key: cord-0686000-0pnhk3j7 authors: Akinci Ozyurek, Berna; Sahin Ozdemirel, Tugce; Akkurt, Esma Sevil; Yenibertiz, Derya; Saymaz, Zeynep Tilbe; Büyükyaylacı Özden, Sertaç; Eroğlu, Zehra title: What are the factors that affect post COVID 1st month's continuing symptoms? date: 2021-09-12 journal: Int J Clin Pract DOI: 10.1111/ijcp.14778 sha: cb62099e1e940c8c263f267fd7b8c2e6a9d7f361 doc_id: 686000 cord_uid: 0pnhk3j7 AIM: The aim of our research was to investigate retrospectively the relationship between the symptoms and general characteristics, initial laboratory values and treatments in patients who had COVID‐19 and who applied to the chest diseases outpatient clinic for control after 1 month. METHOD: Three hundred fifteen patients who were diagnosed with COVID‐19 and applied to the chest diseases outpatient clinic between May 2020 and August 2020 for control in the 1st month were included in the study. Patient information was collected from the hospital information system and the e‐pulse system. RESULTS: Females accounted for 50.2% of our patients and their mean age was 47.9 ± 14.8 (19‐88) years. About 14.3% (n: 45) of the individuals were 65 years of age and older, 20.6% (n: 65) of our patients were smoking and 70.2% (n: 221) of our patients were treated at home. A total of 133 patients had at least one comorbid disease. The patients most frequently reported cough, dyspnoea, weakness, myalgia and diarrhoea. The most common symptoms were cough, dyspnoea, weakness and myalgia in the 1st month. Initial D‐dimer, initial CRP and the values of platelet, D dimer and CRP in the 1st month were detected to be higher in patients with persistent symptoms when the laboratory values of patients whose symptoms continue after 1 month were examined. It was determined that the symptoms had persisted in patients who had been hospitalised, had dual therapy, had comorbid diseases and had more common pathologies in their pulmonary imaging. CONCLUSION: Symptoms may persist for a long time in hospitalised patients, in patients with COVID‐19–related pneumonia and concomitant chronic diseases and in patients with high D‐dimer and high CRP at the time of admission. Patients are informed that their symptoms may last for a long time, unnecessary hospital admissions can be avoided. course from pneumonia to respiratory failure and may have a fatal course. 1, 2 Fever, cough, shortness of breath, myalgia and fatigue are most common; sputum, haemoptysis, loss of sense of smell and taste, sore throat, headache, chest pain, diarrhoea are also common symptoms of COVID-19 infection. 3, 4 In mild cases, symptoms continue for 2 weeks. It goes on for up to 3-6 weeks in severe cases. Symptoms can get worse in a week or so. Approximately 2-8 weeks after the onset of symptoms, deaths were also seen. It was found that some symptoms also existed in the outpatient clinic controls. The aim of our research was to investigate retrospectively the relationship between the symptoms and general characteristics, initial laboratory values and treatments in patients who had Covid 19 and who applied to the chest diseases outpatient clinic for control after 1 month. Three hundred fifteen patients who were diagnosed with and applied to the chest diseases outpatient clinic between May 2020 and August 2020 for control in the 1st month were included in the study. Patient information were collected from the hospital information system and the e-pulse system. Patients' general characteristics (age, gender, history of smoking, treatment regimen and additional diseases), initial symptoms and ongoing symptoms within the 1st month, radiological characteristics, laboratory parameters Females accounted for 50.2% (n:158) of our patients and their mean age was 47.9 ± 14.8 years. 14.3% (n: 45) of the individuals were 65 years of age and older, 34.3% (n: 108) had no findings in their lung computed tomography (CT) and chest X-rays, 20.6% (n: 65) of our patients were smoking and 70.2% (n: 221) of our patients were treated at home. A total of 133 (42.2%) patients had at least one comorbid disease. Hypertension (HT) was determined in 43 (32.3%) patients, asthma was determined in 29 (21.8%) patients, diabetes mellitus (DM) was determined in 25 (18.7%) patients, coronary artery disease (CAD) was determined in 15 (11.2%) patients, chronic obstructive pulmonary disease (COPD) was determined in 12 (9%) patients, neurological disease was determined in 7 (5%) patients, a history of malignancy was determined in 7 (5%) patients (two patients with lung cancer, three patients with thyroid cancer, one patient with brain cancer, one patient with osteosarcoma), hypothyroidism was determined in 5 (3.7%) patients, rheumatological disease Table 1 . When the symptoms of the study group were evaluated, while 7% (n: 22) of the subjects were asymptomatic in the first part of the study, 27.3% (n: 86) of the subjects were found to be asymptomatic in the 1-month period (P < .001). It was found that the symptoms of fever myalgia, diarrhoea, dyspnoea, cough, loss of taste and smell and sore throat decreased within 1 month of the first period when the contrast of the two periods was examined ( Table 2 ). The symptom distribution of the study group by period is shown in • Long COVID is the name used by patients to identify symptoms of COVID-19 that persist after acute illness. • The working