Cited by 864Long-Term Effects of COVID-19COVID-19 Clinical Research StudiesCOVID-19 and Mental Health

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‘Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19

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Mandal, Swapna, Barnett, Joseph, Brill, Simon E, Brown, Jeremy S, Denneny, Emma K, Hare, Samanjit S, Heightman, Melissa, Hillman, Toby E, Jacob, Joseph, Jarvis, Hannah C, Lipman, Marc C I, Naidu, Sindhu B, Nair, Arjun, Porter, Joanna C, Tomlinson, Gillian S, Hurst, John R·2021·Thorax

DOI 10.1136/thoraxjnl-2020-215818PMC PMC7615158

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Abstract

Large numbers of people are being discharged from hospital following COVID-19 without assessment of recovery. In 384 patients (mean age 59.9 years; 62% male) followed a median 54 days post discharge, 53% reported persistent breathlessness, 34% cough and 69% fatigue. 14.6% had depression. In those discharged with elevated biomarkers, 30.1% and 9.5% had persistently elevated d-dimer and C reactive protein, respectively. 38% of chest radiographs remained abnormal with 9% deteriorating. Systematic follow-up after hospitalisation with COVID-19 identifies the trajectory of physical and psychological symptom burden, recovery of blood biomarkers and imaging which could be used to inform the need for rehabilitation and/or further investigation.

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“Initial reports are emerging of significant on-going symptom burden [1] termed ‘Long-COVID’, and of changes in lung function [2] and imaging [3].”

