Clinical features of post-COVID period. Results of an International Register "Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (ACTIV SARS-CoV-2)" (12-month follow-up)
https://doi.org/10.15829/1560-4071-2023-5270
Abstract
Aim. To investigate on post-COVID period in patients of the Eurasian region.
Material and methods. A total of 9364 consecutively hospitalized patients were included in ACTIV registry. Enrollment of patients began on June 29, 2020, and was completed on March 30, 2021, corresponding to the first and second waves of the pandemic. Demographic, clinical, and laboratory data, computed tomography (CT) results, information about inhospital clinical course and complications of COVID-19 during hospitalization were extracted from electronic health records using a standardized data collection form. The design included follow-up telephone interviews with a standard questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.
Results. According to ACTIV register, 63% of patients after COVID-19 had new adverse symptoms or exacerbations of the existing symptoms lasting for up to 1 year. After hospital discharge, 79,8% of patients sought unscheduled medical attention in the first 3 months, 79,1% at 4-6 months, and 64,8% at 7-12 months. Readmission rate was 11,8% in the first 3 months, 10,9% at 4-6 months, and 10,1% at 7-12 months. The most common reasons for unscheduled treatment in the first 3 months were uncontrolled hypertension, decompensated type 2 diabetes, destabilization of coronary artery disease, gastrointestinal disease, AF episodes, exacerbation of asthma and chronic obstructive pulmonary disease, decompensated heart failure (HF). The 12-month mortality of COVID-19 survivors after the discharge was 3,08%. Multivariate analysis showed that independent risk factors for fatal outcome were age (direct correlation), the levels of hemoglobin (inverse correlation), oxygen saturation (inverse correlation), and aspartate aminotransferase (direct correlation), as well as class III-IV HF, prior stroke, cancer, inhospital acute kidney injury. Based on these identified risk factors, a nomogram was constructed to determine the 3-month mortality risk after discharge.
Conclusion. Analysis of ACTIV register showed that end of the acute phase of COVID-19 does not imply a complete recovery.
About the Authors
G. P. ArutyunovRussian Federation
MD, PhD, professor, corresponding member of the Russian Academy of Sciences, President of the Eurasian Association of Therapists, Head of the Department of Propaedeutics of Internal Diseases (Pediatric School), Pirogov Russian National Research Medical University, Honored Doctor of the Russian Federation
E. I Tarlovskaya
Russian Federation
MD, PhD, Professor, Chairperson of the Eurasian Association of Therapists branch in Nizhny Novgorod, head of the Department of therapy and cardiology, Privolzhsky Research Medical University
A. G. Arutyunov
Russian Federation
MD, PhD, vice-president of the Eurasian Association of Therapists, Professor at National Institute of Health named after S. Avdalbekyan
Yu. N. Belenkov
Russian Federation
Аcademician of RAS, MD, PhD, head of Department of hospital therapy №1 medical faculty Sechenov University
A. O. Konradi
Russian Federation
Сorresponding member of the Russian Academy of Sciences. MD, PhD, Professor, Deputy General Director of scientific work
Yu. M. Lopatin
Russian Federation
MD, PhD, Professor, Head of the Departrment of Cardiology and Functional Diagnostics,
Faculty of Advanced Training for Doctors
A. P. Rebrov
Russian Federation
PhD, MD, Professor at the Department of the Internal Medicine, Saratov State Medical University named after V.I. Razumovsky
S. N. Tereshchenko
Russian Federation
MD, PhD, Professor, head of the Department of myocardial diseases and heart failure
A. I. Chesnikova
Russian Federation
MD, PhD, Professor, Professor in the Department of Internal Medicine No.1
H. G. Hayrapetyan
Armenia
MD, PhD, Professor,
Head of Erebouni Cardiology Center, Head of Cardiology Department at Yerevan State Medical University
