Two-year follow-up of patients with post-COVID-19 condition in Sweden: a prospective cohort study.

Background: Few studies have reported the long-term health effects of COVID-19. The regional population-based Linköping COVID-19 study (LinCoS) included all patients hospitalised due to COVID-19 during the first pandemic wave. Four months post-discharge, over 40% (185/433) experienced persisting symptoms and activity/participation limitations, indicating post-COVID-19 condition (PCC). The present follow-up study aimed to determine the long-term recovery among these patients 24 months post-admission. Methods: This prospective cohort study included all patients from LinCoS with PCC at four months post-discharge. We repeated the same structured interview at a 24-month follow-up to identify persisting symptoms and their impact on daily life. Intercurrent health issues were identified by reviewing medical records. Findings: Of 185 patients with PCC at 4 months post-discharge, 181 were alive at the 24-month assessment and 165 agreed to participate. Of those, 21% (35/165) had been readmitted to hospital for various causes in the interim period. The majority of patients (139/165, 84%) reported persisting problems affecting everyday life at 24 months. Significant improvements were seen in the prevalence and magnitude of some symptoms/limitations compared with four months post-discharge. Cognitive, sensorimotor, and fatigue symptoms were the most common persisting symptoms at 24 months. No clear difference was evident between individuals treated in the intensive care unit (ICU) and non-ICU-treated individuals. Approximately half of those who were on sick leave related to PCC at four months after infection were on sick leave at 24 months. Interpretation: This is one of the first studies to report 2-year outcomes in patients with PCC following COVID-19 hospitalisation. Despite some improvements over time, we found a high prevalence of persisting symptoms and a need for long-term follow-up and rehabilitation post COVID-19 infection. Funding: The study was funded by Region Östergötland.

Two-year follow-up of patients with post-COVID-19 condition in Sweden: a prospective cohort study

Background Few studies have reported the long-term health effects of COVID-19. The regional population-based Linköping COVID-19 study (LinCoS) included all patients hospitalised due to COVID-19 during the first pandemic wave. Four months post-discharge, over 40% (185/433) experienced persisting symptoms and activity/participation limitations, indicating post-COVID-19 condition (PCC). The present follow-up study aimed to determine the long-term recovery among these patients 24 months post-admission. Methods This prospective cohort study included all patients from LinCoS with PCC at four months post-discharge. We repeated the same structured interview at a 24-month follow-up to identify persisting symptoms and their impact on daily life. Intercurrent health issues were identified by reviewing medical records. Findings Of 185 patients with PCC at 4 months post-discharge, 181 were alive at the 24-month assessment and 165 agreed to participate. Of those, 21% (35/165) had been readmitted to hospital for various causes in the interim period. The majority of patients (139/165, 84%) reported persisting problems affecting everyday life at 24 months. Significant improvements were seen in the prevalence and magnitude of some symptoms/limitations compared with four months post-discharge. Cognitive, sensorimotor, and fatigue symptoms were the most common persisting symptoms at 24 months. No clear difference was evident between individuals treated in the intensive care unit (ICU) and non-ICU-treated individuals. Approximately half of those who were on sick leave related to PCC at four months after infection were on sick leave at 24 months. Interpretation This is one of the first studies to report 2-year outcomes in patients with PCC following COVID-19 hospitalisation. Despite some improvements over time, we found a high prevalence of persisting symptoms and a need for long-term follow-up and rehabilitation post COVID-19 infection. Funding The study was funded by 10.13039/100016670Region Östergötland.

Brain MRI and Neuropsychological Findings at Long-Term Follow-Up After COVID-19 Hospitalisation: An Observational Cohort Study...American Congress of Rehabilitation Medicine (ACRM) Annual Conference, November 8-11, 2022, Chicago, Illinois

