Uncertainty Remains for Long-Term Outcomes After Recovering from COVID-19

At 6 months after acute COVID-19 infection, patients were struggling with fatigue or muscle weakness, sleep difficulties, and anxiety or depression, according to a study published in The Lancet. Patients who were more severely ill experienced more pulmonary concerns, and were identified as the target population for intervention of long-term recovery.¹

Previous SARS outbreaks have indicated there may be lingering health consequences and patients who recovered from SARS have exhibited lung damage up to 15 years after infection. A few small studies conducted early in the SARS-CoV-2 pandemic observed radiological and pulmonary diffusion abnormalities among patients who had been discharged from the hospital for 3 months, validating the patterns observed during previous SARS waves.

The newly published study was the largest long-term assessment of clinical outcomes from SARS-CoV-2 illness to date. In total, 1733 adults discharged from a hospital in China were assessed 6 months after their illness. Over 76% of patients reported that at least 1 symptom, such as fatigue or muscle weakness (63%), and over 50% of patients had chest imaging abnormalities.

However, a commentary published in The Lancet in response to the study advised that some findings should be interpreted with caution for a few specific reasons.

The patient population presented in the study had relatively mild SARS-CoV-2 infections; only 4% (n=76) of patients have been admitted to the intensive care unit. This cohort of individuals was too small to adequately assess long-term consequences among the severely ill.

The study found that 13% of patients who did not develop acute kidney injury while hospitalized with SARS-CoV-2 presented with a declined estimated glomerular filtration rate less than 90 mL/min at the 6-month follow-up. These findings did not appear to be consistent with their SARS-CoV-2 disease course during hospitalization.

The authors of the commentary speculated that the gold standard of GFR measurement, plasma clearance of iohexol or iothalamate, would not have been feasible in the sample size they presented. Instead, GFR-estimating equations were likely employed, which are prone to over or under estimation of renal function.

The commentary authors concluded that long-term (1-2 year) studies are currently ongoing in the United Kingdom and United States of patients who have recovered from SARS-CoV-2 illness. These studies will likely inform the medical community to more aspects of long-term sequelae after SARS-CoV-2 infection with regard to respiratory, renal, and cognitive outcomes.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

1. Cortinovis M, Perico N, Remuzzi G. Long-term follow-up of recovered patients with COVID-19. Lancet. 2021;397(10270):173-175. doi:10.1016/S0140-6736(21)00039-8.

2. Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021;397(10270):220-232. doi:10.1016/S0140-6736(20)32656-8.