A. P. Babin
Moldova, Republic of
MD, PhD, Associate Professor, Head of the Department of Family Medicine
I. G. Bakulin
Russian Federation
MD, PhD, Professor, Dean of the General Medicine Faculty, Head of the department of Propedeutics of Internal Diseases, Gastroenterology and Dietology named after S.M. Ryss, Internal Medicine Adviser to the Ministry of Health (the Northwestern federal district of Russia)
N. V. Bakulina
Russian Federation
MD, PhD, Professor, Head of the department of Internal Diseases, Clinical Pharmacology and Nephrology
L. A. Balykova
Russian Federation
MD, PhD, Professor, Director of the Medicine Institute, corresponding member of the Russian Academy of Sciences
A. S. Blagonravova
Russian Federation
MD, PhD, Associate Professor, Vice rector for research, professor of epidemiology, microbiology and evidence based medicine
M. V. Boldina
Russian Federation
PhD, associate Professor of the Department of therapy and cardiology
M. I. Butomo
Russian Federation
Ultrasound doctor
A. R. Vaisberg
Russian Federation
PhD, Associate Professor, Department of Therapy and Cardiology
A. S. Galyavich
Russian Federation
MD, PhD, Professor, head of the department of Therapy at the Faculty of Advanced Training and Professional Continuing at Kazan State Medical University, Chief Freelance Cardiologist of the Volga Federal District, Academician of the Academy of Sciences of the Republic of Tatarstan
V. V. Gomonova
Russian Federation
Deputy Chief Physician
N. Yu. Grigorieva
Russian Federation
I. V. Gubareva
Russian Federation
MD, PhD, Associated Professor, head of Internal Diseases Department,
I. V. Demko
Russian Federation
MD, PhD, Professor, Head of the Department of Hospital Therapy and Immunology with Postgraduate Education, Head of the Department of Pulmonary Allergology Center,
pulmonologist, allergist-immunologist
A. V. Evzerikhina
Russian Federation
PhD, deputy chief physician
A. V. Zharkov
Russian Federation
PhD, chief physician
A. A. Zateishchikova
Russian Federation
Chief of therapeutical department
U. K. Kamilova
Uzbekistan
MD, PhD, Professor, Deputy Director of Scientific Work
Z. F. Kim
Russian Federation
PhD, Associate Professor, deputy chief physician
T. Yu. Kuznetsova
Russian Federation
MD, PhD, Associated Professor, head of the department of Faculty Therapy, Phthisiology, Infectious Diseases and Epidemiology, deputy director for postgraduate education
A. N. Kulikov
Russian Federation
Cardiologist
N. V. Lareva
Russian Federation
MD, PhD, Professor, head of the department of Therapy at the Faculty of Advanced Training and Professional Continuing Education
E. V. Makarova
Russian Federation
MD, PhD, Associate Professor, Head of the Department of Propaedeutics of internal diseases, Senior Researcher
S. V. Malchikova
Russian Federation
MD, PhD, Associate Professor, ptofessor of the Department of Clinical Therapy
S. V. Nedogoda
Russian Federation
MD, PhD, Professor, vice-rector for clinical work and regional health development, head of the Department of Internal Medicine
M. M. Petrova
Russian Federation
MD, PhD, Professor, head of the Department of Polyclinic Therapy and Family Medicine with a Course of Postgraduate Education
I. G. Pochinka
Russian Federation
MD, PhD, associate professor at the Department of Enocrinology and Internal Medicine, head of the Department of Cardiology № 1
K. V. Protasov
Russian Federation
MD, PhD, Professor, deputy director of research
D. N. Protsenko
Russian Federation
PhD, chief physician of The City Clinical Hospital №40, head of the anesthesiology and resuscitation department of the school of continuing medical education of Pirogov Russian National Research Medical University
D. Yu. Ruzanav
Belarus
PhD, Associate Professor, vice-rector for clinical work, professor at the Department of
Phthisiology and Pulmonology
S. A. Sayganov
Russian Federation
MD, PhD, Professor, rector, head of the Department of Hospital Therapy and Cardiology
A. Sh. Sarybaev
Kyrgyzstan
MD, PhD, Professor, Head of the National Center of Cardiology and Internal Medicine named after prof. M. Mirrakhimov