To report findings on brain MRI and neurocognitive function, as well as persisting fatigue at long-term follow-up after COVID-19 hospitalisation in patients identified as high risk for affection of the central nervous system. Ambidirectional observational cohort study. All patients (n=734) previously hospitalized with a laboratory-confirmed COVID-19 in a total regional population in Sweden during the period March 1st to May 31st 2020. A subgroup (n=185) with persisting symptoms still interfering with daily life at a telephone follow-up 4 months after discharge were invited for a medical and neuropsychological evaluation. Thirty-five of those who were assessed with a neurocognitive test battery at the clinical visit, and presented a clinical picture concerning for COVID-19-related brain pathology, were further investigated by brain MRI. N/A. Findings on brain MRI, neurocognitive test results and reported fatigue. Twenty-five patients (71%) had abnormalities on MRI;multiple white matter lesions were the most common finding. Six patients had had MRI performed in the acute phase during their hospitalisation, and all of these patients had additional white matter lesions at the follow-up MRI. Sixteen patients (46%) demonstrated impaired neurocognitive function, of which 10 (29%) had severe impairment. Twenty-six patients (74%) reported clinically significant fatigue. Patients with abnormalities on MRI had a lower Visuospatial Index (p=0.031) compared with the group with normal MRI findings. A majority in this group of patients selected to undergo MRI after a clinical evaluation, showed signs of possible COVID-19 related brain affection detectable by brain MRI and/or neurocognitive test results. Even in a previously fairly healthy group of patients, COVID-19 might have a substantial negative impact on cognition in several domains, persisting several months post discharge. Abnormal findings were not restricted to patients with severe disease. Thus, for clinicians it is important to consider post-covid related changes when facing patients' reports of neuropsychological deficiency, regardless of severity of disease. The authors declare no competing interests.

Brain MRI and Neuropsychological Findings at Long-Term Follow-Up After COVID-19 Hospitalisation: An Observational Cohort Study

Research Objectives To report findings on brain MRI and neurocognitive function, as well as persisting fatigue at long-term follow-up after COVID-19 hospitalisation in patients identified as high risk for affection of the central nervous system. Design Ambidirectional observational cohort study. Setting All patients (n=734) previously hospitalized with a laboratory-confirmed COVID-19 in a total regional population in Sweden during the period March 1st to May 31st 2020. Participants A subgroup (n=185) with persisting symptoms still interfering with daily life at a telephone follow-up 4 months after discharge were invited for a medical and neuropsychological evaluation. Thirty-five of those who were assessed with a neurocognitive test battery at the clinical visit, and presented a clinical picture concerning for COVID-19-related brain pathology, were further investigated by brain MRI. Interventions N/A. Main Outcome Measures Findings on brain MRI, neurocognitive test results and reported fatigue. Results Twenty-five patients (71%) had abnormalities on MRI;multiple white matter lesions were the most common finding. Six patients had had MRI performed in the acute phase during their hospitalisation, and all of these patients had additional white matter lesions at the follow-up MRI. Sixteen patients (46%) demonstrated impaired neurocognitive function, of which 10 (29%) had severe impairment. Twenty-six patients (74%) reported clinically significant fatigue. Patients with abnormalities on MRI had a lower Visuospatial Index (p=0.031) compared with the group with normal MRI findings. Conclusions A majority in this group of patients selected to undergo MRI after a clinical evaluation, showed signs of possible COVID-19 related brain affection detectable by brain MRI and/or neurocognitive test results. Even in a previously fairly healthy group of patients, COVID-19 might have a substantial negative impact on cognition in several domains, persisting several months post discharge. Abnormal findings were not restricted to patients with severe disease. Thus, for clinicians it is important to consider post-covid related changes when facing patients’ reports of neuropsychological deficiency, regardless of severity of disease. Author(s) Disclosures The authors declare no competing interests.

Neurocognitive deficits in COVID-19 patients five months after discharge from hospital.

This observational cohort study explored objective neurocognitive deficits in COVID-19 patients five months after discharge, and any associations with demographic factors and disease severity indicators. Medical notes of all COVID-19 patients admitted to hospital in Region Östergötland, Sweden, March-May 2020, were reviewed. After applying exclusion criteria, 433 patients were screened by telephone. Of these, 185 patients reported persistent and concerning post-COVID-19 problems, including but not restricted to cognitive functions, and were invited to a clinical evaluation. The Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and Colour-Word Interference Test (CWIT) were used to assess immediate memory, visuo-spatial function, language, attention, delayed memory, and executive function. A total of 133 patients had valid test performances. Mean RBANS Global Cognition Score was 83.4, with 37% scoring below cut-off (1.5 SD). Deficits in Attention and Memory indices were most common, each affecting approximately 30% of the patients. After adjustment for sex, language, level of education and premorbid function, neurocognitive performance was positively associated with length of hospital stay, but not with the disease severity indicators WHO CPS and CRP. Findings support that comprehensive neuropsychological assessment should be performed when patients report post-COVID-19 symptoms that affect daily life.

Seven Domains of Persisting Problems after Hospital-treated Covid-19 Indicate a Need For a Multiprofessional Rehabilitation Approach.

