Socio-demographic Characteristics Of The Participants
A total of 405 study participants were involved, 256 (63.2%) were males. The median (IQR) age of the participants was 57.0 (43.0, 65.0) years (Table 1).
Table 1
Socio-demographic and presenting symptoms among recovered COVID-19 patients in Eka Kotebe General Hospital; 2022 (n = 405)
Variable | Category | Frequency | Percent (%) |
Age in years | 20–40 | 88 | 21.7 |
| 41–60 | 168 | 41.5 |
| > 60 | 149 | 36.8 |
Sex | Male | 256 | 63.2 |
| Female | 149 | 36.8 |
Symptoms During Presentation | Yes | 398 | 98.3 |
| No | 7 | 1.7 |
Cough | Yes | 352 | 86.9 |
| No | 46 | 11.4 |
Sneezing | Yes | 3 | 0.7 |
| No | 395 | 97.5 |
Runny Nose | Yes | 7 | 1.7 |
| No | 391 | 96.5 |
Fever | Yes | 215 | 53.1 |
| No | 183 | 45.2 |
Headache | Yes | 140 | 34.6 |
| No | 258 | 63.7 |
Sore throat | Yes | 19 | 4.7 |
| No | 379 | 93.6 |
Loss of appetite | Yes | 222 | 54.8 |
| No | 176 | 43.5 |
Shortness of breath | Yes | 187 | 46.2 |
| No | 211 | 52.1 |
Generalized Fatigue | Yes | 281 | 69.4 |
| No | 117 | 28.9 |
Diarrhoea or Vomiting | Yes No | 66 332 | 16.3 82.0 |
Loss of taste/Smell | Yes | 79 | 19.5 |
| No | 319 | 78.8 |
Admission Status Of Participants
Majority of the participants were symptomatic during admission. Cough (86.9%), easy fatigability (69.4%), loss of appetite (54.8%), and fever (53.1%) were the most common symptoms presentation at admission. Shortness of breath and headache were also recorded in 46.2% and 34.6% of participants respectively (Table 1).
Comorbidities And Imaging Findings
56.5% of participants had at least one comorbidity. Diabetes Mellitus and hypertension were the most common comorbid illnesses during the time of admission, being present in 35.3% and 30.4% of participants respectively.
Chest imaging (X-ray or CT- Scan) was done for 322 (79.5%) participants. The most common findings were ground glass opacities (GGO) and consolidation. Consolidation was found in 159 (39.3%) of participants, while GGO was present in 274 (67.7%). Infiltration and effusion were also found in 69 (17.0%) and 7 (1.7%) participants respectively (Table 2).
Table 2
Comorbidities and imaging findings of participants among recovered COVID-19 patients in Eka Kotebe General Hospital; 2022 (n = 405)
Variable | Category | Frequency | Percent |
Cardiac Illness | Yes | 34 | 8.4 |
| No | 371 | 91.6 |
CKD | Yes | 13 | 3.2 |
| No | 392 | 96.8 |
Hypertension | Yes No | 123 | 30.4 |
282 | 69.6 |
DM | Yes | 143 | 35.3 |
| No | 262 | 64.7 |
Asthma | Yes | 21 | 5.2 |
| No | 384 | 94.8 |
Smoking | Yes No | 2 403 | 0.5 99.5 |
Malignancy | Yes | 1 | 0.2 |
| No | 404 | 99.8 |
HIV | Yes No | 14 391 | 3.5 96.5 |
Consolidation | Yes | 159 | 39.3 |
| No | 246 | 60.7 |
GGO | Yes | 274 | 67.7 |
| No | 131 | 32.3 |
Infiltration | Yes | 69 | 17.0 |
| No | 336 | 83.0 |
Effusion | Yes | 7 | 1.7 |
| No | 398 | 98.3 |
Cardiomegaly | Yes | 1 | 0.2 |
| No | 404 | 99.8 |
Laboratory Parameters
The median (IQR) hemoglobin level was 14.6 g/dl (13.3, 15.8) and the WBC count was 7530 (5340, 10840) cells per microliter. More than half (51.4%) of participants had a low lymphocyte count (ALC) of less than 1000 per microliter. The median (IQR) lymphocyte count was 973 (656, 1437) cells per microliter. The median (IQR) creatinine and BUN level were 0.91 (0.74, 1.12) mg/dl and 14.0 (10.0, 21.0) mg/dl respectively (Table 3).
