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RETRACTED: 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study
Open accessAbstract
Background The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity.Methods We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020. Patients who died before follow-up, patients for whom follow-up would be difficult because of psychotic disorders, dementia, or re-admission to hospital, those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism, those who declined to participate, those who could not be contacted, and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5-6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received severe acute respiratory syndrome coronavirus 2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences.Findings In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 (IQR 47·0-65·0) years and 897 (52%) were men. The follow-up study was done from June 16, to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 (175·0-199·0) days. Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients. The proportions of median 6-min walking distance less than the lower limit of the normal range were 24% for those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5-6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5-6, and median CT scores were 3·0 (IQR 2·0-5·0) for severity scale 3, 4·0 (3·0-5·0) for scale 4, and 5·0 (4·0-6·0) for scale 5-6. After multivariable adjustment, patients showed an odds ratio (OR) 1·61 (95% CI 0·80-3·25) for scale 4 versus scale 3 and 4·60 (1·85-11·48) for scale 5-6 versus scale 3 for diffusion impairment; OR 0·88 (0·66-1·17) for scale 4 versus scale 3 and OR 1·77 (1·05-2·97) for scale 5-6 versus scale 3 for anxiety or depression, and OR 0·74 (0·58-0·96) for scale 4 versus scale 3 and 2·69 (1·46-4·96) for scale 5-6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with estimated glomerular filtration rate (eGFR) 90 mL/min per 1·73 m 2 or more at acute phase had eGFR less than 90 mL/min per 1·73 m 2 at follow-up.Interpretation At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery.Funding National Natural Science Foundation of China, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, National Key Research and Development Program of China, Major Projects of National Science and Technology on New Drug Creation and Development of Pulmonary Tuberculosis, and Peking Union Medical College Foundation.
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“Nevertheless, what emerges from preliminary data is the negative impact of long COVID on quality of life and its effects on patient work ability and social relationships [1,4,19].”
From Female gender is associated with long COVID syndrome: a prospective cohort study (2022) · cites this paper as [1]
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“These mental health symptoms persist even after the acute stage of the disease.”
From Psychological treatments for the mental health symptoms among individuals infected with COVID-19: a scoping review protocol (2023) · cites this paper as [5]
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“Further, severe lung complications from COVID-19 may have persisting limitations to respiratory function and gas exchange; this group of patients, therefore, should be the primary target population for the intervention of long-term recovery.”
From Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study (2022) · cites this paper as [32]
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“Abdominal chest imaging, and severe impairment to pulmonary diffusion capacities was reported in COVID-19 patients recovered from severe illness [32].”
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“These symptoms can endure up to 6–7 months and even longer [[1], [2], [3], [4], [5]].”
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“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].”
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“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]].”
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Metadata
- Authors
- Huang, C., Huang, L., Wang, Y., Li, X., Ren, L., Gu, X., Kang, L., Guo, L., Liu, M., Zhou, X., Luo, J., Huang, Z., Tu, S., Zhao, Y., Chen, L., Xu, D., Li, Y., Li, C., Peng, L., Li, Y., Xie, W., Cui, D., Shang, L., Fan, G., Xu, J., Wang, G., Wang, Y., Zhong, J., Wang, C., Wang, J., Zhang, D., & Cao, B.
- Affiliations
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Capital Medical University (CN)
- China-Japan Friendship Hospital (CN)
- Jinyintan Hospital (CN)
- Peking University (CN)
- Harbin Medical University (CN)
- Beijing University of Chinese Medicine (CN)
- Tsinghua University (CN)
- Corresponding author
- Cao, Bin
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 397
- Issue
- 10270
- Pages
- 220-232
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC7833295
- OpenAlex
- W3120387768
- Cited by
- 4,084
- References
- 41
- Citations by year
- 2026: 67 · 2025: 180 · 2024: 510 · 2023: 934 · 2022: 1300 · 2021: 1088
- FWCI
- 458.37
- Type
- journal article
- Language
- en
- Status
- Retracted
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Science and Technology Major Project (2020ZX09201001)
- Chinese Academy of Medical Sciences (2020-I2M-CoV19\u2013005)
- National Natural Science Foundation of China (82041011/H0104)
- National Key Research and Development Program of China (2018YFC1200102)
- China-Japan Friendship Hospital
- Topics
- Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- COVID-19 pandemic, long-term health effects, long COVID, fatigue, muscle weakness, sleep disorders, anxiety, depression, disease severity, health-related quality of life, physical function, lung function, SARS-CoV-2, retraction, Wuhan, post-discharge follow-up, risk factors, lopinavir
- MeSH terms
- COVID-19, SARS-CoV-2, COVID-19 Serological Testing, Post-Acute COVID-19 Syndrome, Aged, China, Fatigue, Female, Humans, Length of Stay, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Severity of Illness Index, Sleep Wake Disorders, Cohort Studies, Comorbidity, Muscle Weakness, Pandemics
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