Factors associated with functional limitation and symptom persistence in a prospective cohort of post-hospitalization COVID-19 patients

Abstract

Introduction: Many patients with COVID-19 required hospitalization to manage the most severe forms of the disease. Functional outcomes and mid-term symptom evolution of survivors need to be evaluated and better understood. Objective: The aim of this study was to analyze the presence of functional limitation and persistence of symptoms in a cohort of patients hospitalized for COVID-19 at three months (D0) and 12 months (D12) after hospital discharge. Methods: All adults from the post-COVID follow-up outpatient clinic at a Public Rehabilitation Center in Rio de Janeiro were recruited (n=258). All patients who did not meet exclusion criteria (n=140) were included for follow-up (n=118) and of these, 114 volunteers were initially evaluated on D0 (3 months) and D12 (12 months after hospital discharge. All patients were submitted to assessments of pulmonary function, symptoms (dyspnea, fatigue and pain), functional capacity and HRQoL. Results: The summarized results show that volunteers in this cohort have functional limitation on D0, with a higher prevalence among mechanically ventilated (MVI) (75% and 88%; p < 0.004). However, in the follow-up, we observed that only VMI patients remained with functional limitation on D12 (odds ratio: 3.07; 69% and 42 %, p < 0.01). showed reduced functional capacity (6MWD and gait speed) both on D0 (p=0.05; p<0.001, respectively) and on D12 (p<0.001; p<0.001, respectively).The same behavior was observed for dyspnea (p<0.001), fatigue (p<0.001), pain (p=0.05 ), functionality (p< 0.001) and HRQoL (p<0.001) in both D0 and D12 (p< 0.001; p<0.001; p<0.001; p<0.001, respectively). These findings of functional limitation and persistent symptoms are strongly correlated with 6MWD (r=0.63; p<0.001) and with gait speed (r=0.55; p<0.001) and moderately with
PCFS (r=0.47; p <0.05). The combination of need for IMV, increased PCFS, reduced 6MWD and gait speed increases the risk of persistent functional limitation (odds ratio 4.45, p< 0.006, [95%CI 1.54 – 12.87]) with an accuracy of 81 %. Regarding the
persistence of fatigue and dyspnea symptoms, IMV is an independent predictor with an odds ratio of 08.21, p< 0.001, [95%CI 2.17 – 32.87] and odds ratio 10.52, p<0.001, [95%CI 3.91 – 28.30], respectively), while pain persistence predicts the post COVID functional scale (PCFS) (odds ratio 3.01, p< 0.001, [95%CI 1.70 – 5.34]). The accuracy of these models for predicting dyspnea, fatigue and persistent pain is 69%, 70% and 76%, respectively. Conclusion: Hospitalization affects both functional status and symptoms over time, especially in patients who required IMV, which makes us reflect on whether these changes are in fact a consequence of COVID-19 or higher volume presentations of the post-operative syndrome. intensive therapy.