Residual clinical damage after COVID-19: a retrospective and prospective observational cohort study
Open accessAbstract
Data on residual clinical damage after Coronavirus disease-2019 (COVID-19) are lacking. The aims of this study were to investigate whether COVID-19 leaves behind residual dysfunction, and identify patients who might benefit from post-discharge monitoring. All patients aged ≥18 years admitted to the Emergency Department (ED) for COVID-19, and evaluated at post-discharge follow-up between 7 April and 7 May, 2020, were enrolled. Primary outcome was need of follow-up, defined as the presence at follow-up of at least one among: respiratory rate (RR) >20 breaths/min, uncontrolled blood pressure (BP) requiring therapeutic change, moderate to very severe dyspnoea, malnutrition, or new-onset cognitive impairment, according to validated scores. Post-traumatic stress disorder (PTSD) served as secondary outcome. 185 patients were included. Median [interquartile range] time from hospital discharge to follow-up was 23 [20-29] days. 109 (58.9%) patients needed follow-up. At follow-up evaluation, 58 (31.3%) patients were dyspnoeic, 41 (22.2%) tachypnoeic, 10 (5.4%) malnourished, 106 (57.3%) at risk for malnutrition. Forty (21.6%) patients had uncontrolled BP requiring therapeutic change, and 47 (25.4%) new-onset cognitive impairment. PTSD was observed in 41 (22.2%) patients. At regression tree analysis, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and body mass index (BMI) at ED presentation, and age emerged as independent predictors of the need of follow-up. Patients with PaO2/FiO2 <324 and BMI ≥33 Kg/m2 had the highest odds to require follow-up. Among hospitalised patients, age ≥63 years, or age <63 plus non-invasive ventilation or diabetes identified those with the highest probability to need follow-up. PTSD was independently predicted by female gender and hospitalisation, the latter being protective (odds ratio, OR, 4.03, 95% confidence interval, CI, 1.76 to 9.47, p 0.0011; OR 0.37, 95% CI 0.14 to 0.92, p 0.033, respectively). COVID-19 leaves behind physical and psychological dysfunctions. Follow-up programmes should be implemented for selected patients.
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Severity of psychiatric symptoms after virus clearance is proportional to the severity of systemic inflammation during the acute infection.
“with severity of psychiatric symptoms after virus clearance being proportional to the severity of systemic inflammation during the acute infection and significantly contributing to the quality of life of survivors (De Lorenzo et al., 2020, Ma et al., 2020, Mazza et al., 2020, Varatharaj et al., 2020).”
From Persistent psychopathology and neurocognitive impairment in COVID-19 survivors: effect of inflammatory biomarkers at three-month follow-up (2021) · cites this paper as De Lorenzo et al., 2020
COVID-19 is associated with delirium, fatigue, confusion, depression, anxiety, PTSD, obsessive-compulsive symptoms, and insomnia in acute infection or short-term follow-up.
“Emerging data show that COVID-19 outbreak is associated with delirium, fatigue, confusion, depression, anxiety, post-traumatic stress disorder (PTSD), obsessive–compulsive symptoms, and insomnia in the context of acute viral infection or at short-term follow-up after clinical recovery”
From Persistent psychopathology and neurocognitive impairment in COVID-19 survivors: effect of inflammatory biomarkers at three-month follow-up (2021) · cites this paper as De Lorenzo et al., 2020
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- Authors
- De Lorenzo, R., Conte, C., Lanzani, C., Benedetti, F., Roveri, L., Mazza, M. G., Brioni, E., Giacalone, G., Canti, V., Sofia, V., D’Amico, M., Di Napoli, D., Ambrosio, A., Scarpellini, P., Castagna, A., Landoni, G., Zangrillo, A., Bosi, E., Tresoldi, M., Ciceri, F., & Rovere-Querini, P.
- Affiliations
- Vita-Salute San Raffaele University (IT)
- IRCCS Ospedale San Raffaele (IT)
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-10-14
- Volume
- 15
- Issue
- 10
- Pages
- e0239570
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7556454
- OpenAlex
- W3092984339
- Cited by
- 179
- References
- 46
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 21 · 2023: 23 · 2022: 64 · 2021: 56 · 2020: 1
- FWCI
- 15.58
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- 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 COVID, post-discharge follow-up, dyspnea, tachypnea, malnutrition, uncontrolled hypertension, post-traumatic stress disorder, PaO2/FiO2 ratio, body mass index, emergency department
- MeSH terms
- COVID-19, Aftercare, Aged, Dyspnea, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pneumonia, Viral, Stress Disorders, Post-Traumatic, Coronavirus Infections, Malnutrition, Pandemics, Cognitive Dysfunction
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