Persistence of Symptoms and Long-Term Recovery in Hospitalized COVID-19 Patients: Results from a Five-Year Follow-Up Cohort

A variable propotion of COVID-19 patients still complain from persistent symptoms many weeks after the acute disease. The purpose of our study was to identify the prevalence, the spectrum and the related factors of residual symptoms one and three months after hospital disharge in patients admitted with COVID-19 We set up systematic COVID-19 follow up consultations dedicated to discharged patients from the pulmonary department B at Abderrahmen Mami hospital, TUNISIA. The follow up evaluation occured 30 and 90 days after hospital discharge. Until 30 January 2021, 115 consecutive patients were enrolled with a mean follow up period of 62 days from the acute COVID-19. The median age was 60 years old [28-90] and 52% were men. Seventeen patients required intensive care (14%). The median hospital stay was 9 days [2-45]. Four patients needed home oxygen after hospital discharge (3%). One month after the infection, 73% of the patients reported at least one residual symptom. The most common complain were dyspnea (60%), fatigue (45%), sleep distubance (18%) and chest tightness (15%). Other Less common symptoms were noted (<10%) : sore throat, myalgia, diarrhea, dizziness, dysgueusia, hiccough and hairloss. There were no association between residual symptoms and the severity of the acute disease, however, symptomatic patients were older, with female predomination and with more comorbidities (p>0.01). Three months after hospital discharge, 38% of the patients are still symptomatic and further investigations were needed. Follow-up of COVID-19 patients is mandotary to detect any residual or emerging symptom. Physical and psychological rehabilitation care must be implemented early to manage the post COVID-19 syndrome.

A temporal examination of inspiratory muscle strength and endurance in hospitalized COVID-19 patients

Introduction: Many COVID-19 survivors suffer from persisting sequelae after acute disease. This is referred to as long COVID. The objectives of this study were to assess factors associated with long COVID and to analyze differences in persistent symptoms, findings on chest imaging, and pulmonary function between intensive care unit (ICU) and non-ICU hospitalized patients. Methods: We conducted a retrospective study including patients hospitalized with COVID-19. Patients were stratified into ICU patients and non-ICU patients. We analyzed the outcomes of patients who were in clinical follow-up 6 months after discharge with persistent symptoms, radiological and/or functional abnormalities. Logistic regression was used to examine the association between long COVID and patient characteristics. Results: A total of 549 patients were included. Eighty-one ICU patients (66%) and 146 (34%) non-ICU patients had persistent symptoms or abnormalities on chest imaging or lung function test minimally 6 months after discharge. Significantly more ICU patients had residual fibrotic abnormalities on chest CT and functional impairment. Female gender, myocardial infarction, OSAS, low PCO2 at admission, and longer hospital stay were associated with a higher risk of developing long COVID. Diabetes and treatment with tocilizumab were associated with a lower risk of developing long COVID. Conclusion: Of the patients hospitalized for COVID-19, 34–66% suffered from persistent symptoms, residual abnormalities on chest imaging, or reduced lung function at around 6 months after discharge. While persistent sequelae were more frequent in ICU patients, admission to the ICU was not found to be an independent risk factor for developing long COVID.

Research data on hospitalized coronavirus 2019 (COVID-19) survivors indicate the persistence of symptoms, radiological abnormalities, and physiological disorders months after the initial infection. Given the scale of the ongoing pandemic, a substantial number of patients with severe residual pulmonary fibrosis (PF) and oxygen dependence are anticipated. Currently, the search for risk factors associated with the development of fibrotic radiological abnormalities after moderate to severe COVID-19 is underway. Furthermore, the extent to which computed tomography (CT) data correlate with postdischarge symptoms and physical functions remains unclear. This study aimed to characterize patients experiencing persistent pulmonary consequences after hospital discharge. We examined clinical, radiological, and laboratory predictors of pulmonary fibrosis after COVID-19 infection. We retrospectively evaluated fibrosis-like lung changes and their prognostic factors in COVID-19 survivors. Our study included 77 patients with laboratory-confirmed COVID-19 who received inpatient treatment at City Clinical Hospital No. 1 in Almaty between November and December 2020. We assessed patients during the acute phase of the disease and again 6 to 8 months after discharge using high-resolution computed tomography (CT). Patients were classified into 2 cohorts based on semi-quantitative analysis of subsequently added tomograms-those with radiological fibrosis-like abnormalities (main group) and those who had recovered (control group). Parenchymal cords, irregular interfaces, reticulation, and traction bronchiectasis were common CT findings among all COVID-19 patients. Our study focused on patients who developed pulmonary fibrosis within 1 month after the onset of the disease. After 6 to 8 months, fibrosis-like lung changes persisted in 49.35% of patients (leading group), while 50.65% showed disease resolution (control group). Age, body mass index, high interleukin-6 (IL-6) levels, low IO levels, and the need for mechanical ventilation were identified as prognostic indicators for the persistence of pulmonary fibrosis. Our study revealed that pulmonary function can return to normal in over half of COVID-19 patients 8 months after infection onset. Despite advancements in COVID-19 treatment, there remains a significant knowledge gap in managing long-term effects, especially pulmonary fibrosis. Continued clinical trials and research on post COVID-19 fibrosis are essential to prevent early mortality due to the long-term impacts on these patients.

