1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study.
Open accessAbstract
Background The full range of long-term health consequences of COVID-19 in patients who are discharged from hospital is largely unclear. The aim of our study was to comprehensively compare consequences between 6 months and 12 months after symptom onset among hospital survivors with COVID-19.Methods We undertook an ambidirectional cohort study of COVID-19 survivors who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7 and May 29, 2020. At 6-month and 12-month follow-up visit, survivors were interviewed with questionnaires on symptoms and health-related quality of life (HRQoL), and received a physical examination, a 6-min walking test, and laboratory tests. They were required to report their health-care use after discharge and work status at the 12-month visit. Survivors who had completed pulmonary function tests or had lung radiographic abnormality at 6 months were given the corresponding tests at 12 months. Non-COVID-19 participants (controls) matched for age, sex, and comorbidities were interviewed and completed questionnaires to assess prevalent symptoms and HRQoL. The primary outcomes were symptoms, modified British Medical Research Council (mMRC) score, HRQoL, and distance walked in 6 min (6MWD). Multivariable adjusted logistic regression models were used to evaluate the risk factors of 12-month outcomes.Findings 1276 COVID-19 survivors completed both visits. The median age of patients was 59·0 years (IQR 49·0-67·0) and 681 (53%) were men. The median follow-up time was 185·0 days (IQR 175·0-198·0) for the 6-month visit and 349·0 days (337·0-361·0) for the 12-month visit after symptom onset. The proportion of patients with at least one sequelae symptom decreased from 68% (831/1227) at 6 months to 49% (620/1272) at 12 months (p<0·0001). The proportion of patients with dyspnoea, characterised by mMRC score of 1 or more, slightly increased from 26% (313/1185) at 6-month visit to 30% (380/1271) at 12-month visit (p=0·014). Additionally, more patients had anxiety or depression at 12-month visit (26% [331/1271] at 12-month visit vs 23% [274/1187] at 6-month visit; p=0·015). No significant difference on 6MWD was observed between 6 months and 12 months. 88% (422/479) of patients who were employed before COVID-19 had returned to their original work at 12 months. Compared with men, women had an odds ratio of 1·43 (95% CI 1·04-1·96) for fatigue or muscle weakness, 2·00 (1·48-2·69) for anxiety or depression, and 2·97 (1·50-5·88) for diffusion impairment. Matched COVID-19 survivors at 12 months had more problems with mobility, pain or discomfort, and anxiety or depression, and had more prevalent symptoms than did controls.Interpretation Most COVID-19 survivors had a good physical and functional recovery during 1-year follow-up, and had returned to their original work and life. The health status in our cohort of COVID-19 survivors at 12 months was still lower than that in the control population.Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, the National Natural Science Foundation of China, the National Key Research and Development Program of China, Major Projects of National Science and Technology on New Drug Creation and Development of Pulmonary Tuberculosis, the China Evergrande Group, Jack Ma Foundation, Sino Biopharmaceutical, Ping An Insurance (Group), and New Sunshine Charity Foundation.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In a large cohort of COVID-19 patients, anxiety and depression were significantly more common among the critically ill than among other less severely ill COVID-19 survivors (32 percent vs. 22-23 percent).
“anxiety and depression were significantly more common among the critically ill than among other less severely ill COVID-19 survivors (32 percent vs. 22–23 percent).”
From Cognitive Behavioral Therapy and Acceptance and Commitment Therapy (CBT-ACT) vs. Standard Care After Critical Illness Due to COVID-19: Protocol for a Pilot Randomized Controlled Trial (2022) · cites this paper as [2]
Table 2 in the Results reports anxiety or depression in the most severely ill group at 36% after six months and 29% after 12 months, not 32%; the less severely ill groups were at 21–26%, depending on severity and visit. The Results also state that the adjusted comparison between the most and least severely ill groups was not statistically significant for anxiety or depression (OR 1.42, 95% CI 0.80–2.52). (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredPeople surviving the acute phases of a severe COVID-19 condition requiring intensive care are at high risk of developing mental health symptoms.
“It has been reported that people surviving the acute phases of a severe COVID-19 condition requiring intensive care are at high risk of developing mental health symptoms.”
From Cognitive Behavioral Therapy and Acceptance and Commitment Therapy (CBT-ACT) vs. Standard Care After Critical Illness Due to COVID-19: Protocol for a Pilot Randomized Controlled Trial (2022) · cites this paper as [2]
The Results (Table 2; page not supplied) report anxiety or depression in 29% of the highest-severity group at 12 months, supporting concern about mental health symptoms after severe COVID-19. But that group was defined by respiratory support, not ICU admission, and the main adjusted analysis found no significant difference in anxiety or depression compared with the lowest-severity group. The paper therefore does not establish the stated risk specifically for ICU survivors. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPost-covid syndrome is characterized by several symptoms affecting quality of life.