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Background
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BackgroundMethodResult
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Background
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Method
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Background
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BackgroundInfluential
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Background
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Chronic fatigue, depression and anxiety symptoms in Long COVID are strongly predicted by neuroimmune and neuro-oxidative pathways which are caused by the inflammation during acute infectionPreprint
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Cognitive fatigability assessment test (cFAST): Development of a new instrument to assess cognitive fatigability and pilot study on its association to perceived fatigue in multiple sclerosis
Barrios, L., Amon, R., Oldrati, P., Hilty, M., Holz, C., & Lutterotti, A. (2022) · Digital Health · doi:10.1177/20552076221117740 · Cited by 14
Chest CT features and functional correlates of COVID-19 at 3 months and 12 months follow-up
Kumar, K., Ratnakumar, R., Collin, S. M., Berrocal-Almanza, L. C., Ricci, P., Al-Zubaidy, M., Coker, R. K., Coleman, M., Elkin, S., Mallia, P., et al. (2023) · Clinical Medicine · doi:10.7861/clinmed.2023-0059 · Cited by 11
SARS-CoV-2 infection is associated with self-reported post-acute neuropsychological symptoms within six months of follow-up
Andronescu, L. R., Richard, S. A., Scher, I., Lindholm, D. A., Mende, K., Ganesan, A., Huprikar, N., Lalani, T., Smith, A. G., Mody, R. M., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0297481 · Cited by 11
“While earlier studies primarily focused on persistent symptoms in COVID-19 patients with severe initial presentations, our SARS-CoV-2 positive participants were less severely ill, with presentations ranging mostly from asymptomatic to moderately ill [48,49].”
Result
Combined Use of Electrocardiography and Ultrasound to Detect Cardiac and Pulmonary Involvement after Recovery from COVID-19 Pneumonia: A Case Series
Marazzato, J., Ponti, R. D., Verdecchia, P., Masnaghetti, S., Visca, D., Spanevello, A., Trapasso, M., Zappa, M., Mancinelli, A., & Angeli, F. (2021) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd8100133 · Cited by 11
“Although the virus is well known to lead to a variety of multiorgan clinical manifestations during the acute phase [1–5], preliminary clinical [6] and radiological [7] data have recently reported mid-term cardiopulmonary sequelae in fully recovered patients.”
Background
Description of frequent and persistent symptoms of COVID-19 among older adults who attend senior centers
Contreras, P. J., Romero-Albino, Z., & Cuba-Fuentes, M. S. (2022) · Medwave · doi:10.5867/medwave.2022.01.002510 · Cited by 10
The Potential Use of Carnosine in Diabetes and Other Afflictions Reported in Long COVID Patients
Diniz, F., Hipkiss, A. R., & Ferreira, G. C. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.898735 · Cited by 11
“Long COVID symptoms include physical pain, fatigue, dyspnea, gastrointestinal symptoms, headaches, and memory and psychological disturbances (Mahase, 2020; Mandal et al., 2020; Yelin et al., 2020).”
Background
Cardiac impairments in postacute COVID ‐19 with sustained symptoms: A review of the literature and proof of concept
Singh, J., Bhagaloo, L., Sy, E. J., Lavoie, A., Dehghani, P., Bardutz, H. A., Mang, C. S., Buttigieg, J. A., & Neary, J. P. (2022) · Physiological Reports · doi:10.14814/phy2.15430 · Cited by 10
Psychiatric symptoms in COVID-19-positive individuals in the general population: Trajectories of depression, anxiety, and insomnia
Johnson, S. U., Amundsen, O. M., Johnson, M. S., Hoffart, A., Halsøy, Ø., Skjerdingstad, N., Ebling, S., & Ebrahimi, O. V. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114806 · Cited by 12
Imbalance of Peripheral Temperature, Sympathovagal, and Cytokine Profile in Long COVID
das Neves, P. F. M., Quaresma, J. A. S., Queiroz, M. A. F., Silva, C. C., Maia, E. V., Oliveira, J. S. D. S., das Neves, C. M. A., Mendonça, S. D. S., Falcão, A. S. C., Melo, G. S., et al. (2023) · Biology · doi:10.3390/biology12050749 · Cited by 11
“The persistence of biomarkers [45] and inﬂammatory cytokines [46,47] in the acute phase of infection can cause an increase in temperature.”
Background
Impact of COVID-19 infection experience on mental health status of intensive care unit patients’ family members: a real-world study
Liu, T., Zhao, Z., Wu, C., Lu, C., Liu, M., An, X., Sha, Z., Wang, X., Luo, Z., Chen, L., et al. (2023) · QJM · doi:10.1093/qjmed/hcad184 · Cited by 10
Current landscape of long COVID clinical trials
Bhattacharya, M., Chatterjee, S., Saxena, S., Nandi, S. S., Lee, S., & Chakraborty, C. (2024) · International Immunopharmacology · doi:10.1016/j.intimp.2024.111930 · Cited by 10
Acute and sustained increase in endothelial biomarkers in COVID-19
Méndez, R., González‐Jiménez, P., Latorre-Pellicer, A., Piqueras, M., Bouzas, L., Yépez, K., Ferrando, A. D. G., Olmeda, E. Z., Moscardó, A., Alonso, R., et al. (2021) · Thorax · doi:10.1136/thoraxjnl-2020-216797 · Cited by 11