Table 3
Laboratory parameter during admission and 3rd month visit of participants among recovered COVID-19 patients in Eka Kotebe General Hospital; 2022 (n = 405)
Laboratory Parameters | Admission | 3rd month visit |
Hemoglobin in g/dl: Median (IQR) | 14.6 (13.3,15.8) | 15.0 (14.0, 16.2) |
WBC Count in cells/microliter: Median (IQR) | 7530 (5340, 10840) | 6530 (5010, 8290) |
Neutrophil Percentage: Median (IQR) | 81.4 (71.9, 87.6) | 57.7 (48.7, 65.5) |
Lymphocyte percentage: Median (IQR) | 12.6 (8.0, 19.8) | 28.9 (21.2, 36.8) |
ALC per microliter: Median (IQR) | 973 (656, 1437) | 1776 (1294, 2343) |
ALC < 1000 per microliter: Frequency (%) | 208 (51.4) | 32 (7.9) |
ALC \(\ge\)1000 per microliter: Frequency (%) | 197 (48.6) | 373 (92.1) |
Platelet per microliter: Median (IQR) | 211000 (159000, 282000) | 212000 (167500, 267500) |
Creatinine in mg/dl: Median (IQR) | 0.91 (0.74, 1.12) | 0.80 (0.67, 1.00) |
BUN in mg/dl: Median (IQR) | 14.0 (10.0, 21.0) | 10.0 (7.0, 14.0) |
AST in mg/dl: Median (IQR) | 33.0 (21.5, 49.0) | 18.0 (14.0, 23.0) |
ALT in mg/dl: Median (IQR) | 29.0 (12.0, 48.0) | 26.0 (18.0, 36.0) |
Clinical Course Of Participants During Admission
Among the 405 participants, 327 (80.7%) had severe COVID-19 diagnosis during their hospital stay. Twenty eight (6.9%) had critical COVID-19, 29 (7.2%) had moderate COVID-19 and 21 (5.2%) had mild COVID-19. Majority (87.7%) were admitted to the medical ward while 8.9% of participants admitted to ICU/HDU. The remaining 14 (3.5%) participants were admitted to other wards like the labor ward or psychiatry ward.
Participants received different levels of oxygen support during their stay. Forty seven (11.6%) participants were maintaining their oxygen saturation with room air, without any support, 70.4% of them were supported with 1-5liters per minute of oxygen, 47 (11.6%) participants were given 6-15liters per minute while 5.2% (n = 21) were put on non-invasive ventilation (NIV) support. Only 5 (1.2%) of participants were put on a mechanical ventilator (MV). Steroid was given to 92.1% (n = 373) of participants and 86 (21.2%) participants received antiviral treatment for COVID-19.
The median (IQR) length of stay was 11 (8, 15) days, with a range of 45 days (3–48). When discharged, symptom-based discharge criteria was used for 214 (52.8%) participants. 176 (43.5%) and 15 (3.7%) participants were discharged according to time-based and test-based criteria respectively (Table 4).
Table 4
Clinical Course of participants among recovered COVID-19 patients in Eka Kotebe General Hospital; 2022 (n = 405)
Variables | Category | Frequency | Percent (%) |
COVID-19 Severity | Mild | 21 | 5.2 |
| Moderate | 29 | 7.2 |
| Severe | 327 | 80.7 |
| Critical | 28 | 6.9 |
Admission place | ICU/HDU | 36 | 8.9 |
| Medical ward | 355 | 87.7 |
| Other ward | 14 | 3.5 |
Steroid given | Yes | 373 | 92.1 |
| No | 32 | 7.9 |
Length of stay in days | \(\le\)14 | 294 | 72.6 |
| 15–28 | 93 | 23.0 |
| \(>\)29 | 18 | 4.4 |
Maximum Oxygen support | Room air | 47 | 11.6 |
| 1–5 liter | 285 | 70.4 |
| 6–15 liter | 47 | 11.6 |
| NIV | 21 | 5.2 |
| MV | 5 | 1.2 |
Antiviral given | Yes | 86 | 21.2 |
| No | 319 | 78.8 |
Discharge Criteria | Time based | 176 | 43.5 |
| Symptom based | 214 | 52.8 |
| Test based | 15 | 3.7 |
Prevalence Of Post-covid-19 Pulmonary Complication
The median (IQR) number of days elapsed from the date of discharge to the visit day was 88 (78, 93) days. During this visit, 72 (17.8%) participants had respiratory complaints. 57(14.1%) had shortness of breath and 31(7.7%) had a cough. Among these symptomatic patients, 16 (4%) participants complained of both cough and shortness of breath, while 56 (13.8%) of them had only one respiratory complaint.
