A total of 387 patients were identified as having been discharged with a coded diagnosis of COVID-19. Of these, 298 met the criteria for follow-up (admission related to COVID-19 pneumonia). 108 were followed-up by the local frailty team and their data were not included in this analysis. A further 56 patients were lost to follow-up.
A total of 134 patients (median age = 58 [range 25-89], 65.7% male [n=88]) attended their follow-up appointments. Patients were followed up at a median of 113 days (range = 46-167) post-discharge. Demographics, pre-COVID-19 comorbidities, and admission details are displayed in Table 1. All patients had radiological evidence of COVID-19 pneumonia and 87% (n=116) required oxygen and/or respiratory support. 80% (n=107) were treated on hospital wards, and 20% were treated in the intensive care unit (ICU) during their admission.
Symptom burden at follow-up
Breathlessness was the most commonly reported symptom with 60% of people experiencing increased breathlessness compared to their pre-COVID-19 state. Other common symptoms included myalgia (reported by 51.5% of patients), anxiety (47.8%), extreme fatigue (39.6%), low mood (37.3%), and sleep disturbance (35.1%). Females were significantly more likely than males to report anxiety (p=0.001), low mood (p=0.031), myalgia (p=0.022), fatigue (p=0.004), sleep disturbance (p=0.009), and memory impairment (p=0.001). Higher BMI was associated with myalgia (p=0.012) and fatigue (p=0.046).
There were no significant differences in lasting symptom burden based on the level of care, maximum oxygen or respiratory support received.
The proportion of patients reporting persistent symptoms diminished with a longer time to follow-up but this trend was not significant. Symptom data are displayed in Table 2 and Figure 1.
The median discharge C-reactive protein (CRP) level was significantly lower than that of admission (107mg/L vs 23mg/L, p<0.001, Wilcoxon Signed Rank Test. Of the 76 patients who were tested at follow-up, CRP and white cell count were within the normal range in 84% (n=64) and 92% (n=70) respectively.
130 patients had radiographic evidence of COVID-19 pneumonia at presentation and the remaining 4 patients developed this during the course of their admission. 125 patients had a follow-up CXR, of which 77% (n=103) were normal, (PCVCX0) and 8% (n=10) showed a resolution of ≥50% of their abnormalities (PCVCX1). The remainder had persistent non-COVID related changes. No patients’ CXRs were unchanged or had worsening changes. There was no difference in symptom burden at follow-up between those who had follow-up CXRs coded as PCVCX0 and PCVCX1.
Through the use of a co-occurrence matrix , we were able to identify 3 symptom “clusters”: Cluster A included myalgia and fatigue; Cluster B included low mood, anxiety, and sleep disturbance; and Cluster C comprised memory impairment, attention deficit, and cognitive impairment. Females were significantly more likely to report symptoms in cluster A, when compared to males (p=<0.001). No significant differences between patients were observed for clusters B and C.
The co-occurrence matrix used to identify these clusters can be found in Figure 2.