tetano
Editor, Senior Moderator
PLoS One
. 2020 Oct 14;15(10):e0239570.
doi: 10.1371/journal.pone.0239570. eCollection 2020.
Residual clinical damage after COVID-19: A retrospective and prospective observational cohort study
Rebecca De Lorenzo[SUP] 1 [/SUP], Caterina Conte[SUP] 1 2 [/SUP], Chiara Lanzani[SUP] 3 [/SUP], Francesco Benedetti[SUP] 1 4 [/SUP], Luisa Roveri[SUP] 5 [/SUP], Mario G Mazza[SUP] 1 4 [/SUP], Elena Brioni[SUP] 3 [/SUP], Giacomo Giacalone[SUP] 5 [/SUP], Valentina Canti[SUP] 2 [/SUP], Valentina Sofia[SUP] 1 [/SUP], Marta D'Amico[SUP] 1 [/SUP], Davide Di Napoli[SUP] 6 [/SUP], Alberto Ambrosio[SUP] 6 [/SUP], Paolo Scarpellini[SUP] 2 [/SUP], Antonella Castagna[SUP] 1 2 [/SUP], Giovanni Landoni[SUP] 1 7 [/SUP], Alberto Zangrillo[SUP] 1 7 [/SUP], Emanuele Bosi[SUP] 1 2 [/SUP], Moreno Tresoldi[SUP] 8 [/SUP], Fabio Ciceri[SUP] 1 2 [/SUP], Patrizia Rovere-Querini[SUP] 1 2 [/SUP]
Affiliations
Abstract
Data on residual clinical damage after Coronavirus disease-2019 (COVID-19) are lacking. The aims of this study were to investigate whether COVID-19 leaves behind residual dysfunction, and identify patients who might benefit from post-discharge monitoring. All patients aged ≥18 years admitted to the Emergency Department (ED) for COVID-19, and evaluated at post-discharge follow-up between 7 April and 7 May, 2020, were enrolled. Primary outcome was need of follow-up, defined as the presence at follow-up of at least one among: respiratory rate (RR) >20 breaths/min, uncontrolled blood pressure (BP) requiring therapeutic change, moderate to very severe dyspnoea, malnutrition, or new-onset cognitive impairment, according to validated scores. Post-traumatic stress disorder (PTSD) served as secondary outcome. 185 patients were included. Median [interquartile range] time from hospital discharge to follow-up was 23 [20-29] days. 109 (58.9%) patients needed follow-up. At follow-up evaluation, 58 (31.3%) patients were dyspnoeic, 41 (22.2%) tachypnoeic, 10 (5.4%) malnourished, 106 (57.3%) at risk for malnutrition. Forty (21.6%) patients had uncontrolled BP requiring therapeutic change, and 47 (25.4%) new-onset cognitive impairment. PTSD was observed in 41 (22.2%) patients. At regression tree analysis, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and body mass index (BMI) at ED presentation, and age emerged as independent predictors of the need of follow-up. Patients with PaO2/FiO2 <324 and BMI ≥33 Kg/m2 had the highest odds to require follow-up. Among hospitalised patients, age ≥63 years, or age <63 plus non-invasive ventilation or diabetes identified those with the highest probability to need follow-up. PTSD was independently predicted by female gender and hospitalisation, the latter being protective (odds ratio, OR, 4.03, 95% confidence interval, CI, 1.76 to 9.47, p 0.0011; OR 0.37, 95% CI 0.14 to 0.92, p 0.033, respectively). COVID-19 leaves behind physical and psychological dysfunctions. Follow-up programmes should be implemented for selected patients.
. 2020 Oct 14;15(10):e0239570.
doi: 10.1371/journal.pone.0239570. eCollection 2020.
Residual clinical damage after COVID-19: A retrospective and prospective observational cohort study
Rebecca De Lorenzo[SUP] 1 [/SUP], Caterina Conte[SUP] 1 2 [/SUP], Chiara Lanzani[SUP] 3 [/SUP], Francesco Benedetti[SUP] 1 4 [/SUP], Luisa Roveri[SUP] 5 [/SUP], Mario G Mazza[SUP] 1 4 [/SUP], Elena Brioni[SUP] 3 [/SUP], Giacomo Giacalone[SUP] 5 [/SUP], Valentina Canti[SUP] 2 [/SUP], Valentina Sofia[SUP] 1 [/SUP], Marta D'Amico[SUP] 1 [/SUP], Davide Di Napoli[SUP] 6 [/SUP], Alberto Ambrosio[SUP] 6 [/SUP], Paolo Scarpellini[SUP] 2 [/SUP], Antonella Castagna[SUP] 1 2 [/SUP], Giovanni Landoni[SUP] 1 7 [/SUP], Alberto Zangrillo[SUP] 1 7 [/SUP], Emanuele Bosi[SUP] 1 2 [/SUP], Moreno Tresoldi[SUP] 8 [/SUP], Fabio Ciceri[SUP] 1 2 [/SUP], Patrizia Rovere-Querini[SUP] 1 2 [/SUP]
Affiliations
- PMID: 33052920
- DOI: 10.1371/journal.pone.0239570
Abstract
Data on residual clinical damage after Coronavirus disease-2019 (COVID-19) are lacking. The aims of this study were to investigate whether COVID-19 leaves behind residual dysfunction, and identify patients who might benefit from post-discharge monitoring. All patients aged ≥18 years admitted to the Emergency Department (ED) for COVID-19, and evaluated at post-discharge follow-up between 7 April and 7 May, 2020, were enrolled. Primary outcome was need of follow-up, defined as the presence at follow-up of at least one among: respiratory rate (RR) >20 breaths/min, uncontrolled blood pressure (BP) requiring therapeutic change, moderate to very severe dyspnoea, malnutrition, or new-onset cognitive impairment, according to validated scores. Post-traumatic stress disorder (PTSD) served as secondary outcome. 185 patients were included. Median [interquartile range] time from hospital discharge to follow-up was 23 [20-29] days. 109 (58.9%) patients needed follow-up. At follow-up evaluation, 58 (31.3%) patients were dyspnoeic, 41 (22.2%) tachypnoeic, 10 (5.4%) malnourished, 106 (57.3%) at risk for malnutrition. Forty (21.6%) patients had uncontrolled BP requiring therapeutic change, and 47 (25.4%) new-onset cognitive impairment. PTSD was observed in 41 (22.2%) patients. At regression tree analysis, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and body mass index (BMI) at ED presentation, and age emerged as independent predictors of the need of follow-up. Patients with PaO2/FiO2 <324 and BMI ≥33 Kg/m2 had the highest odds to require follow-up. Among hospitalised patients, age ≥63 years, or age <63 plus non-invasive ventilation or diabetes identified those with the highest probability to need follow-up. PTSD was independently predicted by female gender and hospitalisation, the latter being protective (odds ratio, OR, 4.03, 95% confidence interval, CI, 1.76 to 9.47, p 0.0011; OR 0.37, 95% CI 0.14 to 0.92, p 0.033, respectively). COVID-19 leaves behind physical and psychological dysfunctions. Follow-up programmes should be implemented for selected patients.