https://doi.org/10.4081/monaldi.2022.2307
Predictors of post COVID complications in patients admitted with moderate to severe COVID symptoms: A single center, prospective, observational study
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Published: 20 July 2022
While the world was still busy battling active COVID-19 infections, a large subset of patients started showing prolonged symptoms or developing complications following an initial recovery from COVID-19. Post covid complications range from mild symptoms such as fatigue, headache, shortness of breath to serious, life threatening conditions like opportunistic infections, deep venous thrombosis, pulmonary embolism, pneumothorax and lung fibrosis. A single center, prospective, observational study was carried out in a tertiary respiratory care institute in North India from June 2021 to August 2021 where 224 cases of previously treated COVID-19/ongoing symptomatic COVID-19 (those patients who were manifesting symptoms beyond 4 weeks), were enrolled and followed up for a period of 3 months to estimate the prevalence of persistent symptoms, complications and any risk factors associated with it. Data analysis was done using SPSS software version 21. Univariate and multivariate analysis done among risk factors and outcome variables. ROC was done on predictor variables and area under curve (AUC) calculated. p value less than 0.05 was considered significant. Among the 24.6% symptomatic patients at follow up, the most common symptom was fatigue (51.8%) followed by dyspnea (43.8%) and anxiety (43.3%). Among the complications of COVID-19, the most common according to our study was fibrosis (15.2%), followed by pulmonary thromboembolism (PTE) (12.1%), echocardiographic abnormalities (11.2%) and pulmonary mucormycosis (5.4%). Female gender, presence of comorbidities, requirement of non-invasive or invasive ventilation during hospital stay emerged as independent risk factors for complications following COVID-19. This study brings forth the huge morbidity burden that COVID-19 brought upon seemingly cured individuals and lists the risk factors associated with persistence of symptoms and complications. This would help to better streamline health resources and standardize follow up guidance of COVID-19 patients.
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World Health Organization. Global covid statistics. Assessed on March 21, 2022. Available from: https://www.who.int/news/item/27-04-2020-who-timeline---covid
Vaman RS, Valamparampil M, Ramdas J, et al. A confirmed case of COVID-19 among the first three from Kerala, India. Indian J Med Res 2020;151:493–4. DOI: https://doi.org/10.4103/ijmr.IJMR_2205_20
Worldometers [Internet]. India COVID statistics. Assessed on March 22, 2022. Available from: https://www.worldometers.info/coronavirus/country/india
National Institute for Health and Care Excellence (NICE), Royal College of General Practitioners, Healthcare Improvement Scotland SIGN. COVID-19 rapid guideline: managing the long-term effects of COVID-19. National Institute for Health and Care Excellence; London: 2020. Accessed on: 30 December 2020. Available from: https://www.nice.org.uk/guidance/ng188
George PM, Wells AU, Jenkins RG. Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy. Lancet Respir Med 2020;8:807-15. DOI: https://doi.org/10.1016/S2213-2600(20)30225-3
Oudit GY, Kassiri, Z, Jiang, C, et al. Sars-coronavirus modulation of myocardial ace2 expression and inflammation in patients with sars. Eur J Clin Investig 2009;39:618-25. DOI: https://doi.org/10.1111/j.1365-2362.2009.02153.x
Lin Z, Phyu WH, Phyu ZH, Mon TZ. The role of steroids in the management of COVID-19 infection. Cureus 2021;13:23-4. DOI: https://doi.org/10.7759/cureus.16841
Mishra GP, Mulani J. Corticosteroids for COVID-19: the search for an optimum duration of therapy. Lancet Respir Med 2021;9:e8. DOI: https://doi.org/10.1016/S2213-2600(20)30530-0
British Thoracic Society. Guidance on respiratory follow up of patients with a clinico-radiological diagnosis of covid-19 pneumonia. Assessed on: March 23, 2021. Available from: www.brit-thoracic.org.uk
Fraser E. Long term respiratory complications of covid-19. BMJ 2020;370:m3001. DOI: https://doi.org/10.1136/bmj.m3001
FACIT Group [Internet]. Functional Assessment of Chronic Illness Therapy – Fatigue Scale. Assessed on March 21, 2021. Available from: https://www.facit.org/measures/FACIT-F
Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest 1988;93:580-6. DOI: https://doi.org/10.1378/chest.93.3.580
Murhekar MV, Bhatnagar T, Selvaraju S, et al. Prevalence of SARS-CoV-2 infection in India: findings from the national serosurvey. Indian J Med Res 2020;152:48–60. DOI: https://doi.org/10.4103/ijmr.IJMR_3290_20
Leung TYM, Chan AYL, Chan EW, et al. Short- and potential long-term adverse health outcomes of Covid-19: A rapid review. Emerg Microbes Infect 2020;9:2190–9. DOI: https://doi.org/10.1080/22221751.2020.1825914
Pavli A, Theodoridou M, Maltezou HC. Post-COVID syndrome: incidence, clinical spectrum, and challenges for primary healthcare professionals. Arch Med Res 2021;52:575-81. DOI: https://doi.org/10.1016/j.arcmed.2021.03.010
Giustino G, Pinney SP, Lala A, et al. Coronavirus and cardiovascular disease, myocardial injury, and arrhythmia: JACC focus seminar. J Am Coll Cardiol 2020;76:2011-23. DOI: https://doi.org/10.1016/j.jacc.2020.08.059
Silva AB, Siqueira S, de Assis Soares, et al. Long-COVID and post-COVID health complications: An up-to-date review on clinical conditions and their possible molecular mechanisms. Viruses 2021;13:700-1. DOI: https://doi.org/10.3390/v13040700
Sykes DL, Holdsworth L, Jawad N, et al. Post-COVID-19 symptom burden: what is long-COVID and how should we manage it? Lung 2021;199:113-9. DOI: https://doi.org/10.1007/s00408-021-00423-z
Aul DR, Gates DJ, Draper DA, et al. Complications after discharge with COVID-19 infection and risk factors associated with development of post-COVID pulmonary fibrosis. Respir Medi 2021;188:106602. DOI: https://doi.org/10.1016/j.rmed.2021.106602
Kamal M, Abo OM, Hussein A, et al. Assessment and characterisation of post-COVID-19 manifestations. Int J Clin Pract 2021;75:e13746. DOI: https://doi.org/10.1111/ijcp.13746
Van AG, Van DB, Wilmer R, et al. Intensive care unit acquired muscle weakness in COVID-19 patients. J Intensive Care Med 2020;46:2083-5. DOI: https://doi.org/10.1007/s00134-020-06244-7
Taboada M, Carinena A, Moreno E, et al. Post-COVID-19 functional status six-months after hospitalization. J Infect 2020;82:e31-3. DOI: https://doi.org/10.1016/j.jinf.2020.12.022
Carfì A, Bernabei R, Landi F, Gemelli against COVID-19 post-acute care Study Group. Persistent symptoms in patients after acute COVID-19. J Am Med Assoc 2020;324:603-5. DOI: https://doi.org/10.1001/jama.2020.12603
Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021;397:220–32. DOI: https://doi.org/10.1016/S0140-6736(20)32656-8
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