ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The COVID-19 pandemic is a growing public health concern, warranting extended social distancing as cases top 30 million in the United States. Between March and December 2020, the CDC reported up to 15% of COVID-19 cases necessitated hospitalization, entailing further social isolation. With increased acceptance of mental health's role in physical illness, the following represents a single-center study characterizing the prevalence and severity of depressive symptoms in patients hospitalized with COVID-19 at discharge and 6-weeks post-discharge. METHODS: Patients (n= 66, age= 59.45 ±1.47 years, 58% male) hospitalized for COVID-19 (8.79 ±0.66 days) at a community hospital were administered the Patient Health Questionnaire-9 (PHQ-9) to characterize depressive symptoms in the prior 2-weeks. Patients recalled depressive symptoms prior to COVID-19 diagnosis (PR), immediately post-discharge (PD), and 6-weeks post-discharge (PD+6). RESULTS: The mean depressive symptom number experienced more than half the days per week were 1.00 ±0.18 (PR), 3.82 ±0.29 (PD), and 2.30 ±0.25 (PD+6), with a mean PHQ-9 score of 3.50 ±0.47 (PR), 11.11 ±0.73 (PD), and 7.30 ±0.65 (PD+6). Compared to PR, at PD patients reported a significant increase in PHQ-9 score (Z= -6.60, p<0.01) and depressive symptom number (Z= -6.11, p<0.01). At PD+6, significant improvements were noted on both parameters (Z= -5.54, p<0.01 and Z= -5.14, p<0.01 respectively). However, this did not represent a return to PR values, with significant residual depression (Z= -4.39, p<0.01 and Z= -5.38, p<0.01 respectively). PHQ-9 scores were classified as possible Other Depressive Disorder (ODD) and Major Depressive Disorder (MDD) according to interpretation guidelines. At PR, 19.67% of patients experienced substantial depression, with 15.15% characterized as ODD (Mild severity, PHQ-9= 7.50 ±0.64) and 4.55% as MDD (Moderate severity, PHQ-9= 13 ±2.00). At PD, 69.70% experienced substantial depression, with a significant increase in the prevalence of ODD (33.34%, Z= -2.35, p<0.05) and MDD (36.37%, Z= -4.01, p<0.01). Symptom severity also increased, warranting category changes in ODD (Moderate, PHQ-9= 9.74 ±0.81) and MDD (Moderately-severe, PHQ-9= 17.77 ±0.73). At PD+6, 36.36% of patients still experienced substantial depression, with a significant prevalence reduction in MDD (16.67%, Z= -2.95, p<0.01) but not ODD (19.70%, Z= -1.51, p= 0.13). Symptom severity remained unchanged in MDD (Moderately-severe, PHQ-9= 15.55 ±0.81) while reducing in ODD (Mild, PHQ-9= 8.85 ±0.32). CONCLUSIONS: Hospitalized COVID-19 patients were found to have substantial increased prevalence and severity of depression at discharge. Whilst a moderate reduction was noted 6-weeks post-discharge, depressive symptoms were found to persist. CLINICAL IMPLICATIONS: The present study highlights the importance of addressing and supporting the mental health of hospitalized COVID-19 patients post-discharge. DISCLOSURES: No relevant relationships by Moustapha Doulaye Seydou, source=Web Response No relevant relationships by Mohsin Ijaz, source=Web Response No relevant relationships by Christian Karime, source=Web Response No relevant relationships by Amir Khan, source=Web Response No relevant relationships by Dar-Yin Li, source=Web Response No relevant relationships by Shahhan Spall, source=Web Response
ABSTRACT
Rational: The Coronavirus Disease 2019 (COVID-19) pandemic is a growing public health concern, with over 18 million cases reported to-date in the United States. The Centers for Disease Control and Prevention reports that up to 15% of COVID-19 cases warranted hospitalization between March and December 2020 due to symptom severity. With significant respiratory manifestations, there has been increased interest in the characterization of pulmonary function following recovery from COVID-19 and the potential role of inhaled medications. The following represents a single-center study investigating the pulmonary function of patients hospitalized for COVID-19 at 1- and 2.5-months following discharge. Methods: Patients without prior pulmonary pathology (n= 25, mean age= 59.28 ±2.07 years, 52% male) hospitalized for COVID-19 (mean hospitalization= 8.32 ±0.93 days) underwent pulmonary function testing 1-month (27.23 ±2.67 days) following hospital discharge using the Platinum Elite body plethysmograph (MGC Diagnostics, Minnesota, USA). Patients were prescribed albuterol with or without an inhaled corticosteroid according to symptom severity on the modified Medical Research Council dyspnea scale. Subsequent pulmonary testing was conducted at 2.5-months (76.45 ±11.68 days) postdischarge using the EasyOne Plus Spirometer (NND Medical Technologies, Zurich, Switzerland). Results: At 1-month post-discharge, characterization of pulmonary function noted moderately-severe restrictive lung disease (FEV1= 64.36 ±2.86%, FVC= 59.36 ±2.71%, FEV1/FVC= 92.40 ±3.10%) with reduced total lung capacity (TLC= 79.68 ±6.84%) and preserved diffusion capacity for carbon monoxide divided by alveolar volume (DLCO/VA= 97.50 ±8.89%). At 2.5-months post-discharge, significant improvement of FEV1 (+13.82%, p<0.001) and FVC (+13.16%, p<0.001) was found, with an overall restrictive lung disease pattern of mild severity and near-normalization of FEV1 (FEV1= 78.19 ±2.78%, FVC= 72.52 ±2.46%, FEV1/FVC= 95.82 ±4.32%). At 2.5-months post-discharge, patients prescribed albuterol sulfate with an inhaled corticosteroid were found to have a tendency for greater improvement of pulmonary function (n= 12, FEV1= +15.73%, FVC= +12.75%, p<0.01 and p<0.01 respectively) compared to patients prescribed albuterol sulfate alone (n= 11, FEV1= +12.36%, FVC= +10.64%, p<0.05 and p<0.01 respectively). However, this improvement difference did not reach significance. Conclusions: The current study aimed to characterize the pulmonary function of patients hospitalized with COVID-19 at 1- and 2.5-months following hospital discharge. At 1-month post-discharge, patients were found to have moderately-severe restrictive lung disease with reduced total lung capacity and preserved diffusion capacity. Significant improvement in pulmonary function was noted at 2.5-months postdischarge, with FEV1 nearing normalization. Pulmonary function improvement did not differ significantly between patients prescribed albuterol sulfate versus albuterol sulfate with an inhaled corticosteroid.