“This is typically referred to as a post-covid syndrome, characterized by several symptoms affecting quality of life (1–5).”
Neurovascular processes may play a role in postinfection cognitive decline among COVID-19 survivors.
“neurovascular elements might be involved in the development of postinfection cognitive decline in COVID-19 survivors”
From One-Year Trajectory of Cognitive Changes in Older Survivors of COVID-19 in Wuhan, China: A Longitudinal Cohort Study (2022) · cites this paper as [31]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
1 retracted
RETRACTED: 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study
Huang, C., Huang, L., Wang, Y., Li, X., Ren, L., Gu, X., Kang, L., Guo, L., Liu, M., Zhou, X., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(20)32656-8 · Cited by 4,084 · see citing works
Self-citationRetractedDevelopment and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)
Herdman, M., Gudex, C., Lloyd, A., Janssen, M., Kind, P., Parkin, D., Bonsel, G., & Badia, X. (2011) · Quality of Life Research · doi:10.1007/s11136-011-9903-x · Cited by 9,795 · see citing works
EQ-SD: a measure of health status from the EuroQol Group
Rabin, R., & Charro, F. D. (2001) · Annals of Medicine · doi:10.3109/07853890109002087 · Cited by 5,613 · see citing works
WHO Coronavirus Disease (COVID-19) Dashboard
(2020) · Bangladesh Physiotherapy Journal · doi:10.46945/bpj.10.1.03.01 · Cited by 5,545 · see citing works
A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19
Cao, B., Wang, Y., Wen, D., Liu, W., Wang, J., Fan, G., Ruan, L., Song, B., Cai, Y., Wei, M., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2001282 · Cited by 5,187 · see citing works
Self-citationRogers, J. P., Chesney, E., Oliver, D., Pollak, T. A., McGuire, P., Fusar-Poli, P., Zandi, M. S., Lewis, G., & David, A. S. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30203-0 · Cited by 2,407 · see citing works
Taquet, M., Geddes, J. R., Husain, M., Luciano, S., & Harrison, P. J. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00084-5 · Cited by 2,189 · see citing works
Evaluation of Clinical Methods for Rating Dyspnea
Mahler, D. A., & Wells, C. K. (1988) · CHEST Journal · doi:10.1378/chest.93.3.580 · Cited by 1,821 · see citing works
High-dimensional characterization of post-acute sequelae of COVID-19
Al-Aly, Z., Xie, Y., & Bowe, B. (2021) · Nature · doi:10.1038/s41586-021-03553-9 · Cited by 1,518 · see citing works
Sequelae in Adults at 6 Months After COVID-19 Infection
Logue, J. K., Franko, N., McCulloch, D. J., McDonald, D., Magedson, A., Wolf, C. R., & Chu, H. Y. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.0830 · Cited by 882 · see citing works
Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study
Ayoubkhani, D., Khunti, K. K., Nafilyan, V., Maddox, T., Humberstone, B., Diamond, I. D., & Banerjee, A. (2021) · BMJ · doi:10.1136/bmj.n693 · Cited by 843 · see citing works
Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study
Xiong, Q., Xu, M., Li, J., Liu, Y., Zhang, J., Xu, Y., & Dong, W. (2021) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2020.09.023 · Cited by 751 · see citing works
Lam, M. H.-B. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.384 · Cited by 723 · see citing works
Wu, X., Liu, X., Zhou, Y., Yu, H., Li, R., Zhan, Q., Ni, F., Fang, S., Yang, L., Ding, X., et al. (2021) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(21)00174-0 · Cited by 696 · see citing works
Self-citationLong COVID in a prospective cohort of home-isolated patients
Blomberg, B., Mohn, K. G.-I., Brokstad, K. A., Zhou, F., Linchausen, D. W., Hansen, B.-A., Lartey, S., Onyango, T. B., Kuwelker, K., Sævik, M., et al. (2021) · Nature Medicine · doi:10.1038/s41591-021-01433-3 · Cited by 659 · see citing works
Arnold, D., Hamilton, F., Milne, A., Morley, A. J., Viner, J., Attwood, M., Noel, A. R., Gunning, S., Hatrick, J., Hamilton, S., et al. (2020) · Thorax · doi:10.1136/thoraxjnl-2020-216086 · Cited by 627 · see citing works
