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Long-Term Clinical Sequelae and Immunological Features of COVID-19 Survivors: A Cross-Sectional Study in Wuhan, China

23 Pages Posted: 7 Jan 2021

See all articles by Danwen Zheng

Danwen Zheng

Guangzhou University of Chinese Medicine - Department of Emergency Medicine

Linjie Zhang

Department of Medical Administration, Hubei Provincial Hospital of Traditional Chinese & Western Medicine

Bing Feng

Department of Pharmacology of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Yuntao Liu

Department of Emergency, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Huiling Liu

Physical Examination Center, Hubei Provincial Hospital of Traditional Chinese & Western Medicine

Jiajun Hu

Department of Emergency, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Qiaoli Lin

Department of Geriatrics, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Xiaotu Xi

Department of Emergency, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Wenqiang Wang

Department of Rehabilitation, Hubei Provincial Hospital of Traditional Chinese & Western Medicine

Wei Ye

Department of Clinical Laboratory, Hubei Provincial Hospital of Traditional Chinese & Western Medicine

Xiaohua Xu

Second Clinical College, Guangzhou University of Chinese Medicine

Qian Wang

Second Clinical College, Guangzhou University of Chinese Medicine

Meixuan Lin

Second Clinical College, Guangzhou University of Chinese Medicine

Liqun Huang

Second Clinical College, Guangzhou University of Chinese Medicine

Xin Zhou

Second Clinical College, Guangzhou University of Chinese Medicine

Yihui Wang

Department of Pneumology , Hubei Provincial Hospital of Traditional Chinese & Western Medicine

Jixian Zhang

Department of Respiratory Medicine, Hubei Provincial Hospital of Integrated Chinese & Western Medicine

Yangpu Zhang

Department of Rehabilitation, Hubei Provincial Hospital of Traditional Chinese & Western Medicine

Zehui He

Department of Clinical Epidemiology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Heng Weng

Department of Clinical Epidemiology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Linda Zhong

School of Chinese Medicine, Hong Kong Baptist University

Banghan Ding

Guangzhou University of Chinese Medicine - Department of Emergency Medicine

Guangjuan Zheng

Department of Pharmacology of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Jianwen Guo

Department of Medical Administration, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Zhongde Zhang

Guangzhou University of Chinese Medicine - Department of Emergency

More...

Abstract

Objectives: To describe the clinical sequelae and immunological features of COVID-19 survivors who have been discharged from the hospital for 5-8 months.

Methods: This study is a cross-sectional study of confirmed COVID-19 patients aged ≥18 years who were discharged from hospitals in Wuhan from January to April 2020. The demographics, clinical features, and laboratory findings of the participants were collected from medical records in the hospital. The participants from the study completed an investigation of clinical sequelae, blood tests, a pulmonary function examination and an unarmed rehabilitation evaluation at Hubei Provincial Hospital of Traditional Chinese & Western Medicine. A group of volunteers who were free of COVID-19 and lived in Wuhan during the outbreak were recruited as the comparison group.

Results: The average age of the 574 COVID-19 survivors was 57.7±11.4 years, and 348 (60.6%) survivors were female. The average number of days from the onset of symptoms was 241.79±16.16. The average number of days from discharge was 194.3±14.4. Clinical sequelae were common, including general symptoms (n=321, 55.9%), respiratory symptoms (n=265, 46.2%), digestive symptoms (n=84, 14.6%), nervous symptoms (n=75,13.1%) and psychosocial symptoms (n=201, 35%). A total of 190 (33.7%) survivors reported reduced exercise capacity. Through the results of pulmonary function examination, anomalies were noted in carbon monoxide diffusion capacity (DLCO)% in 110 cases (32.4%), maximal mid-expiratory flow (MMEF)% in 105 cases (30.7%), forced expired flow at 50% of forced vital capacity (FEF 50 )% in 128 cases (37.4%), and forced expired flow at 75% of forced vital capacity (FEF 75 )% in 240 cases (70.2%). The counts of T lymphocyte, CD4+ T lymphocyte counts, CD8+ T lymphocyte counts, B lymphocyte and NK cell in the survival group was significantly lower than that in the comparison group(all P < 0.05).There were 252 (43.9%) survivors whose total T lymphocyte counts had dropped, 260 (45.3%) whose CD4+T lymphocyte counts had dropped, 231 (40.2%) whose CD8+ T lymphocyte counts had dropped, 119 (20.7%) whose B lymphocyte counts had dropped, and 54 (9.4%) whose NK cell counts had dropped. But there were no statistically significant differences in the incidence of lymphocyte subsets reduction between severe and nonsevere groups (all P > 0.05). The T lymphocyte counts, CD4+ T lymphocyte counts and CD8+ T lymphocyte counts of the patients before discharge were significantly higher than those in the early stage of admission (P < 0.025). There were 319 (55.6%) survivors with positive or weakly positive IgG antibodies and 17 (2.9%) survivors with positive or weakly positive IgM antibodies.

