Nearly half COVID-19 patients did not fully recover within a year after hospital discharged
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Nearly half COVID-19 patients did not fully recover within a year after hospital discharged
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The latest study: Nearly half COVID-19 patients did not fully recover within a year after hospital discharged. Is it a “sequelae”?
There have been more than 510 million COVID-19 infections in the world, of which more than 6 million have died. Regarding the “sequelae” of COVID-19 patients, it has always been a topic of great concern to everyone.
Two days ago, a prospective study was published in Lancet Respiratory Medicine , and the results showed that only 28.9% of hospitalized patients reported complete recovery 1 year after discharge, 48.8% of patients did not fully recover, and 22.4% said they did not. Determine if you are recovering.
Reference 1
Nearly half COVID-19 patients did not fully recover within a year after hospital discharged
How should we understand this set of data? Does this mean that there is a high probability of “sequelae” after the COVID-19 infection?
New study: Nearly half of hospitalized patients with COVID-19 have not fully recovered after one year of discharge
The study looked at discharged patients (aged 18 and over) with Covid-19 across the UK and followed up at 5 months and 1 year after discharge, including physical performance and test results such as inflammation in plasma. protein) etc.
A total of 2320 patients completed the 5-month follow-up, 924 patients participated in the 1-year follow-up, and 807 patients completed both the 5-month and 1-year follow-up.
Findings: The proportion of patients reporting complete recovery did not change significantly from 5 months to 1 year after discharge (25.5% vs 28.9%).
At 5 months after discharge, 25.5% of these patients felt fully recovered, 19.6% felt uncertain, and 54.9% felt incomplete; by 1 year after discharge, these three figures were 28.9%, 22.4 % and 48.8%.
Reference 1
Risk factors associated with being less likely to fully recover within 1 year were female gender, obesity, and having received mechanical ventilation in the hospital; all three of the above reduced the likelihood of complete recovery 1 year after discharge in these patients, with ORs (hazard ratios) of 0.68, 0.68, 0.5 and 0.42.
One year after discharge, the 10 most common long-term symptoms were fatigue (60.1%), muscle pain (54.6%), slow movement (52.9%), and poor sleep (52.3%).
The incidence of these symptoms did not change from 5 months to 1 year, and patient-reported measures of measure, physical function, cognition, or organ dysfunction improved little or no improvement at 1 year.
In addition, due to the high incidence of musculoskeletal symptoms (such as muscle pain, fatigue, slow movement, dyspnea, and limb weakness, etc.), this finding supports future research into rehabilitation and other therapies (such as some drugs that act on mitochondria) necessary to combine to improve musculoskeletal function.
In terms of mental health, 21.5% and 24.9% of patients had clinically relevant symptoms of anxiety and depression 1 year after discharge.
Compared with the mild cognitive impairment group, the moderate and severe cognitive impairment group had increased tissue damage and repairing inflammatory factors (such as IL-6).
Plasma proteomic analysis data showed increased levels of IL-6 (interleukin-6) and CD70 in the latter two groups, suggesting that neuroinflammation may contribute to cognitive impairment, as CD70 is associated with CNS ( central nervous system) inflammation.
The rise in these inflammatory markers reminds us that future use of anti-IL-6 biologics in hospitalized patients may help improve long-term symptoms.
The researchers believe that only a minority felt fully recovered one year after discharge from the hospital. Inpatients’ self-perceived health-related quality of life was still lower than before admission.
While systemic inflammation and obesity are potentially treatable features that warrant further investigation in future clinical trials.
Characteristics of hospitalized patients, not applicable to all infected persons
From the conclusions of this study, it seems that the sequelae of the COVID-19 is indeed more serious, but this is not the whole picture.
Let’s first look at the study time. The study enrollment time was from March 2020 to April 2021. The main strains at that time were the original strain and Alpha, not the current mainstream strain Omicron.
Second, the paper did not mention the vaccination status of these patients – because almost no patients were vaccinated at that time, and even at the end of the entire enrollment period (April 2021), only 8% of the UK population completed it. vaccinated.
What’s more, the UK study was conducted on hospitalized patients with Covid-19. Let’s take a look at a few characteristics of the patients in this study who were followed for one year:
1. The median age is 58.9 years old.
2. Median BMI=31.5, 59.7% of patients were ≥30 (obesity standard).
3. 81.4% of the patients required different degrees of oxygen support, of which 37.1% were WHO class 5 (mask or nasal oxygen inhalation) and 18.1% were WHO class 6 (non-invasive ventilation or high-flow oxygen inhalation). ), 26.2% of patients were WHO class 7-9 (requiring mechanical ventilation). That is to say, more than 40% of the patients were already on the ventilator at that time.
