [4·1%]). Almost all patients (98·2%) had normal cognitive function. Risk factors associated with ADL disability were advanced age, intensive care unit (ICU) stay, and cancer, which were also associated with respiratory function abnormality. Risk factors associated with cardiac function abnormality were long hospital stay, cancer, and respiratory diseases. Advanced age, ICU stay, and nonischemic heart diseases were associated with psychosocial problems. Compared with female patients, male patients had decreased odds of declined respiratory, cardiac function, depression and anxiety, and pain.Interpretation: Nearly normal ADL, moderate cardiopulmonary function and psychosocial issues, and minor sensory abnormalities were observed in COVID-19 survivors. Advanced age, ICU stay, cancer, and female sex were adverse risk factors in long-term sequelae. These data provide a generalisable estimate of long-term outcomes for COVID-19.Trial Registration: This study was registered in the ClinicalTrial.gov database (NCT04508712).Funding: National Natural Science Foundation of China, Shanghai Shenkang Hospital Development Center, Shanghai municipal Education Commission, State Key Laboratoy of Neuroscience, and Renji Hospital.Declaration of Interests: All authors declare no competing interests.Ethics Approval Statement: This study was approved by the Institutional Research Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiaotong University (Ethical Committee approval number: KY2020-34). Oral consent was acquired from patients or from their immediate family members in cases of communication disorder or death.