The respiratory rate of participants during the 3rd month visit ranged from 10–38 breaths per minute, with a mean number of 22.29 (SD = 2.87), and participants with a respiratory rate of more than 22 breaths per minute were 42.2% (n = 171) of all participants. Oxygen saturation measured at room air during the visit also ranged from 72% − 99%, with a mean measure of 95.54% (SD = 2.74). 23 (5.7%) participants had an oxygen saturation level of less than 90%. (Table 5)
Table 5
3rd month visit status of participants for Prevalence and associated factors of Post-COVID-19 Pulmonary Complications among recovered COVID-19 patients in Eka Kotebe General Hospital; 2022 (n = 405)
Variables | Category | Frequency | Percent (%) |
Symptom at 3rd month | Yes | 72 | 17.8 |
| No | 333 | 82.2 |
Cough | Yes | 31 | 7.7 |
| No | 374 | 92.3 |
Shortness of breath | Yes | 57 | 14.1 |
| No | 348 | 85.9 |
RR: Median (IQR) | RR \(>\)22 | 171 | 42.2 |
| RR \(\le\)22 | 234 | 57.8 |
SpO2 | SpO2 < 90 | 23 | 5.7 |
| SpO2 \(\ge\)90 | 382 | 94.3 |
Number of pulmonary complications | 1 | 135 | 33.3 |
| 2 | 31 | 7.7 |
| 3 | 19 | 4.7 |
| 4 | 7 | 1.7 |
Consolidation on imaging | Yes | 3 | 0.7 |
| No | 402 | 99.3 |
GGO | Yes | 19 | 4.7 |
| No | 386 | 95.3 |
Infiltration | Yes | 3 | 0.7 |
| No | 402 | 99.3 |
Cardiac illness | Yes | 10 | 2.5 |
| No | 395 | 97.5 |
CKD | Yes | 8 | 2.0 |
| No | 397 | 98.0 |
Hypertension | Yes | 38 | 9.4 |
| No | 367 | 90.6 |
DM | Yes | 47 | 11.6 |
| No | 358 | 88.4 |
Asthma | Yes | 1 | 0.2 |
| No | 404 | 99.8 |
Smoking | Yes | 1 | 0.2 |
| No | 404 | 99.8 |
Stroke | Yes | 0 | 0 |
| No | 405 | 100 |
Malignancy | Yes | 1 | 0.2 |
| No | 404 | 99.8 |
HIV | Yes | 1 | 0.2 |
| No | 404 | 99.8 |
When we take these four pulmonary complications (presence of cough, presence of shortness of breath, increased respiratory rate, and lower oxygen saturation level), 135 (33.3%) of participants had one or more of these complications. Two of the complications were present in 7.7% (n = 31) of participants, while 19 (4.7%) had three complications. 1.7% (n = 7) of participants had all the above four complications. The proportion of participants with 2 or more pulmonary complications which is used to define the prevalence of post COVID-19 pulmonary complications is 14.1% (n = 57) with 95% CI: 10.8%, 17.8%.
3rd Month Visit Status Of Participants
New onset comorbid illnesses, which were not diagnosed during admission were also reported during this period, the most common being DM and hypertension. They were reported in 11.6% (n = 47) and 9.4% (n = 38) of participants respectively. Cardiac disease was found in 10 (2.5%) and CKD was diagnosed in 8(2.0%). GGO was found in 19 (4.7%) and consolidation was seen in 3(0.7%) of participants (Table 5).
