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Residual clinical damage after COVID-19: A retrospective and prospective observational cohort study
Rebecca De Lorenzo1, Caterina Conte1,2, Chiara Lanzani3
1School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Insights
Coronavirus disease-2019 (COVID-19) can cause lasting physical and psychological issues, including breathing difficulties and cognitive impairment. Selected patients require follow-up care to manage these residual clinical damages.
Area of Science:
- Medical Research
- Infectious Diseases
- Public Health
Background:
- Limited data exist on residual clinical damage following Coronavirus disease-2019 (COVID-19).
- Understanding post-discharge sequelae is crucial for effective patient management.
- Identifying patients who may benefit from continued monitoring is a public health priority.
Purpose of the Study:
- To investigate residual dysfunction after COVID-19 infection.
- To identify specific patient groups who would benefit from post-discharge monitoring.
- To analyze predictors for the need of follow-up and post-traumatic stress disorder (PTSD).
Main Methods:
- Retrospective analysis of 185 adult patients admitted to the Emergency Department (ED) for COVID-19.
- Follow-up evaluations conducted between 7 April and 7 May 2020.
- Primary outcome: need for follow-up (defined by respiratory rate, blood pressure, dyspnoea, malnutrition, or cognitive impairment). Secondary outcome: PTSD.
- Regression tree analysis to identify predictors.
Main Results:
- 58.9% of patients required follow-up, with common issues including dyspnoea (31.3%), uncontrolled blood pressure (21.6%), and new-onset cognitive impairment (25.4%).
- PTSD was observed in 22.2% of patients.
- Predictors for follow-up need included low arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2) and high body mass index (BMI) at ED presentation, along with age.
- Female gender and hospitalization predicted PTSD, with hospitalization being protective.
Conclusions:
- COVID-19 can result in significant physical and psychological dysfunctions post-discharge.
- Targeted follow-up programs are necessary for selected patients based on clinical predictors.
- Early identification of at-risk individuals can improve long-term outcomes after COVID-19.
Abstract:
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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