Few studies have examined the course of coexisting dementia and depression. The purpose of this study was to compare elderly patients who had coexisting dementia and depression with elderly patients who had either disorder alone in terms of their utilization of inpatient and outpatient services. The study group included 7,115 veterans aged 60 years or older who had been discharged from Department of Veterans Affairs inpatient units in 1992 with diagnoses of major depression, dementia, or both. Outcome measures were analyzed for a 2-year period following the index hospitalization for each diagnostic study group. Patients with coexisting dementia and depression had significantly more psychiatric inpatient days than the other two study groups and more medical inpatient days and nursing home readmissions than patients with depression alone. Patients with coexisting dementia and depression had significantly more total inpatient days than the other two groups. Notably, patients with coexisting dementia and depression did not utilize more outpatient resources than the other study groups; in fact, they had significantly fewer medical, psychiatric, and total visits than patients with depression alone. The findings suggest that patients with coexisting dementia and depression are high utilizers of inpatient services, with a course of illness that may resemble dementia in terms of nursing home and inpatient medical care utilization and depression in terms of inpatient psychiatric care utilization; however, these patients utilized significantly fewer outpatient resources than the group with depression alone. Aggressive outpatient treatment approaches might reduce utilization of inpatient care for patients with coexisting depression and dementia.

Post-COVID-19 condition: current evidence and unanswered questions

BackgroundEffective cancer pain management is critical for patient quality of life but may vary significantly between inpatient and outpatient care settings. This study aimed to identify and compare pain assessment practices, patient behaviors, and treatment barriers across these environments.MethodsA cross-sectional survey was conducted among 730 nursing professionals from 75 hospitals across China. Respondents completed structured questionnaires evaluating pain assessment frequency, methods, treatment responses, and perceived barriers in both inpatient and outpatient settings. Comparative analyses were performed using chi-square tests or Fisher’s exact test. Multivariable adjusted logistic regression models were used to explore the associations.ResultsPain assessment was performed more frequently in inpatient settings (79.3%) than outpatient settings (57.6%) (difference, 21.8%; 95% CI, 4.6–38.9%; P < 0.01). Alignment with patients’ self-assessments did not differ significantly (71.9% inpatient vs. 63.6% outpatient; P > 0.05). Patients in inpatient care more often reported pain proactively (60.0% vs. 24.2%; difference, 35.7%; 95% CI: 20.7–50.8%; P < 0.01). Major outpatient barriers included difficulty in patient pain description (90.9% vs. 20.9%; difference, 70%; 95% CI, 59.7–80.2%; P < 0.01), while inpatient settings were affected by provider inattention to pain (82.4% vs. 21.2%; difference, 61.1%; 95% CI, 46.9–75.4%; P < 0.01). The proportion of patients receiving treatment after pain assessment was similar (74.9% inpatient vs. 66.7% outpatient; P > 0.05). However, outpatient nurses reported greater reluctance to prescribe opioids (24.2% vs. 7.0%; difference, 17.2%; 95% CI, 2.5–32.0%; P < 0.01), and outpatient settings saw a higher incidence of ineffective analgesia (33.3% vs. 18.8%; difference, 14.5%; 95% CI, -1.8–30.9%; P < 0.05).ConclusionThe exploratory cross-sectional survey suggests that cancer pain managements between outpatient and inpatient settings appear to be different, particularly in assessment frequency, patient communication, and opioid prescribing practices. Targeted, setting-specific interventions may be beneficial to optimize pain control and improve patient outcomes in both environments.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-025-10130-7.