N. M. Selezneva
Russian Federation
PhD, associate professor at the Department of Hospital Therapy
A. B. Sugraliev
Kazakhstan
PhD, Associate Professor, head of the Department of Internal Diseases with a Course of Propaedeutics
I. V. Fomin
Russian Federation
MD, PhD, Associate Professor, head of the department of hospital therapy
O. V. Khlynova
Russian Federation
MD, PhD, Professor, corresponding member of the Russian Academy of Sciences, Head of the Department of Hospital Therapy
O. Yu. Chizhova
Russian Federation
MD, PhD, professor at the department of Propedeutics of Internal Diseases, Gastroenterology and Dietology named after S.M. Ryss
I. I. Shaposhnik
Russian Federation
MD, PhD, Professor, head of the department of the propaedeutics of internal diseases
D. A. Sh'ukarev
Russian Federation
head of department of infectious deseases
A. K. Abdrakhmanova
Kazakhstan
PhD, head of the Department of Infectious Diseases, chief physician
S. A. Avetisian
Armenia
clinical resident at cardiology department
H. G. Avoyan
Armenia
cardiologist
K. K. Azarian
Armenia
cardiologist
G. T. Aimakhanova
Kazakhstan
PhD, Associate Professor at the Department of Internal Diseases with a course of propaedeutics
D. A. Ayipova
Kyrgyzstan
head of the department of nephrology
A. Ch. Akunov
Kyrgyzstan
PhD, head of the Department of urgent cardiology and reanmation-2
M. K. Alieva
Russian Federation
therapist
A. R. Almukhambedova
Russian Federation
therapist
A. V. Aparkina
Russian Federation
PhD, assistant at the Department of Hospital Therapy, Medical Faculty
O. R. Aruslanova
Russian Federation
PhD, cardiovascular surgeon
E. Yu. Ashina
Russian Federation
assistant at the Department of Propedeutics of Internal Diseases
O. Yu. Badina
Russian Federation
Head of the Infectious Diseases Department
O. Yu. Barysheva
Russian Federation
MD, PhD, associated professor, professor of department of hospital therapy
T. I. Batluk
Russian Federation
PhD, Medical adviser
A. S. Batchayeva
Russian Federation
clinical laboratory diagnostician
R. A. Bashkinov
Russian Federation
Medical adviser, postgraduate student of the department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E. E. Eichwald 2019-2022
A. M. Bitieva
Russian Federation
cardiologist
I. U. Bikhteyev
Russian Federation
student
N. A. Borodulina
Russian Federation
cardiologist
M. V. Bragin
Russian Federation
student
V. A. Brazhnik
Russian Federation
therapist
A. M. Budu
Moldova, Republic of
head at the Department of Therapy
G. A. Bykova
Russian Federation
PhD, associate professor at the Department of Hospital Care, pulmonologist
K. R. Vagapova
Russian Federation
endocrinologist
D. D. Varlamova
Russian Federation
2-year student
N. N. Vezikova
Russian Federation
Professor, MD, PhD, head of department of hospital therapy
E. A. Verbitskaya
Russian Federation
therapist
O. E. Vilkova
Russian Federation
PhD, Senior Lecturer at the Department of Clinical Medicine
E. A. Vinnikova
Russian Federation
attending physician
V. V. Vustina
Russian Federation
PhD, cardiologist
E. A. Gаlova
Russian Federation
PhD, deputy director for science of the University clinic
V. V Genkel
Russian Federation
PhD, associated professor at the Department of Propedeutics of Internal Medicine
D. B. Giller
Russian Federation
Chair of the Department (M.I. Perelman Department of Phthisiopulmonology and Thoracic Surgery)
E. I. Gorshenina
Russian Federation
PhD, associate professor at the Department of Hospital Care
E. V. Grigorieva
Russian Federation
PhD, associate professor at the Department of Hospital Therapy, Medical Faculty
E. U. Gubareva
Russian Federation
PhD, assistant of the Department of Faculty Therapy, physician at Functional Diagnostics Department of Clinic of Samara State Medical University
G. M. Dabylova
Kazakhstan
assistant of the Department of Internal Diseases with the Course of Propaedeutics
A. I. Demchenko
Russian Federation
laboratory assistant at the Department of Faculty Therapy, intern doctor
O. Yu. Dolgikh
Russian Federation
PhD, chief physician
M. Y. Duyshobayev
