Persistent poor health post-COVID-19 not associated with respiratory complications or initial disease severity

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Persistent poor health following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was not associated with respiratory complications or initial disease severity, according to a study published in the Annals of the American Thoracic Society.

In a study of 153 patients with coronavirus disease 2019 (COVID-19), Liam Townsend, St James’s Hospital, Dublin, Ireland, and colleagues found little evidence for post-infectious pulmonary fibrosis on chest x-ray or hypoxia on six-minute-walk testing (6MWT). “However, 62% of patients did not feel back to full health, and this was associated with increased perception of exertion. [Additionally], 47% of our cohort met the diagnostic criteria for fatigue, independent of initial severity of infection,” the researchers reported. “The lack of association with infection severity highlights that this may be an issue for a large number of patients, and this should be used to inform management strategies for convalescent patients.”

For the study, 487 patients were offered an outpatient appointment, of which 153 (31%) attended for assessment at a median of 75 days after diagnosis. Infection severity was graded as (1) not requiring admission, (2) requiring hospital admission, or (3) requiring admission into the intensive care unit (ICU). Of the patients, 74 (48%) had required hospital admission during acute infection, while 19 (12%) were admitted to ICU. Fatigue and subjective return to health were assessed after initial infection.

A total of 115 (75%) participants underwent chest radiography at follow up. Persistent abnormal x-rays of either persistent infiltrate or atelectasis were found in 14 (19%) of the admitted cohort with no abnormal findings in those managed as outpatients. All 14 patients who had an abnormal follow up x-ray underwent repeat imaging 6 weeks later, with 5 having persistent abnormalities. Thus, persistent x-ray abnormalities attributable to COVID-19 were seen in 4% (5/115) of the cohort.

Meanwhile, a total of 109 (71%) patients completed a 6MWT. The median distance covered was 460m (interquartile range [IQR], 225 – 640). The researchers found that distance covered was not associated with initial disease severity and reduced distance covered was associated with length of inpatient stay.

Of the patients, 95 (62%) felt that they had not returned to full health. The median fatigue score across the cohort was 15 (IQR, 11 – 20) and 73 (48%) participants met the case definition for fatigue. The study found that fatigue was not associated with severity of initial infection (r2 -0.09, P = 0.25) while not feeling back to full health was associated with increased Modified Borg Dyspnoea Scale (MBS) (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1–1.6; P = 0.005). Further, fatigue was not associated with abnormal chest x-ray or inflammatory markers at follow up but was associated with reduced distance covered (β coefficient, -0.02, 95% CI, -0.03 – -0.01; P = 0.002) and increased MBS (β coefficient, 0.85; 95% CI, 0.36–1.334; P = 0.001).

“Of the patients that attended for outpatient follow-up, we report reassuring findings regarding objective post-COVID respiratory complications at a median follow-up timepoint of 75 days, but clear evidence that patients have not returned to full fitness,” the authors noted. “There appears to be a need for ongoing support and rehabilitation of patients experiencing long-term side-effects of COVID-19, including programmes to optimise patient’s self-management of fatigue and perception of exertion post-COVID-19.”