Risk stratification of individuals undergoing surgery after COVID-19 recovery
Silvapulle, E., Johnson, D. F., & Darvall, J. N. (2021) · British Journal of Anaesthesia · doi:10.1016/j.bja.2021.09.026 · Cited by 11
Long COVID and oral health care considerations
France, K., & Glick, M. (2021) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2021.08.007 · Cited by 14
“Systems affected The most common symptoms of long COVID appear to be shortness of breath or difficulty breathing, reported in up to 90% of patients, and fatigue, reported in 69% of patients.(28,29) Pulmonary symptoms appear to be particularly common immediately after COVID-19 but seem to decrease with time.”
Association of post-COVID-19 fatigue with mental health problems and sociodemographic risk factors
Uygur, Ö. F., & Uygur, H. (2021) · Fatigue Biomedicine Health & Behavior · doi:10.1080/21641846.2021.2000251 · Cited by 13
Post-COVID-19 interstitial lung disease presenting with profound hypoxemia: Report of three cases demonstrating a good response to high-dose corticosteroid therapy
Uemasu, K., Yasuda, Y., Hirayama, Y., Arasawa, S., Iwashima, D., & Takahashi, K. P. (2021) · Journal of Infection and Chemotherapy · doi:10.1016/j.jiac.2021.11.010 · Cited by 11
“Imaging abnormalities are improved without specific treatments in some cases [14], and corticosteroid therapy has the potential to improve respiratory symptoms and radiological changes in persistent post-COVID-19 ILD [7,16].”
Síndrome pós-Covid-19: breve revisão sistemática / Long-Covid: brief systematic review
de Oliveira, R. D. C. S., Amaral, L. M. B., Silva, A. B. D., Brandão, A. S., Teixeira, F. T. B., Maia, L. C., Berni, L. C., Lopes, L. B. C., & Garcia, T. M. P. (2022) · Brazilian Journal of Health Review · doi:10.34119/bjhrv5n2-150 · Cited by 11
Long COVID and its cardiovascular consequences: What is known?
Składanek, J. A., Leśkiewicz, M., Gumiężna, K., Baruś, P., Piasecki, A., Klimczak‐Tomaniak, D., Sygitowicz, G., Kochman, J., Grabowski, M., & Tomaniak, M. (2023) · Advances in Clinical and Experimental Medicine · doi:10.17219/acem/167482 · Cited by 11
Severity of Postcovid Syndrome: A Systematic Review
Karaseva, A. A., Khudiakova, A. D., Garbuzova, E. V., Ragino, Y. I., & Логвиненко, И. И. (2024) · The Russian Archives of Internal Medicine · doi:10.20514/2226-6704-2023-13-6-422-435 · Cited by 10
Persistent CD8+ T cell proliferation and activation in COVID-19 adult survivors with post-acute sequelae: a longitudinal, observational cohort study of persistent symptoms and T cell markers
LaVergne, S. M., Dutt, T. S., McFann, K., Baxter, B. A., Webb, T. L., Berry, K., Tipton, M., Stromberg, S., Sullivan, B. M., Dunn, J., et al. (2024) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1303971 · Cited by 10
Long COVID ‐19 gastrointestinal related disorders and traditional Chinese medicine: A network target‐based approach
Mattioli, L., Frosini, M., Corazza, I., Fiorino, S., Zippi, M., Micucci, M., & Budriesi, R. (2024) · Phytotherapy Research · doi:10.1002/ptr.8163 · Cited by 10
“…common symptoms of Long COVID-19 (caused directly by the virus or by the trauma of the infection) consist of widespread fatigue, headache, attention disorders, dyspnea, and gastrointestinal (GI) alterations, including dysgeusia (Lopez-Leon et al., 2021; Mandal et al., 2021; Thomas et al., 2022).”
Background
Long COVID Characteristics and Experience: A Descriptive Study From the Yale LISTEN Research Cohort
Sawano, M., Wu, Y., Shah, R. M., Zhou, T., Arun, A. S., Khosla, P., Kaleem, S., Vashist, A., Bhattacharjee, B., Ding, Q., et al. (2024) · The American Journal of Medicine · doi:10.1016/j.amjmed.2024.04.015 · Cited by 11
Post traumatic stress and sleep disorders in long COVID: Patient management and treatment
Herring, T. E., Chopra, A., Friedly, J. L., Bender, J. A., Gentile, N. L., & Knowles, L. M. (2024) · Life Sciences · doi:10.1016/j.lfs.2024.123081 · Cited by 13
It's not over till it's over: a narrative review of Long COVID
Pergolizzi, J. V., LeQuang, J. A., Magnusson, P., Myrcik, D., & Varrassi, G. (2021) · Signa Vitae · doi:10.22514/sv.2021.067 · Cited by 10
“It is interesting, that of the patients with a chest X-ray showing marked deterioration (n = 23), 9% had had normal X-rays at admission, 48% had indeterminate radiographic findings, and 43% had “typical COVID” chest X-rays [28].”
BackgroundInfluential
Post-COVIDLMU: Implementierung und Evaluierung eines interdisziplinären und sektorenübergreifenden Versorgungs- und Forschungsnetzwerks für eine evidenzgeleitete Behandlung von Patienten mit schwerem Post-COVID-Syndrom
Adorjan, K., Heindl, B., & Stubbe, H. C. (2022) · Der Nervenarzt · doi:10.1007/s00115-022-01322-1 · Cited by 10
Clinical characteristics and quality of life of persistent symptoms of COVID-19 syndrome in Indonesia
Susanto, A. D., Isbaniah, F., Pratomo, I. P., Antariksa, B., Samoedro, E., Taufik, M., Harinda, F., & Nurwidya, F. (2022) · GERMS · doi:10.18683/germs.2022.1319 · Cited by 12
Blood group O is associated with post-COVID-19 syndrome in outpatients with a low comorbidity index
Díaz-Salazar, S., Navas, R., Sainz-Maza, L., Fierro, P., Maamar, M., Artime, A., Basterrechea, H., Petitta, B., Lamadrid, C., Pedraja, L., et al. (2022) · Scandinavian Journal of Infectious Diseases · doi:10.1080/23744235.2022.2115548 · Cited by 10