Four-Month Clinical Status of a Cohort of Patients After Hospitalization for COVID-19
Morin, L., Savale, L., Pham, T. O., Colle, R., Figueiredo, S., Harrois, A., Gasnier, M., Lecoq, A.-L., Meyrignac, O., Noël, N., et al. (2021) · JAMA · doi:10.1001/jama.2021.3331 · Cited by 598 · see citing works
Hui, D. S. C. (2005) · Thorax · doi:10.1136/thx.2004.030205 · Cited by 525 · see citing works
Ngai, J. C. L., Ko, F. W. S., Ng, S. S., To, K., Tong, M. M. B., & Hui, D. S. C. (2010) · Respirology · doi:10.1111/j.1440-1843.2010.01720.x · Cited by 502 · see citing works
Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial
Sonnweber, T., Sahanic, S., Pizzini, A., Luger, A. K., Schwabl, C., Sonnweber, B., Kurz, K., Koppelstätter, S., Haschka, D., Petzer, V., et al. (2020) · European Respiratory Journal · doi:10.1183/13993003.03481-2020 · Cited by 433 · see citing works
Hui, D. S. C., Wong, K. T., Ko, F. W. S., Tam, L., Chan, D. P. S., Woo, J., & Sung, J. J. �. (2005) · CHEST Journal · doi:10.1378/chest.128.4.2247 · Cited by 369 · see citing works
Hypoxaemia related to COVID-19: vascular and perfusion abnormalities on dual-energy CT
Lang, M., Som, A., Mendoza, D. P., Flores, E. J., Reid, N., Carey, D. E., Li, M., Witkin, A. S., Rodriguez‐Lopez, J., Shepard, J.-A. O., et al. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30367-4 · Cited by 322 · see citing works
One-Year Outcomes and Health Care Utilization in Survivors of Severe Acute Respiratory Syndrome
Tansey, C. M. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.12.1312 · Cited by 313 · see citing works
Pulmonary Angiopathy in Severe COVID-19: Physiologic, Imaging, and Hematologic Observations
Patel, B. V., Arachchillage, D. J., Ridge, C. A., Bianchi, P., Doyle, J. F., Garfield, B. E., Ledot, S., Morgan, C., Passariello, M., Price, S., et al. (2020) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202004-1412oc · Cited by 297 · see citing works
Neuromuscular Disorders in Severe Acute Respiratory Syndrome
Tsai, L., Hsieh, S., Chao, C., Chen, Y., Lin, Y.-H., Chang, S., & Chang, Y. (2004) · Archives of Neurology · doi:10.1001/archneur.61.11.1669 · Cited by 247 · see citing works
Pulmonary long-term consequences of COVID-19 infections after hospital discharge
Blanco, J. R., Cobos-Ceballos, M. J., Navarro-Romero, F., Sanjoaquín, I., Revillas, F. A. D. L., Bernal, E., Buzón, L., Viribay, M., Romero, L., Espejo-Pérez, S., et al. (2021) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2021.02.019 · Cited by 149 · see citing works
Toward Understanding COVID-19 Recovery: National Institutes of Health Workshop on Postacute COVID-19
Lerner, A. M., Robinson, D. A., Yang, L., Williams, C., Newman, L. M., Breen, J. J., Eisinger, R. W., Schneider, J. S., Adimora, A. A., & Erbelding, E. J. (2021) · Annals of Internal Medicine · doi:10.7326/m21-1043 · Cited by 70 · see citing works
Hyperoxia and modulation of pulmonary vascular and immune responses in COVID-19
Hanidziar, D., & Robson, S. C. (2020) · American Journal of Physiology-Lung Cellular and Molecular Physiology · doi:10.1152/ajplung.00304.2020 · Cited by 65 · see citing works
Follow-up study of pulmonary function among COVID-19 survivors 1 year after recovery
Yan, X., Huang, H., Wang, C., Jin, Z., Zhang, Z., He, J., Yin, S., Fan, M., Huang, J., Chen, F., et al. (2021) · Journal of Infection · doi:10.1016/j.jinf.2021.05.034 · Cited by 54 · see citing works
Residual symptoms and lower lung function in patients recovering from SARS-CoV-2 infection
Trinkmann, F., Müller, M. K., Reif, A., Kahn, N. C., Kreuter, M., Trudzinski, F. C., Eichinger, M., Heußel, C. P., & Herth, F. J. F. (2021) · European Respiratory Journal · doi:10.1183/13993003.03002-2020 · Cited by 48 · see citing works
Hsu, H., Tzao, C., Wu, C., Chang, W., Tsai, C., Tung, H., & Chen, C. (2004) · CHEST Journal · doi:10.1378/chest.126.1.149 · Cited by 41 · see citing works