OBJECTIVES: To identify domains of persisting problems at 4 months after discharge in patients previously hospitalized due to COVID-19, with a focus on a subgroup of patients reporting symptoms to an extent indicative of rehabilitation needs. DESIGN: Ambidirectional observational cohort study. PATIENTS: All patients with a laboratory-confirmed COVID-19 diagnosis admitted to hospital in a Swedish healthcare region during the period 1 March to 31 May 2020. After exclusion, 94% of all survivors (n = 433) participated in the study. Forty-three percent (n = 185) of these reported persisting problems indicating rehabilitation needs and formed a subgroup. METHODS: Explorative factor analysis based on results from comprehensive telephone interviews covering persisting symptoms, including assessment of impact on daily life. RESULTS: Seven domains were identified, comprising problems related to vision, cognition, mental fatigue, swallowing, voice, sensorimotor dysfunction, and feeling anxious/depressed. The patients in the subgroup reported a median of 8 symptoms/limitations affecting everyday life, and two-thirds reported symptoms/limitations in 3 or more domains. CONCLUSION: Seven problem domains corresponding to specific modalities of rehabilitative interventions were identified. A majority of patients reported problems from several domains, indicating the need for multiprofessional teams in post-COVID-19 rehabilitation. Screening of patients previously hospitalized due to COVID-19 should cover all 7 domains of persisting problems.

Multiprofessional Neurorehabilitation After COVID-19 Infection Should Include Assessment of Visual Function.

Objective: To report vision-related symptoms and neuro-visual clinical signs in patients approximately 4 months after discharge from hospitalization after COVID-19 infection. To report on coexisting functional and activity limitations. Design: The study is part of an ambidirectional population-based cohort study. Setting: An outpatient setting in a hospital environment. Participants: Patients from a population-based cohort study including all patients with laboratory-confirmed COVID-19 admitted to hospital during a 3-month period in a health care region in Sweden. Among patients who, based on a standardized telephone interview, were identified as having persisting rehabilitation needs 4 months after discharge (n=185), several (n=57) reported vision-related symptoms. All 57 patients were invited to a neuro-visual examination. Six patients declined, 6 were unavailable, and 3 did not fulfil the inclusion criteria. Thus, 42 patients were included in the analysis (N=42). Interventions: Not applicable. Main Outcome Measures: Vision-related symptoms, neuro-visual function, and coexisting impairments affecting activities of daily life and participation. Results: A total of 31% of patients with rehabilitation needs after COVID-19 reported vision-related symptoms. Reading-related issues (73.8%), blurry vision (69.0%), and light sensitivity (66.7%) were the most common symptoms. Patients with reading-related issues showed a higher level of eye strain (P<.001). Neuro-visual deficits were found in 83.3% of the patients, mainly concerning eye teaming (23.1%-66.7%) and eye movement (28.6%-30.8%) functions. Patients with vision-related symptoms reported fatigue and 18 other coexisting symptoms to a greater extent (P≤.0001 to .049). Conclusions: Neuro-visual symptoms and signs should be considered when assessing rehabilitation needs after COVID-19. The association between vision-related issues and coexisting symptoms with an effect on body function and activity and/or participation underlines the need for multiprofessional rehabilitation assessment and intervention.

Improved 60-day survival but impaired general health in Swedish ICU-COVID patients: An ambidirectional population-based study.

BACKGROUND: Survival among critically ill COVID-19 patients varies between countries and time periods. Mortality rates up to 60% have been reported in intensive care units (ICUs). Standard-of-care has evolved throughout the pandemic. The purpose of the study was to explore management and mortality of COVID-19 ICU-patients during the first pandemic wave and assess their post-ICU health status. METHODS: We conducted an exploratory observational ambidirectional population-based study of ICU-patients with COVID-19 in a Swedish county during 1 March-30 June 2020. Primary outcome was 60-day mortality with secondary outcomes including treatments, complications, self-reported general health and dyspnoea post-discharge. Patients were consecutively divided into equal tertiles with cut-offs on April 4 and April 20, 2020, to analyse time trends. RESULTS: One hundred patients, median age was 63 years, were included, and 60-day mortality rate was 22%. Ninety-one percent had moderate/severe ARDS and 88% required mechanical ventilation. In the first tertile of patients 60-day mortality was 33%, declining to 15% and 18% in the following two. This reduction paralleled increased use of thromboprophylaxis, less steep rise of treated ICU-patients per day and expanded ICU resources. Four months post-discharge, 63% of survivors reported self-assessed decline in general health retrospectively compared to prior COVID-19. CONCLUSIONS: In this cohort, the initial 60-day mortality quickly declined, despite continuous admittance of critically ill patients. This was parallel to adaptation to increased workload and more intense thromboembolic prophylaxis. A majority of survivors reported declined general health four months after discharge. Further studies on long-term health status of ICU-survivors are indicated.