Kyrgyzstan
physician at the department of urgent cardiology and reanmation-2
D. S. Evdokimov
Russian Federation
postgraduate student at the Department of Faculty Therapy 2020-2023
Place of employment: Senior Laboratory Assistant, Department of Faculty Therapy
K. E. Egorova
Russian Federation
Gastroenterologist of nephrology department
A. E. Zheldybayeva
Kazakhstan
assistant of the Department of Internal Diseases with the course of propaedeutics
N. V. Zarechnova
Russian Federation
deputy chief physician at Clinical Hospital №2 of Privolzhsky District Medical Center Federal Medical and Biological Agency of Russia
Yu. D. Zimina
Russian Federation
therapist
S. U. Ivanova
Russian Federation
deputy chief physician
E. U. Ivanchenko
Russian Federation
PhD, associate professor at the department of therapy and cardiology
M. V. Ilina
Russian Federation
therapist
M. V. Kazakovtseva
Russian Federation
PhD, associate professor of the Department of Clinical Therapy
E. V. Kazymova
Russian Federation
deputy chief physician
Yu. S. Kalinina
Russian Federation
assistant at the Department of Нospital Therapy and Immunology with Postgraduate Education Course
N. A. Kamardina
Russian Federation
cardiologist
A. M. Karachenova
Russian Federation
therapist, pulmonologist
I. A. Karetnikov
Russian Federation
deputy chief phisician
N. A. Karoli
Russian Federation
MD, PhD, professor at the Department of Hospital Therapy, Medical Faculty
M. Kh. Karsiev
Russian Federation
attending physician
D. S. Кaskaeva
Russian Federation
PhD, associate professor of the Department of Outpatient Therapy and Family Medicine with a Course of Postgraduate Education
K. F. Kasymova
Russian Federation
resident of Department of Нospital Therapy and Immunology with Postgraduate Education Course
Zh. B. Kerimbekova
Kyrgyzstan
junior researcher at the department of mountain medicine and pulmonary hypertension
E. S. Kim
Russian Federation
administrator
N. V. Kiseleva
Russian Federation
therapist
D. A. Klimenko
Russian Federation
laboratory assistant at the Department of Faculty Therapy, intern doctor
O. V. Kovalishena
Russian Federation
MD, PhD, head of the Department of Epidemiology, Microbiology and Evidence-Based Medicine, director of the Research Institute of Preventive Medicine of the University Clinic
S. V. Kozlov
Russian Federation
GP
E. V. Kolmakova
Russian Federation
PhD, associate professor at the Department of Internal Diseases, Clinical Pharmacology and Nephrology
T. P. Kolchinskaya
Russian Federation
deputy chief physician on outpatient therapy
M. I. Koliadich
Russian Federation
PhD, associate professor of the Department of Propedeutics of Internal Medicine, deputy chief physician at the Municipal Autonomous Healthcare Institution of the Order of the Red Banner of Labour "City Clinical Hospital №1", Chelyabinsk city
O. V. Kondriakova
Russian Federation
6-year student
M. P. Konoval
Russian Federation
therapist
D. U. Konstantinov
Russian Federation
MD, PhD, associate professor, head of the Department of Infectious Diseases
E. A. Konstantinova
Russian Federation
PhD, associate professor at the Department of Infectious Diseases
V. A. Kordukova
Russian Federation
resident in pulmonology
E. V. Koroleva
Russian Federation
physician of the department of cardiology №2 , assistant at the Department of of clinical medicine of National Research Lobachevsky State University of Nizhni Novgorod
A. U. Kraposhina
Russian Federation
PhD, Associate Professor at the Department of Hospital Therapy and Immunology with Postgraduate Education, pulmonologist in Regional state budgetary healthcare institution "Regional Clinical Hospital"
T. V. Kryukova
Russian Federation
project manager
A. S. Kuznetsova
Russian Federation
PhD, associate professor of the Department of Clinical TherapyPhD
T. U. Kuzmina
Russian Federation
PhD, associate professor at the Depatment of Infecction Diseases and Epidemiology
K. V. Kuzmichev
Russian Federation
resident
Ch. K. Kulchoroeva
Kyrgyzstan
junior researcher
T. V. Kuprina
Russian Federation
postgraduated student
I. M. Kuranova
