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Panminerva Medica 2021 Jun 01

DOI: 10.23736/S0031-0808.21.04399-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Physical and psychological sequelae at three months after acute illness in COVID-19 survivors

Rebecca DE LORENZO ¹, Elena CINEL ¹, Marta CILLA ¹, Nicola COMPAGNONE ¹, Marica FERRANTE ¹, Elisabetta FALBO ¹, Alessandro PATRIZI ¹, Jacopo CASTELLANI ¹, Cristiano MAGNAGHI ², Stefania L. CALVISI ³, Teresa ARCIDIACONO ⁴, Chiara L. LANZANI ⁴, Valentina CANTI ², Mario G. MAZZA ⁵, Sabina MARTINENGHI ², Giordano VITALI ², Francesco BENEDETTI ⁵, Fabio CICERI ^{1, 2}, Caterina CONTE ², Patrizia ROVERE QUERINI ^{1, 2} ✉

¹ Vita-Salute San Raffaele University, Milan, Italy; ² Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; ³ Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; ⁴ Unit of Nephrology, IRCCS San Raffaele Scientific Institute, Milan, Italy; ⁵ Unit of Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy

BACKGROUND: Coronavirus disease 2019 (COVID-19) may leave behind an altered health status early after recovery. We evaluated the clinical status of COVID-19 survivors at three months after hospital discharge.
METHODS: In this prospective observational cohort study, hospitalized patients aged ≥18 years, evaluated at one (M1) and three (M3) months post-discharge were enrolled. 251 patients (71.3% males, median [IQR] age 61.8 [53.5-70.7] years) were included. Median (IQR) time from discharge to M3 was 89 (79.5-101) days. Primary outcome was residual respiratory dysfunction (RRD), defined by tachypnea, moderate to very severe dyspnea, or peripheral oxygen saturation ≤95% on room air at M3.
RESULTS: RRD was found in 30.4% of patients, with no significant difference compared with M1. Chronic obstructive pulmonary disease and length of stay were independent predictors of RRD at multivariable logistic regression (odds ratio, OR, [95% confidence interval, CI] 4.13 [1.17-16.88], p 0.033; OR [95% CI] 1.02 [1.00-1.04], p 0.047, respectively). Obesity and C-reactive protein levels upon admission were additional predictors at regression tree analysis. Impaired quality of life (QoL) was reported by 53.2% of patients. Anxiety and insomnia were each present in 25.5% of patients, and PTSD in 22.4%. No difference was found between M1 and M3 in QoL, anxiety or PTSD. Insomnia decreased at M3. Current major psychiatric disorder as well as anxiety, insomnia and PSTD at M1 independently predicted PTSD at M3.
CONCLUSIONS: Clinical damage may persist at three months after discharge in COVID-19 survivors. Post-recovery follow-up is an essential component of patient management.

KEY WORDS: COVID-19; Follow-up; Long-term; Respiratory dysfunction; Post-traumatic stress disorder