definitions of "post-acute" (symptoms after 3-4 weeks) and "chronic" (symptoms after 12 weeks) COVID- 19 have not yet been officially confirmed. • The cause of persistent symptoms is unknown, but it probably involves several different mechanisms of disease, including an inflammatory reaction with a vasculitic component. • Does this contribute to the reduction of unnecessary hospital admissions? month later, when certain laboratory values of the study group were analysed, and there was no difference between the two times. In our study, no statistically significant difference was found between age, gender and smoking status (P > .005 for each) when the distribution of individuals with persistent symptoms was examined after 1 month. It was determined that the symptoms had persisted in patients who had been hospitalised, had dual therapy, had comorbid diseases and had more common pathologies in their pulmonary imaging (Table 3) . A total of 182 (57.7%) patients had no comorbidities, 115 (63.1%) of those without comorbidity continued to have symptoms in the 1st month. 114 (75.4%) of those with comorbid diseases continued to have symptoms in the 1st month. Table 3 describes the distribution of general characteristics of the study group according to the occurrence of symptoms after 1 month. All patients received corticosteroid therapy had at least one symptom in the 1st month (P < .001). Initial D-dimer, initial CRP and the values of platelet, D dimer and CRP in the 1st month were detected to be higher in patients with persistent symptoms when the laboratory values of patients whose symptoms continue after 1 month were examined. No difference was found between the values of initial Neutrophil%, Lymphocyte% and NLR and the 1st month ( NLR values. The distribution of laboratory values by treatment received by the research group is shown in Table 5 . Note: X 2 test was used. Abbreviation: CT, computed tomography. Distribution of general characteristics of the study group according to the presence of symptoms 1 mo later bilateral, peripheral and basal predominant ground-glass opacity, consolidation or both. 6 Air bubble signs and nodules are rare findings. 7, 8 In 3%-13% of COVID-19 pneumonia patients. nodules were identified, 9, 10 which was lower than that seen in other types of viral pneumonia. 11 All but one of the patients had at least one groundglass or consolidation on their CT scans. Nodular infiltration has been observed in one patient. Ground-glass opacity with or without consolidation is the main feature of the disease. The most common symptoms were fever (98%) followed by cough (76%) with more than half (55%) of patients developing dyspnoea in a study (n = 41) conducted by Huang et al in patients with confirmed COVID-19 infection. 3 In a large study (n = 1.099) from China. Guan after acute illness. 23 The working definitions of "post-acute" (symptoms after 3-4 weeks) and "chronic" (symptoms after 12 weeks) COVID- 19 have not yet been officially confirmed. 24, 25 People with long COVID experience a confounding variety of recurrent and fluctuating symptoms, including cough, dyspnoea, fever, sore throat, chest pain, palpitations, cognitive deficiencies, myalgia, neurological symptoms, skin rashes and diarrhoea 24, [26] [27] [28] [29] [30] ; some of which also have persistent or intermittent low oxygen saturation. 31 In our study, cough, dyspnoea, weakness and myalgia were the most common in the 1st month. It was determined that the symptoms had persisted in patients who had been hospitalised, had dual therapy, had comorbid TA B L E 4 Distribution of laboratory values of the study group according to the presence of symptoms after 1 mo <0.001. Abbreviations: CRP, C-reactive protein; NLR, neutrophil/lymphocyte ratio. diseases and had more common pathologies in their pulmonary imaging. Also, all patients who started corticosteroid therapy at the beginning had at least one symptom in the 1st month. Corticosteroid therapy was thought to be related to the initiation of patients with severe pneumonia. The cause of persistent symptoms is unknown, but it probably involves several different mechanisms of disease, including an inflammatory reaction with a vasculitic component. 32 Recent studies estimated that 10%-20% of people are still ill after 3 weeks and 1-3% are still severely ill after 12 weeks. 25, 33 In individuals with conditions such as asthma, diabetes and autoimmune disorders, mainstream medical opinion considers them more common (though they are also known to occur in those with no pre-existing conditions), 26, 27, 33, 34 in those who have been admitted to hospital. 27, 28, 33 This study found that 87.4% reported persistence with at least 1 symptom, particularly fatigue and dyspnoea, in patients who had recovered from COVID-19. 27 They subsequently complained of a relapse of chronic symptoms, in particular myalgia, extreme weakness, fever, dyspnoea, tightness of the chest, tachycardia, headaches and anxiety. 35 Interestingly few of them show biological anomalies (no lymphocytopenia or elevated C-reactive protein in particular) and in rare cases, chest computed tomographic scan traces of infection. 35 We declare that there is no conflict of interest, in particular no financial funding potentially relevant to the contents of manuscript. 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