Analysis Of Residual Symptoms And Chest Imaging Findings Of Patients With COVID-19 One Year After Discharge

ObjectiveCollecting the residual symptoms and chest imaging data of patients with COVID-19 one year after discharge,and the clinical data in hospital,to analyze and compare the influence of severity of the patients’ illness in hospital on prognosis.At the same time,evaluating the relationship between chest imaging prognosis and clinical features,as well as screening for independent risk factors leading to abnormal prognosis in chest imaging.Methods1.The study recruited COVID-19 patients who have recovered and were discharged from the designated hospitals for COVID-19 treatment in Henan Province between January 2020 and February 2020,and from January 2021 to March 2021 these patients were followed up by the questionnaires and chest imaging examination.This study included 94 patients with COVID-19 who met the criteria for admission.The clinical data of 94 patients were collected by the electronic medical record system.Combined with these clinical data,the whole patients were divided into the mild group(mild and ordinary type of COVID-19)and the severe group(severe and critical type of COVID-19),and the differences of residual manifestations between the two groups were compared.Combined with the chest imaging review data,the whole patients were divided into normal imaging group and abnormal imaging group,the clinical characteristics of the two groups were compared,and the independent risk factors for abnormal chest imaging were screened out.2.These data were analyzed and compared,included(1)the questionnaire survey materials:the residual symptom questionnaire,24-item Hamilton depression scale(HAMD-24)and 14-itemHamilton Anxiety Scale(HAMA-14);(2)the Chest imaging data of patients reexamined one year after discharge:HRCT;(3)the general clinical data in hospitalization:Sex,age,smoking history,comorbidities,medication situation;(4)Laboratory tests in hospitalization:blood routine examination(white blood cell count,red blood cell count,hemoglobin concentration,neutrophil count,lymphocyte count,eosinophil count,blood platelet count),biochemical indexes(AST,ALT,GGT,albumin,total protein,total bilirubin,direct bilirubin,indirect bilirubin,serum creatinine,uric acid,LDH,C-reaction protein)and coagulation testing(PT,APTT,fibrinogen,D-dimer).3.SPSS 26.0 software and GraphPad Prism 8.0 were used for data processing and mapping.Firstly,the residual symptoms and chest imaging data of the whole patient one year after discharge were statistically described,then univariate analysis was used to compare the differences in residual symptoms between the mild and severe groups.At the same time,univariate analysis was used to compare the clinical characteristics of the normal imaging group and the abnormal imaging group,and all indexes with P<0.05 were included in multivariate analysis,screen for independent risk factors leading to abnormal prognosis in chest imaging by logistic regression analysis.Results1.Residual symptoms and chest imaging findings of 94 patients with COVID-19 1 year after recovery and discharge:common sequelae were fatigue(37 cases,39.96%),insomnia(21 cases,22.34%),joint pain(19 cases,20.21%)and abnormal chest imaging(67 cases,71.28%).HAMD-24 questionnaire found 7 cases(7.45%)with mild to moderate depression and 3 cases(3.19%)with severe depression.HAMA-14 questionnaire indicated that 9 cases(9.57%)were definitely anxious.2.The residual symptoms and re-examination of chest images were compared between mild and severe patients:The difference of fatigue between the two groups was statistically significant[22 cases(51.16%)VS 15 cases(29.41%),OR=2.514,95%CI:1.076～5.875,;χ2=4.624,P=0.032].The severe group was more likely to have lingering fatigue symptoms one year after discharge.The incidence of abnormal chest imaging in severe group was higher than that in mild group[36 cases(83.72%)VS 31 cases(60.78%),OR=3.318,95%CI:1.238～8.891,φ2=5.995,P=0.014],and the difference was statistically significant.3.Comparison of clinical features and laboratory indicators between the normal and abnormal imaging groups:the differences between two groups in age≥50(OR=3.744,95%CI:1.395～10.047,χ2=7.311,P=0.007),severe and critical COVID-19(OR=3.318,95%CI:1.238～8.891,χ2=5.995,P=0.014),cough(OR=3.029,95%CI:1.159～7.916,χ2=5.334,P=0.021),glucocorticoid medication(OR=3.423,95%CI:1.061～11.045,χ2=4.566,P=0.033)in hospitalization were statistically significant.The patients,who were older than 50 years[38 cases(56.72%)],coughed,had severe and critical disease[36 cases(53.73%)],treated with glucocorticoids in hospitalization[25 cases(37.31%)],were more likely to have residual lesions on chest imaging one year after discharge.4.Comparison of clinical features and laboratory indicators between the normal and abnormal imaging groups:the lymphocyte count(P<0.05),eosinophil count(P<0.05),albumin content(P<0.05)of abnormal imaging group were lower than those of normal imaging group.The levels of lactate dehydrogenase(P<0.05)and C-reactive protein(P<0.05)in abnormal imaging group were higher than those in normal imaging group.5.Multivariate analysis of chest imaging abnormalities:Cough(OR=3.502,95%CI:1.123～10.922,P=0.031)was an independent risk factor for abnormal chest imaging at 1 year after discharge.Conclusion1.The COVID-19 patient,who have been discharged from hospital for one year,was mainly left with fatigue,insomnia,joint pain and chest imaging lesions,and the chest imaging lesions were mostly ground glass.Meanwhile,the psychological problems of depression and anxiety should not be ignored.The patients with COVID-19 needed to pay attention to these symptoms and intervention during rehabilitation training.Those severe and critically ill patients should pay special attention to fatigue and pulmonary conditions.2.The abnormal prognosis on chest imaging at 1 year after discharge was influenced by a number of factors at hospital admission,including age,severity of illness,cough symptoms,glucocorticoid therapy,lymphocyte count,eosinophils count,albumin lactate dehydrogenase and CRP levels.3.Cough was an independent risk factor for abnormal chest imaging findings 1 year after discharge,and they were positively correlated.In clinical diagnosis and treatment,we could pay attention to the symptoms of cough,estimate the prognosis of lung after recovery,and intervene timely in order to achieve long-term rehabilitation and improve the quality of life.