What are the most common symptoms in hospitalized patients for coronavirus

The effects of COVID-19 vary widely, from asymptomatic individuals to patients who develop severe acute respiratory distress syndrome, with possible involvement of almost all organs and systems.

However, The possible medium and long term effects of COVID-19 have become of growing concern. The inflammation that characterizes severe forms of the disease suggests that severe sequelae can affect multiple organs. Other coronaviruses have been shown to induce long-term effects, particularly in the lungs.

So far, perhaps due to the severity of the disease, there were few comprehensive assessments of the long-term consequences of COVID-19. In addition, most of the investigations were carried out on patients who decided to actively participate in the follow-up, which limits the field of study.

The purpose of a new investigation Four months after discharge, a large team of professionals from the University of Paris-Saclay was tasked with systematically assessing the clinical condition of COVID-19 survivors requiring hospitalization..

Respiratory, cognitive, and functional symptoms were assessed over the telephone with a cognitive screening questionnaire and symptom checklist.

During the outpatient visit, patients underwent lung function tests, lung CT scans, psychometric and cognitive studies (including an abridged 36-item health survey and a 20-item multidimensional fatigue inventory) and, for patients who had been hospitalized in intensive care or reported persistent symptoms, echocardiography.

During the telephone interview, 51% of patients report having at least one symptom that they did not have before COVID-19: fatigue (31%), cognitive symptoms (21%) and recent onset dyspnea (16%).

The median multidimensional fatigue inventory score gave 4.5 (range 3 to 5) for reduced motivation and 3.7 for mental fatigue (in a range where 1 means better and 5 means worse).

Likewise, abnormalities were found in the CT scan of the lungs in 63% of patients., mainly subtle opacities, and fibrous lesions were seen in 19%, affecting less than 25% of the parenchyma (i.e. the essential tissue of the organ) in all but one patient.

In contrast, fibrous lesions were also seen in 39% of people with acute respiratory distress syndrome. Among former intensive care patients, anxiety, depression and post-traumatic symptoms were observed in 23%, 18% and 7%, respectively.

Among patients evaluated four months after hospitalization for COVID-19, 51% reported at least one symptom that did not exist before the illness.

Among patients who returned for further evaluation, CT scans frequently revealed persistent lung abnormalities as well as pulmonary fibrotic lesions in a minority of patients. Persistent cardiac dysfunction and renal failure were rare. Almost all of the patients had a positive anti-SARS-CoV-2 serology.

“The respiratory sequelae of COVID-19 have raised significant concerns,” said lead author of the study, Luc Morin. However, severe lung disease was rare in the patients in the present study, although all had severe or very severe forms of COVID-19“.

The results of the pulmonary CT scan, performed in all patients receiving symptomatic and intensive treatment, were abnormal in most patients, but the most frequent lesions were subtle frosted glass opacities, confirming the earlier results.

Fibrotic lesions, suspected of initial severe inflammation, were only present in 19% of patients with CT scans.

According to this research, fibrous changes affected less than 25% of the lung parenchyma in all patients and it has occurred almost exclusively in intensive care patients. “While it is possible that people with mild fibrous lesions did not report dyspnea during the telephone consultation and did not have a CT scan afterwards, it appears that this is a small proportion of those assessed. Says Morin.

Although severe pulmonary sequelae are rare, recent onset dyspnea has been reported in 16% of patients.. If this is confirmed in other studies and found to be persistent, it could be clinically important, given the large number of critically ill COVID-19 patients around the world.

Additionally, although parenchymal sequelae were the most common finding, respiratory dysfunction was confirmed by the hyperventilation challenge test in 12% of patients, a finding that to our knowledge has not been previously described. . Dysfunctional breathing is probably not specific to COVID-19. However, this could be the sequel to the dissociation between dyspnea and the severity of hypoxemia described in patients with acute COVID-19.

In the French studio, cognitive problems, reported by telephone evaluation and confirmed during the outpatient consultation, were frequent: 21% of patients reported at least one cognitive symptom and cognitive impairment was confirmed in 38% of those who were subsequently assessed. The underlying mechanisms are unknown, but these symptoms could be a sequel to damage to the central nervous system by SARS-CoV-2, as occurs with other viral infections.

Symptoms of anxiety were found in 31% of patients and symptoms of depression in 21%. The prevalence of psychological symptoms in intensive care patients, systematically evaluated on an outpatient basis, was significant.

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