4. The median number of underlying diseases (comorbidities, such as hypertension, diabetes, heart disease, etc.) of patients before admission was 2, and 52.2% of the patients had ≥2.
5. The median length of hospital stay was 17 days.
Therefore, the conclusions of this study are for hospitalized patients, not for all patients with new coronavirus infection. The British study itself is a good prospective observation in the medical field, allowing us to understand the long-term symptoms and changes in test results of hospitalized patients with the COVID-19, but it should not be over-interpreted.
Chinese study data: Most people who have recovered from the COVID-19 recover well after 1 year
Last August, Lancet also had a study on the sequelae of the COVID-19 from the China-Japan Friendship Hospital, which can also provide us with some reference.
The study included 1,276 patients who were discharged from Jinyintan Hospital between January and May 2020 (it is worth noting that none of the patients had been vaccinated at that time), and the researchers followed them up twice, after discharge.
6-month (median 185 days) and 1-year (median 349 days) follow-up questionnaires for symptoms and health-related quality of life (HRQoL), as well as physical examination, 6-minute walk test, and laboratory tests .
Reference 2
The study found that the proportion of people with at least one symptom of COVID-19 sequelae dropped from 68% at 6 months to 49% at 1 year.
One year after discharge, fatigue, muscle weakness (20%) were the most common symptoms, sleep disturbance (17%) and arthralgia (12%) were also more common, while anxiety or depression increased from 23 at 6 months % rose to 26% at 1 year.
88% of Covid-19 patients who had a job before contracting Covid-19 returned to their original job 1 year later.
Compared with controls, recovered patients had more problems with mobility, pain or discomfort, anxiety or depression, and more general symptoms 1 year after discharge.
Compared with men, women have slower recovery rates for some manifestations such as fatigue, mental health and respiratory diffusion (this is similar to the findings of the latest research mentioned above).
The researchers’ overall conclusion is that most people who have recovered from COVID-19 have recovered well physically and functionally after 1 year, returning to their original work and life, although their health is lower than that of the control group.
Reference 2
The “sequelae” of the COVID-19 is not accurate
It should be emphasized that “COVID-19 sequelae” itself is not a scientific statement.
According to most people’s understanding, the so-called “COVID-19 sequelae” is the symptoms left after infection with the COVID-19, such as coughing or fatigue after a few months of infection.
But the question is, which symptoms are caused by the pathophysiological changes after the new coronavirus infection, which are caused by other viral infections or underlying diseases, and which are due to non-organic factors, which are still under study.
The sequelae will give a hint of causality, which is why the term “COVID-19 sequelae” is rarely used in the academic world.
Therefore, including the “Long COVID” that is said abroad, quotation marks are often used. In this article, just for the convenience of everyone’s understanding, we continue to use the word “sequelae” in this article.
It is now the third year of the outbreak of the COVID-19 epidemic. Due to the continuous improvement of treatment methods, the widespread vaccination of vaccines, and the fact that Omicron mainly affects the upper respiratory tract, data from many places around the world show that the proportion of asymptomatic and mild patients is It is much higher than before, and the proportion of severe cases is not high.
Taking Singapore’s data as an example, among the 450,000 infected people in the past month, the combined ratio of ICU admission and death was 0.09%; taking the data of Jilin City as an example, the ratio of mild to asymptomatic patients exceeded 97.5%.
That is to say, there are only 2.5% of common, severe and critical illnesses, and a large part of them are common illnesses; for example, the number of 2,107 Omicron-infected people in the country according to the weekly report of the China CDC some time ago, the number of people with severe and above is 13, the proportion about 0.6%.
For asymptomatic infected people and patients with mild symptoms, as long as the patient’s immune system is normal, the long-term symptoms caused by the new coronavirus are less, and most infected people can fully recover.
According to a large number of studies over the past two years, if you are really afraid of the “sequelae” of the COVID-19, what you should do is:
1. Maintain a healthy body, quit smoking and alcohol, and avoid obesity.
2. Take personal protective measures during the epidemic, such as wearing a mask; when there is an epidemic in your city, avoid going to crowded places.
3. Most importantly, get vaccinated. Even in the face of Omicron BA.2, which has strong infectivity and immune escape ability, booster vaccination maintains strong protection in preventing severe illness, especially for the elderly with underlying diseases.
references:
1.The PHOSP-COVID Collaborative Group.Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study.The Lancet Respiratory Medicine.April 23, 2022
2. Lixue Huang. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. The Lancet .August 28, 2021
Nearly half COVID-19 patients did not fully recover within a year after hospital discharged
(source:internet, reference only)
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