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‘Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19
Open accessAbstract
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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“whereas lower rates of depression (15 percent) also have been reported after hospitalization for COVID-19 (8).”
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Citations
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MethodRomero-Rodríguez, E., Vélez-Santamaría, R., Pérula-de-Torres, L., González-Lama, J., Castro-Jiménez, R. A., Simón-Vicente, L., Jimenez-Garcia, C., González-Bernal, J., Santamaría-Peláez, M., Fernández-Solana, J., et al. (2023) · Healthcare · doi:10.3390/healthcare11121677 · Cited by 9
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Ko, A. C. S., Candellier, A., Mercier, M., Joseph, C., Carette, H., Basille, D., Lion-Daolio, S., Devaux, S., Schmit, J., Lanoix, J., et al. (2022) · International Journal of General Medicine · doi:10.2147/ijgm.s367273 · Cited by 5
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“As previously demonstrated by Mandal et al. (2021), long COVID is sometimes characterised by elevated CRP and d- dimer levels.”
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Christensen, J. D., Harowicz, M. R., Walker, C. M., Little, B. P., Batra, K., Brixey, A. G., Carroll, M. B., Chelala, L., Cox, C. W., Drummond, M., et al. (2025) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2025.02.034 · Cited by 6
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“A previous study has demonstrated that although most COVID-19 symptoms resolve after discharge from the hospital, approximately 69% of patients still report experiencing persistent fatigue [5] .”
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An oral combined contraceptive user with elevated D-dimer post COVID-19: a case report
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“1% of patients discharged from three large hospitals in London had persistently elevated d-dimer [9], and the value decreases over time postCOVID [9].”
BackgroundLong-COVID: Langzeitsymptome und morphologische/radiologische Korrelate
Thurnher, M. M., Reith, W., Thurnher, A. P., & Rommer, P. S. (2021) · Der Radiologe · doi:10.1007/s00117-021-00910-7 · Cited by 6
Post COVID-19 complications, adjunct therapy explored, and steroidal after effects
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“, increased D-dimer and CRP levels were more common in COVID survivors than in fully recovered cases [14].”
BackgroundGender-Specific Differences in the Intensive Care Treatment of COVID-19 Patients
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“Four (4) days after symptom onset he presented to hospital and experienced worsening dyspnea during admission.”
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“be speculated that post-COVID-19 condition can have different pathways in hospitalized and non-hospitalized patients because older male patients dominate among hospitalized patients [4,5], while middle-aged women more often report persistent symptoms, in survey studies [6].”
BackgroundSubstance Use and the Self-Management of Persistent Symptoms of COVID-19
Veliz, P. T., Zhou, W., Smith, S. M. S., & Larson, J. L. (2023) · Substance Use & Misuse · doi:10.1080/10826084.2023.2184208 · Cited by 7
Koly, K. N., Muzaffar, R., Monisha, U. K., Saba, J., Rahman, L., Billah, M. A., Das, J., Rozars, M. F. K., Alam, N., Kamrunnahar, et al. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e14548 · Cited by 6
“persisting symptoms is still being understudied due to different disease mechanisms, including an inflammatory reaction and increased blood biomarkers [78-80].”
Functional diagnostics of the respiratory system in patients with Long COVID
Бакалець, О. В., Dzyha, S. V., & Behosh, N. B. (2023) · Bulletin Of Medical And Biological Research · doi:10.61751/bmbr.2706-6290.2023.2.60 · Cited by 6
Honchar, O., Ащеулова, Т. В., Chumachenko, T., Chumachenko, D., Bobeiko, A., Blazhko, V., Khodosh, E. M., Matiash, N., Амбросова, Т. М., Herasymchuk, N. M., et al. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1276211 · Cited by 6
Ye, Y., Xiong, C., Dai, Y., Wang, Y., Yang, X., Cheng, L., Hou, C., Nie, N., Tang, H., Ma, X., et al. (2023) · BMC Public Health · doi:10.1186/s12889-023-17382-0 · Cited by 6
“For SARS-CoV-2, which is also a coronavirus, fatigue was found to be a common symptom from the outset, with 69% of patients reporting persistent fatigue for nearly 2 months after discharge [33].”
BackgroundAntoncecchi, V., Antoncecchi, E., Orsini, E., D'Ascenzo, G., Oliviero, U., Savino, K., Aloisio, A., Casalino, L., Lillo, A., Chiuini, E., et al. (2024) · International Journal of Cardiology Cardiovascular Risk and Prevention · doi:10.1016/j.ijcrp.2024.200267 · Cited by 6
Investigating the Role of Serotonin Levels in Cognitive Impairments Associated with Long COVID-19
Eslami, Z., & Joshaghani, H. (2024) · Chonnam Medical Journal · doi:10.4068/cmj.2024.60.3.141 · Cited by 6
Post-acute care management of a patient with COVID-19 using remote cardiorespiratory monitoring
Polsky, M. B., & Moraveji, N. (2021) · Respiratory Medicine Case Reports · doi:10.1016/j.rmcr.2021.101436 · Cited by 6
“The recovery time from COVID-19 can be prolonged with most post-hospitalized patients reporting persistent symptoms at 2 months [1].”
Hennig, V., Schuh, W., Neubert, A. C., Mielenz, D., Jäck, H., & Schneider, H. (2021) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-021-02011-z · Cited by 6
Is Long COVID a State of Systemic Pericyte Disarray?
Jones, O. Y., & Yeralan, S. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11030572 · Cited by 7
“On one side, the affected are the survivors of moderate to severe COVID-19, most of whom, not so surprisingly, with advanced age and known risk factors such as obesity, diabetes, and hypertension [7].”