SARS-CoV-2 may lead to a large spectrum of respiratory manifestations, including pulmonary sequelae. We conducted a single-center longitudinal study of survivors from severe COVID-19 cases who underwent a chest CT during hospitalization (CTH). Three months after being discharged, these patients were evaluated by a clinical examination, pulmonary function tests and a chest-CT scan (CTFU). Sixty-two patients were enrolled. At follow-up, 27% complained of exertional dyspnoea and 12% of cough. Dyspnoeic patients had a lower forced expiratory flow (FEF)25–75 (p = 0.015), while a CT scan (p = 0.016 showed that patients with cough had a higher extent of bronchiectasis. Lung volumes and diffusion of carbon monoxide (DLCO) at follow-up were lower in patients who had been invasively ventilated, which correlated inversely with the length of hospitalization and ground-glass extension at CTH. At follow-up, 14.5% of patients had a complete radiological resolution, while 85.5% presented persistence of ground-glass opacities, and 46.7% showed fibrotic-like alterations. Residual ground-glass at CTFU was related to the length of hospitalization (r = 0.48; p = 0.0002) and to the need for mechanical ventilation or high flow oxygen (p = 0.01) during the acute phase. In conclusion, although patients at three months from discharge showed functional impairment and radiological abnormalities, which correlated with a prolonged hospital stay and need for mechanical ventilation, the persistence of respiratory symptoms was related not to parenchymal but rather to airway sequelae.

The aim of this study was to evaluate residual symptoms in patients achieving remission according to the consensus criteria and to analyze their potential influence on the patient's outcome one year after discharge. In total, 399 patients suffering from a schizophrenia spectrum disorder were evaluated within a naturalistic study. Remission status was examined using the consensus criteria. Residual symptoms were defined as any symptom present at the time-point of remission following analogous analyses performed in depressed patients. Therefore, a PANSS item with a symptom severity of >1 (= at least borderline mentally ill) was defined to be a residual symptom. Remitters with and without residual symptoms were compared regarding psychopathology, functioning and side effects. In total, 236 patients (59%) were remitters at discharge with 94% of them suffering from at least one residual symptom. The most common residual symptoms were blunted affect (49%), conceptual disorganization (42%) and social withdrawal (40%). A significant association was found between the presence of residual symptoms and the severity of side effects (p < 0.0001) and functioning (p = 0.0003) at discharge as well as between residual symptoms and the risk of relapse and chance of remission one year after discharge. Residual symptoms were highly prevalent in remitted schizophrenia inpatients following the suggested definition. Most residual symptoms were persistent baseline symptoms suggesting an ongoing illness severity. Also, the necessity to re-evaluate the consensus criteria questioning the status of remission in these patients is also pointed out.

Most coronavirus disease 2019 (COVID-19) patients are still experiencing persistent clinical symptoms even after being discharged from the hospital. Previous studies have reported the remaining symptoms in 29%–93% of patients. This condition can have a major impact on a patient’s ability to perform daily activities and have a deleterious effect on their quality of life (QoL). Objectives: This study aimed to evaluate persistent symptoms and QoL of COVID-19 patients 3 months after discharge from Dr. Kariadi Hospital Semarang, Central Java, Indonesia. Methods: Confirmed COVID-19 patients were enrolled in this prospective cohort study after discharge from Dr. Kariadi Hospital Semarang from March 1 to May 15, 2021. Telephone interviews were conducted each week in the first month, and every 2 weeks in the second and third months regarding persistent symptoms. EQ-5D-5L questionnaires were completed and evaluated every month for 3 months after hospital discharge. Results: Of the 104 patients enrolled, 55% were male, with a mean age of 48.96 years. The incidence of persistent symptoms in the first, second, and third months was 49%, 31.7%, and 25%, respectively. The most common persistent symptoms were fatigue, cough, shortness of breath, and nausea. The characteristics of the patients included being overweight/obese, having one or more comorbidities, having five or more symptoms classified as moderate COVID-19, and requiring supplemental oxygen during hospitalization. Based on the EQ-5D questionnaire, most patients reported worsening in the quality of their ability to perform usual activities, feelings of pain/discomfort, and anxiety/depression. The total values of the EQ-5D and EQ-VAS indices were lower than those of the Indonesian general population, indicating a decrease in QoL. Conclusions: The patients developed persistent symptoms and decreased quality of life during the 3-month following hospital discharge. Keywords: persistent symptoms, EQ-5D-5L, QoL