Russian Federation
deputy chief phhysician
L. V. Kurenkova
Russian Federation
attending physician
N. U. Kurchugina
Russian Federation
4-year student
N. A. Kushubakova
Kyrgyzstan
junior researcher
V. I. Levankova
Russian Federation
deputy chief physician for therapy
A. A. Ledyaeva
Russian Federation
associate professor of the department
T. V. Lisun
Russian Federation
doctor-metodist
V. E. Lisyanskaya
Russian Federation
Fifth year student
N. A. Lyubavina
Russian Federation
PhD, associated professor
N. A. Magdeyeva
Russian Federation
PhD, associate professor at the Department of Hospital Therapy, Medical Faculty
K. V. Mazalov
Russian Federation
head of the Department of Cardiology
V. I. Maiseenko
Belarus
assistant lecturer at the Department of Phthisiopulmonology with the course of the Faculty of Professional Development and Retraining
A. S. Makarova
Russian Federation
postgraduate student of the department of cardiology and functional diagnostics
A. M. Maripov
Kyrgyzstan
head of Department of Pulmonary Hypertension and High altitude medicine of NCCIM, leading researcher
N. V. Markov
Russian Federation
Pulmonologist
A. A. Marusina
Russian Federation
therapist
E. S. Melnikov
Russian Federation
medical advisor, postgraduate student of the department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E. E. Eichwald 2020-2023
A. I. Metlinskaya
Russian Federation
Cardiologist
N. B. Moiseenko
Russian Federation
student
F. N. Muradova
Russian Federation
postgraduate student of the Department of Therapy and Cardiology
R. G. Muradyan
Russian Federation
general practitioner
Sh. N. Musaelian
Armenia
clinical resident at cardiology department
E. S. Nekaeva
Russian Federation
Head of the Department of the Reception and Consultation, therapist at the Privolzhsky Research Medical University
N. M. Nikitina
Russian Federation
MD, PhD, professor at the Department of Hospital Therapy, Medical Faculty
S. E. Nifontov
Russian Federation
Ultrasound doctor
E. U. Obolentseva
Russian Federation
Functional diagnostics doctor
A. A. Obukhova
Russian Federation
Graduate student, Department of Functional Diagnostics
B. B. Ogurlieva
Russian Federation
postgraduate student, сardiologist
A. A. Odegova
Russian Federation
PhD, asistant of the Department of Clinical Therapy
Yu. V. Omarova
Russian Federation
Postgraduate student of the Department of Therapy and Cardiology
N. A. Omurzakova
Kyrgyzstan
MD, PhD, deputy director
Sh. O. Ospanova
Kazakhstan
assistant at the Department of Internal Diseases with the Course of Propaedeutics
V. A. Pavlova
Russian Federation
Resident, Department of Faculty Therapy
E. V. Pahomova
Russian Federation
phthisiatrician of the Department of Pulmonary Tuberculosis for Adults
L. D. Petrov
Moldova, Republic of
Director
S. S. Plastinina
Russian Federation
PhD, assistant professor at the Internal Medicine Department
D. A. Platonov
Russian Federation
GP
V. A. Pogrebetskaya
Russian Federation
deputy chief physician
D. V. Polyakov
Russian Federation
PhD, associate professor of the department of internal medicine
D. S. Polyakov
Russian Federation
PhD, assistant professor at the Department of Therapy and Cardiology
E. V. Ponomarenko
Russian Federation
cardiologist
L. L. Popova
Russian Federation
MD, PhD, professor at the Department of Infectious Diseases
A. A. Potanin
Russian Federation
Fifth year student
N. A. Prokofeva
Russian Federation
PhD, head of the department of therapy №2
J. D. Rabik
Russian Federation
Ultrasound doctor
N. A. Rakov
Russian Federation
attending physician
A. N. Rakhimov
Uzbekistan
junior researcher
N. A. Rozanova
Russian Federation
nurse
I. V. Samus
Russian Federation
PhD, head of the department of organizational and methodological department
S. Serikbolkyzy
Kazakhstan
assistant of the Department of Internal Diseases with the Course of Propaedeutics
Ya. A. Sidorkina
Russian Federation
GP
A. A. Simonov
Russian Federation
therapist
V. V. Skachkova
Russian Federation
attending physician
R. D. Skvortcova
Russian Federation
Ultrasound doctor
D. S. Skuridin
Russian Federation
Cardiologist
D. V. Solovieva