Assessment of early and long-COVID related retinal neurodegeneration with optical coherence tomography
Şeker, E. D., & Timur, İ. E. E. (2022) · International Ophthalmology · doi:10.1007/s10792-022-02607-9 · Cited by 10
Post-COVID 19 Period: Modern State and Clinical Features
Larina, V. N., Ryzhikh, A. A., & Бикбаева, Л. И. (2021) · The Russian Archives of Internal Medicine · doi:10.20514/2226-6704-2021-11-3-186-195 · Cited by 12
“Сочетание нескольких симптомов/Combination of symptoms 55% 3 месяца после завершения госпитализации/ 3 months aft er hospital discharge Mandal et al. 2020 [16] n=384 средний возраст/median age 59,9 лет 146 женщин/women (38”
Coronavirus infections from 2002 to 2021: neuropsychiatric manifestations
Barthorpe, A., & Rogers, J. P. (2021) · Sleep Medicine · doi:10.1016/j.sleep.2021.11.013 · Cited by 10
Post-COVID symptoms of potential peripheral nervous and muscular origin
Silva-Hernández, L., Cabal-Paz, B., Canalejo, D. M., & Horga, A. (2021) · Neurology Perspectives · doi:10.1016/j.neurop.2021.11.002 · Cited by 10
Asthenia and Post-COVID Syndrome: Pathogenesis, Clinical Presentations, Diagnosis, and Medical Rehabilitation
Петрова, Л. В., Moscow, R. F., Kostenko, E. G., & Ахматовна, Э. М. (2021) · Doctor Ru · doi:10.31550/1727-2378-2021-20-9-36-42 · Cited by 10
Thymic Dysfunction and Atrophy in COVID-19 Disease Complicated by Inflammation, Malnutrition and Cachexia
Chiang, K. C., Kalantar‐Zadeh, K., & Gupta, A. (2022) · Nutrition and Health · doi:10.1177/02601060221083160 · Cited by 10
A Review of Long COVID With a Special Focus on Its Cardiovascular Manifestations
Yousif, E., & Premraj, S. (2022) · Cureus · doi:10.7759/cureus.31933 · Cited by 10
“have reported high rates of persistently elevated biomarkers (d-dimers and C-reactive protein) for up to eight weeks in patients with breathlessness and cough [27].”
Background
O impacto da reabilitação com multicomponentes no pós-COVID
de Oliveira, K. C. V., Ferreira, A. P. D. L., Silva, D. D. A., Monteiro, J. D. S., da Silva, K. E. C., de Lucena, L. C., & de Araújo, M. D. G. R. (2023) · Fisioterapia em Movimento · doi:10.1590/fm.2023.36112 · Cited by 10
A likely association between low mannan-binding lectin level and brain fog onset in long COVID patients
Bulla, R., Rossi, L., Furlanis, G., Agostinis, C., Toffoli, M., Balduit, A., Mangogna, A., Liccari, M., Morosini, G., Kishore, U., et al. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1191083 · Cited by 10
Effect of COVID-19 vaccine on long-COVID: A 2-year follow-up observational study from hospitals in north IndiaPreprint
Budhiraja, S., Indrayan, A., & Mahajan, M. (2022) · medRxiv · doi:10.1101/2022.07.18.22277740 · Cited by 10
Experiences of people with long COVID: Symptoms, support strategies and the Long COVID Optimal Health Programme (LC‐OHP)
Al‐Jabr, H., Thompson, D. R., Castle, D. J., & Ski, C. F. (2023) · Health Expectations · doi:10.1111/hex.13879 · Cited by 9
Hyperbaric oxygen effectively addresses the pathophysiology of long COVID: clinical review
Katz, A. A., Wainwright, S. K., Kelly, M. P., Albert, P., & Byrne, R. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1354088 · Cited by 8
Gender differences in symptomatology, socio-demographic information and quality of life in Spanish population with long COVID condition: a cross-sectional study
Marcilla-Toribio, I., Moratalla-Cebrian, M. L., Notario‐Pacheco, B., López, M. Á. E., Morales-Cuenca, N., & Martínez-Andrés, M. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1355973 · Cited by 9
“Furthermore, other studies have likewise had more women in the sample (33, 34, 60).”
Background
The Effect of Anti-Chemokine Oral Drug XC8 on Cough Triggered by The Agonists of TRPA1 But Not TRPV1 Channels in Guinea Pigs
Romanova, J. R., Rydlovskaya, A. V., Mochalov, S. V., Proskurina, O. V., Gorokh, Y., & Nebolsin, V. E. (2022) · Pulmonary Therapy · doi:10.1007/s41030-022-00183-y · Cited by 9
“It was shown that 34% of recovering patients have persistent cough [69].”
Background
“Long Haulers”
Lutchmansingh, D. D., Sevilla, J. P. H., Possick, J. D., & Gulati, M. (2023) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0042-1759568 · Cited by 9
Fatigue in Post-Acute Sequelae of Coronavirus Disease 2019
Abbott, Z., Summers, W., & Niehaus, W. (2023) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/j.pmr.2023.04.006 · Cited by 9
Quality of life and intrinsic capacity in patients with post-acute COVID-19 syndrome is in relation to frailty and resilience phenotypes
Guaraldi, G., Milić, J., Barbieri, S., Marchiò, T., Caselgrandi, A., Motta, F., Beghé, B., Verduri, A., Belli, M., Gozzi, L., et al. (2023) · Scientific Reports · doi:10.1038/s41598-023-29408-z · Cited by 9
Clinical and Biomarker Profile Responses to Rehabilitation Treatment in Patients with Long COVID Characterized by Chronic Fatigue
Binetti, J., Real, M., Renzulli, M., Bertran, L., Riesco, D., Perpiñán, C., Mohedano, A., Segundo, R. S., Ortiz, M., Porras, J. A., et al. (2023) · Viruses · doi:10.3390/v15071452 · Cited by 9
“The mean LC symptoms and their distribution were similar to those observed in other studies [8,19,22,33], mostly reporting fatigue, headache, dyspnea, amnesia, and olfactory disturbances.”
BackgroundResult