The median (IQR) WBC count during 3rd month visit was 6530 (5010, 8290) cells per microliter. Participants with lymphocyte count less than 1000 cells per microliter were 7.9% (n = 32). The median (IQR) lymphocyte count was 1776 (1294, 2343) cells per microliter (Table 3).
Associated Factors Of Post-covid-19 Pulmonary Complications
In bivariate analysis, p value of < 0.25 was used to determine association between the dependent and independent variables. From demographic characteristics, older age showed significant association with post-COVID-19 pulmonary complications.
From factors in admission status of participants, ALC < 1000 cells per microliter, consolidation, GGO, and infiltration in chest imaging showed significant association with developing pulmonary complications.
When we take variables related with clinical course of participants during admission, COVID severity, admission place, maximum oxygen support level and steroid use were the variables that showed significant association in bivariate analysis.
After adjusting for possible confounders on multivariate analysis, age and consolidation have significant association with the dependent variable at 95% CI (p < 0.05).
Participants whose age is less than 40 years are 77.3% less likely to develop post-COVID-19 pulmonary complications than those aged greater than 60 years [AOR = 0.23, 95% CI (0.08–0.66)]. There is also a 59.9% reduced odds of developing complications in participants aged from 41–60 years [AOR = 0.401, 95% CI (0.21–0.79)]. Participants whose chest imaging did not show consolidation were 50.3% less likely to develop pulmonary complications after discharge than their counterparts [AOR = 0.497, 95% CI (0.258–0.957) (Table 6).
Table 6
Bivariate and multivariate analysis associated factors of Post-COVID-19 Pulmonary Complications among recovered COVID-19 patients in Eka Kotebe General Hospital; 2022 (n = 405)
Variable | Category | Pulmonary complication | COR (95%CI) | AOR (95%CI) | P value |
Yes | No |
Age in years | 20–40 | 5 | 83 | 0.220 (0.082–0.589) | 0.227 (0.08–0.66) | 0.006 |
| 41–60 | 20 | 148 | 0.49 (0.27–0.91) | 0.401 (0.21–0.79) | 0.008 |
| > 60 | 32 | 117 | 1 | 1 | |
ALC per microliter | < 1000 | 34 | 174 | 1 | | |
| \(\ge\)1000 | 23 | 174 | 0.676 (0.383–1.195) | 0.870 (0.46–1.63) | 0.660 |
Consolidation | Yes | 34 | 125 | 1 | | |
| No | 23 | 223 | 0.379 (0.214–0.672) | 0.497 (0.258–0.957) | 0.036 |
GGO | Yes | 45 | 229 | 1 | | |
| No | 12 | 119 | 0.513 (0.261–1.007) | 0.744 (0.352–1.570) | 0.437 |
Infiltration | Yes | 14 | 55 | 1 | | |
| No | 43 | 293 | 0.577 (0.296–1.125) | 0.582 (0.276–1.230) | 0.156 |
COVID severity | Mild-Moderate | 2 | 48 | 0.056 (0.011–0.275) | 0.310 (0.006–15.340) | 0.556 |
| Severe | 43 | 284 | 0.202 (0.089–0.456) | 0.493 (0.032–7.683) | 0.614 |
| Critical | 12 | 16 | 1 | | |
Admission Place | Ward | 44 | 325 | 0.240 (0.113–0.507) | 0.769(0.151–3.903) | 0.751 |
| ICU/HDU | 13 | 23 | 1 | | |
Maximum Oxygen Support | Room air | 2 | 45 | 0.061 (0.012–0.305) | 1.313 (0.028–61.650) | 0.890 |
| 1–15 litre/min | 44 | 288 | 0.208 (0.090–0.483) | 1.132 (0.086–14.954) | 0.925 |
| NIV/MV | 11 | 15 | 1 | | |
Steroid use | Yes | 56 | 317 | 1 | | |
| No | 1 | 31 | 0.183 (0.024–1.365) | 0.521 (0.030–9.029) | 0.654 |