Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study
Open accessAbstract
Objectives To describe the prevalence, nature and risk factors for the main clinical sequelae in coronavirus disease 2019 (COVID-19) survivors who have been discharged from the hospital for more than 3 months.Methods This longitudinal study was based on a telephone follow-up survey of COVID-19 patients hospitalized and discharged from Renmin Hospital of Wuhan University, Wuhan, China before 1 March 2020. Demographic and clinical characteristics and self-reported clinical sequelae of the survivors were described and analysed. A cohort of volunteers who were free of COVID-19 and lived in the urban area of Wuhan during the outbreak were also selected as the comparison group.Results Among 538 survivors (293, 54.5% female), the median (interquartile range) age was 52.0 (41.0-62.0) years, and the time from discharge from hospital to first follow-up was 97.0 (95.0-102.0) days. Clinical sequelae were common, including general symptoms (n = 267, 49.6%), respiratory symptoms (n = 210, 39%), cardiovascular-related symptoms (n = 70, 13%), psychosocial symptoms (n = 122, 22.7%) and alopecia (n = 154, 28.6%). We found that physical decline/fatigue (p < 0.01), postactivity polypnoea (p= 0.04) and alopecia (p < 0.01) were more common in female than in male subjects. Dyspnoea during hospitalization was associated with subsequent physical decline/fatigue, postactivity polypnoea and resting heart rate increases but not specifically with alopecia. A history of asthma during hospitalization was associated with subsequent postactivity polypnoea sequela. A history of pulse ≥90 bpm during hospitalization was associated with resting heart rate increase in convalescence. The duration of virus shedding after COVID-19 onset and hospital length of stay were longer in survivors with physical decline/fatigue or postactivity polypnoea than in those without.Conclusions Clinical sequelae during early COVID-19 convalescence were common; some of these sequelae might be related to gender, age and clinical characteristics during hospitalization.
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Previous studies have not distinctly identified predictors of long COVID syndrome.
“Previous studies have not distinctly identified predictors of long COVID syndrome; factors found to have a correlation with long COVID so far were increased length of acute illness, longer time from symptom onset to virological clearance and comorbidities [11,16].”
From Female gender is associated with long COVID syndrome: a prospective cohort study (2022) · cites this paper as [16]
Factors found to correlate with long COVID so far were increased length of acute illness, longer time from symptom onset to virological clearance, and comorbidities.
“Previous studies have not distinctly identified predictors of long COVID syndrome; factors found to have a correlation with long COVID so far were increased length of acute illness, longer time from symptom onset to virological clearance and comorbidities [11,16].”
From Female gender is associated with long COVID syndrome: a prospective cohort study (2022) · cites this paper as [16]
The proportion of patients with long COVID in this study matched figures from earlier reports.
“The high incidence of long COVID within our cohort was similar to that previously reported: more than half of patients reported symptoms lasting more than 2 months after symptom onset [4,5,16,18,19].”
From Female gender is associated with long COVID syndrome: a prospective cohort study (2022) · cites this paper as [16]
Older age has been linked to persistent fatigue, musculoskeletal pain, and reduced pulmonary function.
“Advanced age was associated with ongoing fatigue and musculoskeletal pain, or impairment in pulmonary functions, reflecting a decline in organ function and a slower ability to recover [1,16].”
From Female gender is associated with long COVID syndrome: a prospective cohort study (2022) · cites this paper as [16]
Published findings on the link between female sex and long COVID are mixed: some studies report higher rates of fatigue or other symptoms in women, whereas others find no association with gender.
“Literature data are not equivocal about the association between females and long COVID: some preliminary studies have shown an increased prevalence of fatigue [24] or other symptoms among women [1,5,13,16], while in other studies no gender association was found [4,[18], [19], [20]].”
From Female gender is associated with long COVID syndrome: a prospective cohort study (2022) · cites this paper as [16]
The lowest anxiety prevalence came from Xiong et al., probably because interviews overestimate less than self-report scales.
“Conversely, Xiong et al. (2021) had the lowest prevalence which is likely to be due to clinical interviews which are less likely to result in overestimation compared to self-rated questionnaires.”
From Long-term effects of COVID-19 on mental health: a systematic review (2022) · cites this paper as Xiong et al. (2021)
Xiong et al.'s interview-based assessment produced much lower depression prevalence than questionnaire-based studies.
“As with anxiety, the clinical interview implemented by Xiong et al. (2021) yielded a much lower depression prevalence compared to the questionnaires.”
From Long-term effects of COVID-19 on mental health: a systematic review (2022) · cites this paper as Xiong et al. (2021)
Fatigue was more common in females in a couple of studies.
“A couple of studies reported that fatigue was more common in females”
From More than 50 long-term effects of COVID-19: a systematic review and meta-analysis (2021) · cites this paper as [24]
Post-activity polypnea and alopecia were more common in females in one study.
“one study reported that post-activity polypnea and alopecia were more common in females4,24”
From More than 50 long-term effects of COVID-19: a systematic review and meta-analysis (2021) · cites this paper as [24]
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- Authors
- Xiong, Q., Xu, M., Li, J., Liu, Y., Zhang, J., Xu, Y., & Dong, W.
- Affiliations
- Renmin Hospital of Wuhan University (CN)
- Corresponding author
- Xu, Yu
- Dong, Weiguo
- Venue
- Clinical Microbiology and Infection
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 27
- Issue
- 1
- Pages
- 89-95
- ISSN
- 1198-743X (ISSN-L)
- PMC
- PMC7510771
- OpenAlex
- W3087934142
- Cited by
- 751
- References
- 30
- Citations by year
- 2026: 17 · 2025: 40 · 2024: 103 · 2023: 172 · 2022: 229 · 2021: 184 · 2020: 4 · 2018: 2
- FWCI
- 63.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Clinical Microbiology and Infection (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- COVID-19 pandemic, post-COVID-19 sequelae, long COVID, convalescence, hair loss, dyspnea, resting heart rate, asthma, pulse rate, length of hospital stay, sex differences, psychosocial symptoms
- MeSH terms
- COVID-19, SARS-CoV-2, Adult, Alopecia, China, Convalescence, Dyspnea, Fatigue, Female, Humans, Length of Stay, Longitudinal Studies, Male, Middle Aged, Patient Discharge, Risk Factors, Severity of Illness Index, Tachycardia, Survivors
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