Conclusion: Even after 5 to 8 months of discharge, many survivors still have clinical sequelae, and some of them have impaired immune function. Therefore, the long-term rehabilitation of COVID-19 survivors remains a concern.

Funding Statement: This study was funded by the National Key R&D Plan of China (2020YFC0841600), Guangdong Provincial Key Laboratory of Research on Emergency in TCM (2017B030314176), R&D plan in key areas of Guangdong Province (2020B1111300005), and National Administration of Traditional Chinese Medicine (2020ZYLCYJ05-11).

Declaration of Interests: The authors declare that they have no competing interests.

Ethics Approval Statement: This study was approved by the ethical committees of Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (GPHCM; No. BF2020-205-01). All participants signed informed consent forms.

Keywords: COVID-19, Survivors, Clinical sequelae, Immunological features, Long-term

Suggested Citation

Zheng, Danwen and Zhang, Linjie and Feng, Bing and Liu, Yuntao and Liu, Huiling and Hu, Jiajun and Lin, Qiaoli and Xi, Xiaotu and Wang, Wenqiang and Ye, Wei and Xu, Xiaohua and Wang, Qian and Lin, Meixuan and Huang, Liqun and Zhou, Xin and Wang, Yihui and Zhang, Jixian and Zhang, Yangpu and He, Zehui and Weng, Heng and Zhong, Linda and Ding, Banghan and Zheng, Guangjuan and Guo, Jianwen and Zhang, Zhongde, Long-Term Clinical Sequelae and Immunological Features of COVID-19 Survivors: A Cross-Sectional Study in Wuhan, China. Available at SSRN: https://ssrn.com/abstract=3745148

Danwen Zheng

Guangzhou University of Chinese Medicine - Department of Emergency Medicine

Guangzhou, Guangdong
China

Linjie Zhang

Department of Medical Administration, Hubei Provincial Hospital of Traditional Chinese & Western Medicine ( email )

Bing Feng

Department of Pharmacology of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Yuntao Liu

Department of Emergency, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Huiling Liu

Physical Examination Center, Hubei Provincial Hospital of Traditional Chinese & Western Medicine

Jiajun Hu

Department of Emergency, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Qiaoli Lin

Department of Geriatrics, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine ( email )

Xiaotu Xi

Department of Emergency, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine ( email )

Wenqiang Wang

Department of Rehabilitation, Hubei Provincial Hospital of Traditional Chinese & Western Medicine ( email )

Wei Ye

Department of Clinical Laboratory, Hubei Provincial Hospital of Traditional Chinese & Western Medicine

Xiaohua Xu

Second Clinical College, Guangzhou University of Chinese Medicine ( email )

Qian Wang

Second Clinical College, Guangzhou University of Chinese Medicine

Meixuan Lin

Second Clinical College, Guangzhou University of Chinese Medicine ( email )

Liqun Huang

Second Clinical College, Guangzhou University of Chinese Medicine ( email )

Xin Zhou

Second Clinical College, Guangzhou University of Chinese Medicine

Yihui Wang

Department of Pneumology , Hubei Provincial Hospital of Traditional Chinese & Western Medicine

Jixian Zhang

Department of Respiratory Medicine, Hubei Provincial Hospital of Integrated Chinese & Western Medicine

Yangpu Zhang

Department of Rehabilitation, Hubei Provincial Hospital of Traditional Chinese & Western Medicine ( email )

Zehui He

Department of Clinical Epidemiology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine ( email )

Heng Weng

Department of Clinical Epidemiology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine ( email )

Linda Zhong

School of Chinese Medicine, Hong Kong Baptist University ( email )

Banghan Ding

Guangzhou University of Chinese Medicine - Department of Emergency Medicine

Guangzhou, Guangdong
China

Guangjuan Zheng

Department of Pharmacology of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine ( email )

Jianwen Guo

Department of Medical Administration, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine ( email )

Zhongde Zhang (Contact Author)

Guangzhou University of Chinese Medicine - Department of Emergency ( email )

Guangzhou
China

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