Long-term clinical, nutritional, and functional outcomes of COVID-19 patients after hospital discharge

Abstract

Background

Long-term nutritional and functional status after hospitalization due to COVID-19 has been poorly described. We show the physical and nutritional stata and the symptoms compatible with Long-COVID in patients who survived after an episode of hospitalization due to COVID-19 and the associated factors.

Methods

Single-center prospective observational study. Clinical, nutritional, and physical function data were assessed in 345 subjects over 18 years of age hospitalized in an university hospital for a diagnosis of COVID-19 in 2020 at three different times of follow-up: 6 (n = 118), 9 (n = 115), and 15 months (n = 112) after discharge. All survivors discharged during each of those periods were called consecutively at the times of follow-up in order to collect data about their nutritional and functional stata, and long-COVID symptoms.

Results

The mean age of the 345 subjects included in the present study was 62.8 years (SD 15.8), and 180 (52.2%) were men. The mean number of comorbidities was 2.6 (SD 2.1). After a mean follow-up time of 10.2 ± 3.2 months, mean Barthel score showed a decrease of 2.00 (SD 0.12) points, that showed to be consistent disregarding the time after discharge (6 months: 1.71 ± 4.8; 9 months: 2.17 ± 5.97; 15 months: 2.20 ± 5.25). The risk factors associated with worsening in the Barthel index score were basal Barthel index [BI < 95; odds ratio (OR): 3.34, 95% confidence interval (CI): 1.26–8.85], age (OR: 1.03, CI: 1.00–1.06, per year), having comorbidities (≥3 pathologies) (OR: 1.98, CI: 1.00–3.90), and female sex (OR: 2.68, CI: 1.47–4.90). Self-reported Long-COVID symptoms were frequent, mainly those related to functioning: fatigue/tiredness (39.4%), decreased mobility (16.2%), and subjective loss of muscle mass/strength (15.9%) plus mental complaints (depression/anxiety; 20.6%). Decreased mobility (OR 7.82, CI: 3.69–16.55), cognitive impairment (OR 6.76, CI: 2.22–20.58) and a score in SARC-F ≥ 2 (OR: 3.89; CI: 2.03–7.49) at follow-up were associated to the worsening in BI. BMI showed a modest, non-significant decrease at 6 months (−0.3 ± 1.7 kg/m²), that was fully recovered in the longest follow-up period (+0.4 ± 2.1).

Conclusions

Admission for COVID-19 produces a significant functional loose, mainly in those who are older, female, and with a poor basal functional status and comorbidities. This impairment does not recover spontaneously and is a main component of the long-term COVID-19 symptoms.