Rehabilitation needs following COVID-19: Five-month post-discharge clinical follow-up of individuals with concerning self-reported symptoms.

BACKGROUND: This report describes and objectivizes reported problems among a cohort of previously hospitalized COVID-19 patients by clinical examination and determination of the required level of rehabilitation sevices. METHODS: This report forms part of the Linköping COVID-19 Study (LinCoS) that included 745 individuals from one of 21 Swedish healthcare regions, Region Östergötland (RÖ), admitted to hospital for COVID-19 during March 1st-May 31st, 2020. In this descriptive ambidirectional cohort study, all 185 individuals who had reported concerning persisting symptoms were invited to a multi-professional clinical assessment of somatic, functional, affective, neuropsychological status and rehabilitation needs. Rehabilitation needs were assessed using three sub-scales of the Rehabilitation Complexity Scale-Extended. FINDINGS: Among the 158 (85·4%) cases consenting and included in the analysis, we found a broad array of symptoms and signs attributable to COVID-19 involving respiratory, visual, auditory, motor, sensory and cognitive functions that could be confirmed clinically at five months post-discharge. This translated into 16% [95% CI 13-20] of survivors (70/433) of the total regional cohort of hospitalised patients requiring further rehabilitative interventions at follow-up. Weakness in extremities was reported in 28·5% [21·6, 36·2] (45/158). On examination, clinically overt muscle weakness could be corroborated in 15 individuals (10·5%) [6·1, 16·4]. 48% [40, 56] (76/158) reported cognitive symptoms, while the physician noted overt cognitive impairments in only 3% [1·1, 7·5]. In neuropsychological testing, 37% [28-46] (45/122) performed 1.5 SD below the norm, indicating neurocognitive deficits. Fifty-five individuals (34·8%) [27·4, 42·8] reported new or aggravated pain. In three fourths of them, it exerted a 'moderate' or worse detrimental effect on their ability to work. INTERPRETATION: Our study underscores the importance of providing extensive examination of cases with persisting problems after COVID-19, especially since symptoms such as fatigue and breathlessness are highly nonspecific, but may represent significant underlying functional impairments. Robust neurocognitive testing should be performed, as cognitive problems may easily be overlooked during routine medical consultation. In the Swedish context, most rehabilitative interventions could be provided in a primary care setting. A substantial minority of patients should be triaged to specialized rehabilitation services.

Brain MRI and neuropsychological findings at long-term follow-up after COVID-19 hospitalisation: an observational cohort study.

OBJECTIVES: To report findings on brain MRI and neurocognitive function, as well as persisting fatigue at long-term follow-up after COVID-19 hospitalisation in patients identified as high risk for affection of the central nervous system. DESIGN: Ambidirectional observational cohort study. SETTING: All 734 patients from a regional population in Sweden with a laboratory-confirmed COVID-19 diagnosis admitted to hospital during the period 1 March to 31 May 2020. PARTICIPANTS: A subgroup (n=185) with persisting symptoms still interfering with daily life at a telephone follow-up 4 months after discharge were invited for a medical and neuropsychological evaluation. Thirty-five of those who were assessed with a neurocognitive test battery at the clinical visit, and presented a clinical picture concerning for COVID-19-related brain pathology, were further investigated by brain MRI. MAIN OUTCOME MEASURES: Findings on brain MRI, neurocognitive test results and reported fatigue. RESULTS: Twenty-five patients (71%) had abnormalities on MRI; multiple white matter lesions were the most common finding. Sixteen patients (46%) demonstrated impaired neurocognitive function, of which 10 (29%) had severe impairment. Twenty-six patients (74%) reported clinically significant fatigue. Patients with abnormalities on MRI had a lower Visuospatial Index (p=0.031) compared with the group with normal MRI findings. CONCLUSIONS: In this group of patients selected to undergo MRI after a clinical evaluation, a majority of patients had abnormal MRI and/or neurocognitive test results. Abnormal findings were not restricted to patients with severe disease.