Russian Federation
assistant at the Department of of clinical medicine of National Research Lobachevsky State University of Nizhni Novgorod
I. A. Solovieva
Russian Federation
MD, PhD, Associate Professor, pulmonologist, allergologist-immunologist
I. M. Sukhomlinova
Russian Federation
therapist
A. G. Sushilova
Russian Federation
resident
D. R. Tagayeva
Uzbekistan
junior researcher
E. P. Tikhonova
Russian Federation
MD, PhD, Professor, head of the Department of Infectious Diseases and Epidemiology with a Course of Postgraduate Education
D. S. Tokmin
Russian Federation
head of analytics
A. A. Tolmacheva
Russian Federation
PhD, assistant of the department of Faculty Therapy n.a. Zalesskiy G.D.;
cardiologist, Head of the Department of Medical Rehabilitation
M. S. Torgunakova
Russian Federation
resident of Department of Нospital Therapy and Immunology with Postgraduate Education Course
K. V. Trenogina
Russian Federation
PhD, cardiologist
N. A. Trostianetckaia
Russian Federation
PhD, cardiologist
D. A. Trofimov
Russian Federation
student, nurse (Department of Cardiology №4)
M. A. Trubnikova
Russian Federation
medical advisor, nephrologist
A. A. Tulichev
Russian Federation
PhD, assistant of Department of Internal Medicine Propedeutics, head of the Emergency Room
A. T. Tursunova
Kazakhstan
assistant of the Department of Internal Diseases with the Course of Propaedeutics
N. D. Ulanova
Russian Federation
resident
O. V. Fatenkov
Russian Federation
MD, PhD, Assistant Professor, director of Clinic of Samara State Medical University, head of the Department of Faculty Therapy, cheef freelance therapist of the Ministry of Healthcare of Samara Region
O. V. Fedorishina
Russian Federation
PhD, associate professor at the department of cardiology and functional diagnostics
T. S. Fil
Russian Federation
PhD, head of the department of gastroenterology, therapist
I. U. Fomina
Russian Federation
PhD, associate professor at the Department of Faculty and Outpatient Therapy, chief physician
I. S. Fominova
Russian Federation
neurologist
I. A. Frolova
Russian Federation
cardiologist
S. M. Tsvinger
Russian Federation
PhD, rheumatologist, associate professor at the department of ambulatory care with courses of medical rehabilitation
V. V. Tsoma
Russian Federation
PhD, associate professor, Department of Internal Medicine, Institute of Continuing Medical Education, head of Additional Professional Education Department, chief freelance pulmonologist of the Health Committee of the Volgograd Region
M. B. Cholponbaeva
Kyrgyzstan
junior researcher
T. I. Chudinovskikh
Russian Federation
PhD, assistant of the Department of Hospital Therapy
I. V. Shavrin
Russian Federation
therapist
O. A. Shevchenko
Russian Federation
general practitioner
D. R. Shikhaliev
Russian Federation
Ultrasound doctor
E. A. Shishkina
Russian Federation
MD, PhD, Associate Professor at the Hopspital Therapy and Cardiology Department
K. U. Shishkov
Russian Federation
6-year student
S. U. Sherbakov
Russian Federation
resident in anaesthesiology and resuscitation
G. V. Shcherbakova
Russian Federation
Assosiate Professor (M.I. Perelman Department of Phthisiopulmonology and Thoracic Surgery)
E. A. Yausheva
Russian Federation
endocrinologist
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Supplementary files
- According to the AKTIV registry, about 80% of COVID-19 survivors seek unscheduled medical attention during the year, while about 10% are rehospitalized.
- The most common reasons for seeking unscheduled care are uncontrolled hypertension, decompensated diabetes, destabilization of coronary artery disease.
- The mortality rate of patients after hospital discharge for the year was 3,08%. There were following risk factors for death: age (direct correlation), the levels of hemoglobin (inverse correlation), oxygen saturation (inverse correlation), and aspartate aminotransferase (direct correlation), as well as severe heart failure, prior stroke, cancer, inhospital acute kidney injury.
Review
For citations:
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