Xie, W., Wu, Y., Wang, W., Zhao, D. H., Liang, L., Wang, M., Yang, Y., Sun, J., Shi, P., & Huo, Y. (2011) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2011.02.011 · Cited by 36 · see citing works
Su, M.-C., Hsieh, Y.-T., Wang, Y.-H., Lin, A.-S., Chung, Y., & Lin, M. (2006) · Respiration · doi:10.1159/000095673 · Cited by 26 · see citing works
Self-citationCOVID-19 pathophysiology: looking beyond acute disease
Medicine, T. L. R. (2021) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(21)00242-3 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Epigenetic memory of coronavirus infection in innate immune cells and their progenitors
Cheong, J.-G., Ravishankar, A., Sharma, S., Parkhurst, C. N., Grassmann, S. A., Wingert, C. K., Laurent, P., Ma, S., Paddock, L., Miranda, I. C., et al. (2023) · Cell · doi:10.1016/j.cell.2023.07.019 · Cited by 309 · see citing works
Liu, Y.-H., Chen, Y., Wang, Q.-H., Wang, L.-R., Jiang, L., Yang, Y., Chen, X., Li, Y., Cen, Y., Xu, C., et al. (2022) · JAMA Neurology · doi:10.1001/jamaneurol.2022.0461 · Cited by 225 · see citing works
Self-citationWatanabe, A., So, M., Iwagami, M., Fukunaga, K., Takagi, H., Kabata, H., & Kuno, T. (2022) · Respirology · doi:10.1111/resp.14311 · Cited by 139 · see citing works
“Consistent with our findings, a longitudinal prospective study indicated that the proportion of reduced DLCO could remain unchanged from mid-term to long-term follow-up, although the absolute value depended on the severity.(11) On the contrary, another study has shown the gradual functional recovery after COVID-19.”
BackgroundResultMartins-Ferreira, R., Calafell-Segura, J., Leal, B., Rodríguez-Ubreva, J., Martínez-Saez, E., Mereu, E., Pinho E Costa, P., Laguna, A., & Ballestar, E. (2025) · Nature Communications · doi:10.1038/s41467-025-56124-1 · Cited by 123 · see citing works
Role of senescence in the chronic health consequences of COVID-19
Wissler Gerdes, E. O., Vanichkachorn, G., Verdoorn, B. P., Hanson, G. J., Joshi, A. Y., Murad, M. H., Rizza, S. A., Hurt, R. T., Tchkonia, T., & Kirkland, J. L. (2022) · Translational Research · doi:10.1016/j.trsl.2021.10.003 · Cited by 38 · see citing works
Håkansson, A., Cronhjort, M., Lidin-Darlington, P., Lilja, G., Nilsson, A., Schandl, A., & Friberg, H. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.907215 · Cited by 5 · see citing works
- Authors
- Huang, L., Yao, Q., Gu, X., Wang, Q., Ren, L., Wang, Y., Hu, P., Guo, L., Liu, M., Xu, J., Zhang, X., Qu, Y., Fan, Y., Li, X., Li, C., Yu, T., Xia, J., Wei, M., Chen, L., Li, Y., Xiao, F., Liu, D., Wang, J., Wang, X., & Cao, B.
- Affiliations
- Capital Medical University (CN)
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- China-Japan Friendship Hospital (CN)
- Tsinghua University (CN)
- Corresponding author
- Cao, Bin
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2021-08
- Volume
- 398
- Issue
- 10302
- Pages
- 747-758
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC8389999
- OpenAlex
- W3194737219
- Cited by
- 1,101
- References
- 34
- Citations by year
- 2026: 61 · 2025: 126 · 2024: 226 · 2023: 285 · 2022: 353 · 2021: 49
- FWCI
- 108.78
- Type
- journal article
- Language
- en
- Update notices
- erratum (2022-05-07)
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- New Sunshine Charity Foundation
- National Natural Science Foundation of China (82041011, COVID-19, 82041011/H0104)
- Chinese Academy of Medical Sciences (CIFMS 2018-I2M-1-003, 2018-I2M-1-003)
- National Key Research and Development Program of China (2018YFC1200102)
- 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, long-term outcomes, post-COVID-19 sequelae, health-related quality of life, dyspnea, post-COVID-19 fatigue
- MeSH terms
- Walk Test, COVID-19, SARS-CoV-2, Aged, Anxiety, Depression, Fatigue, Female, Follow-Up Studies, Humans, Longitudinal Studies, Lung, Male, Middle Aged, Quality of Life, Exercise Tolerance, Survivors, Muscle Weakness
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