Post-acute conditions after coronavirus disease 2019 (COVID-19) are quite common, although the underlying pathogenetic mechanisms leading to these conditions are not yet completely understood. In this prospective observational study, we aimed to test the hypothesis that Growth Arrest-Specific 6 (Gas6) and its soluble receptors, Axl (sAxl) and MerTK (sMer), might be implicated. A total of 263 subjects underwent a structured clinical evaluation one year after their hospital discharge for COVID-19, and they consented to donate a blood sample to measure their circulating Gas6, sAxl, and sMer levels. A total of 98 (37.3%) post-COVID-19 subjects complained of at least one residual physical symptom one year after their hospital discharge. Univariate analysis revealed that sAxl was marginally associated with residual symptoms, but at the level of logistic regression analysis, only the diffusing capacity of the lungs for carbon monoxide (DLCO) (OR 0.98, CI 95%: 0.96–0.99; p = 0.007) and the female sex (OR 2.49, CI 95%: 1.45–4.28; p = 0.001) were independently associated with long-lasting symptoms. A total of 69 (26.2%) subjects had hair loss. At the level of univariate analysis, Gas6, sAxl, DLCO, and the female gender were associated with its development. In a logistic regression analysis model, Gas6 (OR 0.96, CI 95%: 0.92–0.99; p = 0.015) and sAxl (OR 0.98, CI 95%; 0.97–1.0; p = 0.014), along with the female sex (OR 6.58, CI 95%: 3.39–12.78; p = 0.0001), were independent predictors of hair loss. Decreased levels of Gas6 and sAxl were associated with a history of hair loss following COVID-19. This was resolved spontaneously in most patients, although 23.7% complained of persistent hair loss one year after hospital discharge.

ABSTRACTBackgroundThe incidence of persistent clinical symptoms and risk factors in Post-Acute Sequelae of SARS-CoV-2 (PASC) in diverse US cohorts is unclear. While there are a disproportionate share of COVID-19 deaths in older patients, ethnic minorities, and socially disadvantaged populations in the USA, little information is available on the association of these factors and PASC.ObjectiveTo evaluate the association of demographic and clinical characteristics with development of PASC.DesignProspective observational cohort of hospitalized and high-risk outpatients, April 2020 to February 2021.ParticipantsOne thousand thirty-eight adults with laboratory-confirmed symptomatic COVID-19 infection.Main MeasuresDevelopment of PASC determined by patient report of persistent symptoms on questionnaires conducted 60 or 90 days after COVID-19 infection or hospital discharge. Demographic and clinical factors associated with PASC.Key ResultsOf 1,038 patients with longitudinal follow-up, 309 patients (29.8%) developed PASC. The most common persistent symptom was fatigue (31.4%) followed by shortness of breath (15.4%) in hospitalized patients and anosmia (15.9%) in outpatients. Hospitalization for COVID-19 (odds ratio [OR] 1.49, 95% [CI] 1.04–2.14), having diabetes (OR, 1.39; 95% CI 1.02–1.88), and higher BMI (OR, 1.02; 95% CI 1–1.04) were independently associated with PASC. Medicaid compared to commercial insurance (OR, 0.49; 95% CI 0.31–0.77) and having had an organ transplant (OR 0.44, 95% CI, 0.26–0.76) were inversely associated with PASC. Age, race/ethnicity, Social Vulnerability Index, and baseline functional status were not associated with developing PASC.ConclusionsThree in ten survivors with COVID-19 developed a subset of symptoms associated with PASC in our cohort. While ethnic minorities, older age, and social disadvantage are associated with worse acute COVID-19 infection and greater risk of death, our study found no association between these factors and PASC.

ObjectiveWe aim to study the effect of persistent post-concussive symptoms on cognitive performance of elite athletes, based on the hypothesis that persistent symptoms could impair athletes’ cognitive performances and functional...

Persistent Heart Failure Symptoms at Hospital Discharge Predicts 30-Day Clinical Events

<b>Introduction:</b> Secondary infections are a known complication post viral respiratory infections. Secondary infections have always been significant cause of morbidity and mortality in previous well-studied influenza pandemics1. <b>Aims and Objectives:</b> We aimed to diagnose secondary infection early using indicated interventional procedures in post COVID-19 patients with persistent respiratory symptoms more than 4 weeks. <b>Methods:</b> Post COVID-19 patients with persistent respiratory symptoms who presented to GHRI, Nagpur (India) during 2nd wave were selected for the study. Patients with persistent respiratory symptoms more than 4 weeks after recovering from COVID-19 infection and Radiological abnormality on either Chest X-ray or HRCT Chest were subjected to bronchoscopy or medical thoracoscopy as indicated. <b>Results:</b> A total of 72 patients with available culture reports were assessed. Persistent cough, fever and shortness of breath were present in 52.8%, 19.4% and 11.1% of patients respectively. We found evidence of respiratory infections in total 30.5% patients. 11.1% were found to be suffering from pulmonary (3 were drug resistant) and 2.8% from pleural tuberculosis. Also, 4.2% patients were found to be suffering from fungal and 12.5% patients from Bacterial and 6.9% of patients were found to be suffering from more than one infection. <b>Conclusions:</b> Meticulous follow up with indicated interventional procedures is useful and safe in diagnosing pulmonary infections early in post COVID-19 patients. <b>