Authors: Mandal, S., Barnett, J., Brill, S. E., Brown, J. S., Denneny, E. K., Hare, S. S., Heightman, M., Hillman, T. E., Jacob, J., Jarvis, H. C., Lipman, M. C. I., Naidu, S. B., Nair, A., Porter, J. C., Tomlinson, G. S., & Hurst, J. R.
Affiliations: Royal Free London NHS Foundation Trust (GB)
University College London Hospitals NHS Foundation Trust (GB)
University College Hospital (GB)
Corresponding author: Hurst, John R
ORCID: Mandal, Swapna
Barnett, Joseph
Brill, Simon E
Brown, Jeremy S
Denneny, Emma K
Heightman, Melissa
Hillman, Toby E
Jacob, Joseph
Lipman, Marc C I
Naidu, Sindhu B
Nair, Arjun
Porter, Joanna C
Tomlinson, Gillian S
Hurst, John R
Venue: Thorax
Publisher: BMJ
Published: 2020-11-10
Volume: 76
Issue: 4
Pages: 396-398
ISSN: 0040-6376 (ISSN-L)
1468-3296
DOI: 10.1136/thoraxjnl-2020-215818
PMC: PMC7615158
OpenAlex: W3101401355
Cited by: 864
References: 7
Citations by year: 2026: 18 · 2025: 50 · 2024: 111 · 2023: 181 · 2022: 263 · 2021: 235 · 2020: 6
FWCI: 74.15
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: bmj.com/coronavirus/usage (tdm)
Locations: Thorax (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
UCL Discovery (University College London) (submittedVersion)
Funders: Wellcome Trust (Z/17/Z, 209553, 209553/Z/17/Z)
National Institute for Health and Care Research
University College London Hospitals NHS Foundation Trust
Medical Research Council (MR/N007727/1)
Topics: Health Sciences › Medicine › Clinical 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: long COVID, persistent symptoms, dyspnea, cough, fatigue, depression, D-dimer, C-reactive protein, biomarkers, chest X-ray abnormalities, post-discharge follow-up, rehabilitation
MeSH terms: COVID-19, SARS-CoV-2, Cross-Sectional Studies, Diagnostic Imaging, Female, Hospitalization, Humans, Lung, Male, Middle Aged, Severity of Illness Index, Biomarkers, Pandemics

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‘Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19

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