BackgroundThe prevalence and location of musculoskeletal pain following COVID‐19
Mills, G., Briggs‐Price, S., Houchen‐Wolloff, L., Daynes, E., & Singh, S. J. (2022) · Musculoskeletal Care · doi:10.1002/msc.1657 · Cited by 6
“In addition to chronic pain, fatigue is also amongst the most commonly reported symptoms (Evans et al., 2021; Mandal et al., 2021; Shang et al., 2021), which, without intervention, may lead to a cycle of inactivity and further pain.”
BackgroundTracking peripheral vascular function for six months in young adults following SARS‐CoV ‐2 infection
Province, V. M., Szeghy, R. E., Stute, N. L., Augenreich, M. A., Behrens, C. E., Stickford, J. L., Stickford, A. S. L., & Ratchford, S. M. (2022) · Physiological Reports · doi:10.14814/phy2.15552 · Cited by 6
Lo, T., MacMillan, A., Oudit, G. Y., Usman, H., Cabaj, J., MacDonald, J. C., Saini, V., & Sikdar, K. C. (2023) · CMAJ Open · doi:10.9778/cmajo.20220002 · Cited by 5
What might COVID-19 Patients Experience after Recovery? A Systematic ReviewPreprint
Elhiny, R., Al‐Jumaili, A. A., & Jamal, M. Y. (2021) · doi:10.22541/au.162392727.73465025/v1 · Cited by 6
Craddock, V. D., Mahajan, A., Krishnamachary, B., Spikes, L. A., Chalise, P., & Dhillon, N. K. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4186787 · Cited by 6
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
Pérez-Gisbert, L., Brea-Gómez, B., Valenza, M. C., Mateo, A. C., Ortíz‐Rubio, A., & Torres‐Sánchez, I. (2025) · Disability and Rehabilitation · doi:10.1080/09638288.2025.2546553 · Cited by 5
“Sixty-nine percent of patients with PcS experience fatigue, which is the most common symptom [5].”
COVID19 Long Term Effects in Patients Treated with Chlorine Dioxide
Centro Médico Jurica, Q., & Aparicio-Alonso, M. (2021) · INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY RESEARCH AND ANALYSIS · doi:10.47191/ijmra/v4-i8-14 · Cited by 5
“These cases of acute COVID19 long-term sequelae are comparable to documented post-acute viral symptoms in survivors of previous virulent coronavirus outbreaks (Moldofsky and Patcai 2011).”
BackgroundIs there a rationale for hyperbaric oxygen therapy in the patients with Post COVID syndrome?
Pawlik, M. T., Rinneberg, G., Koch, A., Meyringer, H., Loew, T. H., & Kjellberg, A. (2024) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01911-y · Cited by 10
“About 30–50% of COVID-19 survivors suffer from respiratory symptoms such as chronic dyspnoea and cough for up to 24 months [5, 22, 103, 111, 154].”
Мratskova, G. (2022) · MEDIS – International Journal of Medical Sciences and Research · doi:10.35120/medisij010101m · Cited by 4
Askenase, P. W. (2022) · Frontiers in Nanotechnology · doi:10.3389/fnano.2022.987117 · Cited by 5
“persistently elevated D-dimer and C reactive proteins (Mandal et al., 2020) in LCS often due to fibrinolytic-resistant microclots (Grobbelaar et al.”
BackgroundMalandrino, D., Berni, A., Fibbi, B., Borellini, B., Cozzi, D., Norello, D., Fattirolli, F., Lavorini, F., Olivotto, I., Fumagalli, C., et al. (2022) · Journal of Endocrinological Investigation · doi:10.1007/s40618-022-01938-9 · Cited by 5
Abohelwa, M., Peterson, C., Landis, D. M., Le, D., Conde, C., DeWare, C., Elgendy, F., Payne, D., & NUGENT, K. M. (2022) · Journal of Primary Care & Community Health · doi:10.1177/21501319221134560 · Cited by 5
Ultrasonographic findings in long COVID: A cross-sectional study of 312 patients
Imamura, M., Uchyiama, S. S. T., Naves, G. S., Abicalaf, C. A. R. P., Mirisola, A. R., dos Santos, A. C. A., Battistella, L. R., & HCFMUSP COVID-19 Study Group (2023) · Frontiers in Medicine · doi:10.3389/fmed.2022.1051389 · Cited by 7
A multidisciplinary approach to screen the post-COVID-19 conditions
Squillace, N., Cogliandro, V., Rossi, E., Bellelli, G., Pozzi, M., Luppi, F., Lettino, M., Strepparava, M. G., Ferrarese, C., Pollastri, E., et al. (2023) · BMC Infectious Diseases · doi:10.1186/s12879-023-08006-4 · Cited by 5
Wang, F., Rothchild, E., & Ricci, J. A. (2023) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000003431 · Cited by 5
Rao, C. M., Behera, D., Mohapatra, A. K., Mohapatra, S. K., Jagaty, S. K., Banu, P., Pattanaik, A. P., Mohapatra, I., & Patro, S. (2022) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_903_22 · Cited by 5
Kralj‐Hans, I., Li, K., Wesek, A., Lamorgese, A., Omar, F., Ranasinghe, K., McGee, M., Brack, K. E., Li, S., Aggarwal, R., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-068179 · Cited by 5
Metadata
- 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
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2020-11-10
- Volume
- 76
- Issue
- 4
- Pages
- 396-398
- ISSN
- 0040-6376 (ISSN-L)
- 1468-3296
- 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
- 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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