12 januari 2021: Bron: The Lancet

Uit een groot onderzoek uitgevoerd in Wuhan, het centrum waar de pandemie begon wijst uit dat de meeste patiënten die met Covid-19 in het ziekenhuis en / of IC waren opgenomen, zes maanden na de besmetting nog steeds aan verschillende symptomen leden - waaronder vermoeidheid en slaapproblemen.
De studie van meer dan 1.700 patiënten die werden behandeld in de Chinese stad Wuhan toont aan dat 76% van deze groep patiënten ten minste één klacht of symptoom had enkele maanden tot een half jaar nadat ze uit het ziekenhuis waren ontslagen.

De studie: 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study is gepubliceerd in The Lancet.

Het bleek dat vermoeidheid en slaapproblemen de meest voorkomende symptomen waren na Covid-19, die optraden bij respectievelijk 63% en 26% van de patiënten, zes maanden na het begin van hun eerste diagnose.De ziekte kan ook langdurige psychologische complicaties hebben, met angst of depressie gemeld bij 23% van de patiënten, zo bleek uit de studie. Patiënten die ernstiger ziek waren, hadden volgens de onderzoekers de neiging om blijvend bewijs van longschade op röntgenfoto's te hebben.

"Omdat Covid-19 zo'n nieuwe ziekte is, beginnen we pas enkele van de langetermijneffecten ervan op de gezondheid van patiënten te begrijpen", zegt Dr. Bin Cao van het China-Japan Friendship Hospital en Capital Medical University, die de studie leidde.

"Onze analyse geeft aan dat de meeste patiënten met ten minste enkele van de effecten van het virus blijven leven na het verlaten van het ziekenhuis, en dr. Bin Cao benadrukt de behoefte aan zorg na ontslag uit het ziekenhuis, vooral voor degenen die ernstige infecties hebben.

Het US Centers for Disease Control and Prevention (CDC) noemt vermoeidheid, kortademigheid, hoesten, gewrichtspijn en pijn op de borst als de meest gemelde langetermijnsymptomen. Anderen, benoemen problemen met denken en concentratie - bekend als "hersenmist", depressie en hoofdpijn, en worden ook gezien onder coronaviruspatiënten die al lang en breed het ziekenhuis hebben verlaten.

Uit een studie die in augustus in het British Medical Journal werd gepubliceerd, bleek dat ongeveer 10% van de patiënten langdurige klachten hadden veroorzaakt door Covid-19 die langer dan 12 weken duurden.Maar de Chinese studie is de grootste, met de langste follow-upduur, om de langetermijnimpact op ontslagen patiënten te onderzoeken, aldus de auteurs.

De studie: 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study is gepubliceerd in The Lancet.

Hier het abstract:

6-month consequences of COVID-19 in patients discharged from hospital: a cohort study

Published:January 08, 2021DOI:https://doi.org/10.1016/S0140-6736(20)32656-8

Summary

Background

The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity.

Methods

We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020. Patients who died before follow-up, patients for whom follow-up would be difficult because of psychotic disorders, dementia, or re-admission to hospital, those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism, those who declined to participate, those who could not be contacted, and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5–6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received severe acute respiratory syndrome coronavirus 2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences.

Findings

In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 (IQR 47·0–65·0) years and 897 (52%) were men. The follow-up study was done from June 16, to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 (175·0–199·0) days. Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients. The proportions of median 6-min walking distance less than the lower limit of the normal range were 24% for those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5–6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5–6, and median CT scores were 3·0 (IQR 2·0–5·0) for severity scale 3, 4·0 (3·0–5·0) for scale 4, and 5·0 (4·0–6·0) for scale 5–6. After multivariable adjustment, patients showed an odds ratio (OR) 1·61 (95% CI 0·80–3·25) for scale 4 versus scale 3 and 4·60 (1·85–11·48) for scale 5–6 versus scale 3 for diffusion impairment; OR 0·88 (0·66–1·17) for scale 4 versus scale 3 and OR 1·77 (1·05–2·97) for scale 5–6 versus scale 3 for anxiety or depression, and OR 0·74 (0·58–0·96) for scale 4 versus scale 3 and 2·69 (1·46–4·96) for scale 5–6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with estimated glomerular filtration rate (eGFR) 90 mL/min per 1·73 m2 or more at acute phase had eGFR less than 90 mL/min per 1·73 m2 at follow-up.

Interpretation

At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery.

Funding

National Natural Science Foundation of China, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, National Key Research and Development Program of China, Major Projects of National Science and Technology on New Drug Creation and Development of Pulmonary Tuberculosis, and Peking Union Medical College Foundation.