{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:17:10Z","timestamp":1783073830092,"version":"3.54.6"},"reference-count":49,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The acute complications of COVID-19 have been well characterized and are frequently associated with increased mortality. Although substantial knowledge regarding long COVID has accumulated since the beginning of the pandemic, important uncertainties remain regarding the long-term clinical, functional, radiological, and metabolic consequences of SARS-CoV-2 infection. Identification of post-COVID-19 complications is therefore essential for appropriate recognition and management. This study aimed to evaluate the long-term complications of COVID-19 at 3 and 9 months after infection. Methods: This prospective study was conducted at Inonu University Turgut Ozal Medical Center. Patients who presented with active post-COVID-19 complaints or for routine follow-up were enrolled. Participants were evaluated at the pulmonology outpatient clinic at 3 and 9 months. At each visit, persistent or new-onset symptoms were assessed, and pulmonary function tests (PFT), the six-minute walk test (6MWT), echocardiography (ECHO), and thoracic computed tomography (CT) were performed as clinically indicated. Patients were stratified into three groups according to the severity of acute illness: outpatient, ward-hospitalized, and ICU-hospitalized. Results: A total of 205 patients (120 male, 85 female) were included. Male patients had significantly higher rates of ward and ICU hospitalization than female patients (p = 0.006). At 9 months, 85.3% of patients had at least one persistent symptom; dyspnea (69.6%), cough (35.6%), and chest pain (32.5%) were the most common. FVC showed a statistically significant increase between months 3 and 9 (p = 0.014), and the 6MWT distance improved significantly (423.56 m vs. 464.10 m; p = 0.008). Ground-glass opacity, present in 90.2% of patients at admission, persisted in 44.3% at 9 months (p &lt; 0.001). Reticular opacities, pleuroparenchymal bands, and mosaic perfusion patterns increased over time. ICU patients had significantly lower ejection fraction values compared with ward and outpatient groups at 9 months (p = 0.046). During follow-up, 13 patients developed pulmonary embolism and 7 developed new-onset diabetes mellitus. Conclusions: Despite the well-characterized acute phase, the long-term sequelae of COVID-19 remain a significant clinical challenge. Identification of late complications is critical for reducing morbidity and understanding the long-term societal and healthcare burden of the pandemic. Multidisciplinary long-term follow-up is warranted, particularly for patients who experienced severe acute illness.<\/jats:p>","DOI":"10.3390\/jcm15135202","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T07:59:47Z","timestamp":1783065587000},"page":"5202","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Three- and Nine-Month Follow-Up of Patients with COVID-19: Clinical, Functional, and Radiological Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0312-9167","authenticated-orcid":false,"given":"Muhammed","family":"De\u011fer","sequence":"first","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Inonu University Turgut Ozal Medical Center, 44280 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8125-9062","authenticated-orcid":false,"given":"Talat","family":"K\u0131l\u0131\u00e7","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Inonu University Turgut Ozal Medical Center, 44280 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6078-7480","authenticated-orcid":false,"given":"Zeynep","family":"Uluta\u015f","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Inonu University Turgut Ozal Medical Center, 44280 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed Said","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Inonu University Turgut Ozal Medical Center, 44280 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatice","family":"\u00d6d\u00fcml\u00fc","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Inonu University Turgut Ozal Medical Center, 44280 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ay\u015fenur","family":"Atila","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Inonu University Turgut Ozal Medical Center, 44280 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilal B\u00fc\u015fra","family":"Demir","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Inonu University Turgut Ozal Medical Center, 44280 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00fc\u015fra","family":"Soysald\u0131","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Inonu University Turgut Ozal Medical Center, 44280 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira\u00e7","family":"Karaa\u011fa\u00e7","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Inonu University Turgut Ozal Medical Center, 44280 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunus Emre","family":"Er","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Inonu University Turgut Ozal Medical Center, 44280 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozan","family":"Akda\u011f","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Inonu University Turgut Ozal Medical Center, 44280 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2023, January 25). COVID-19 Dashboard. Available online: https:\/\/covid19.who.int."},{"key":"ref_2","unstructured":"World Health Organization (2025, May 19). COVID-19 Vaccine Data. Available online: https:\/\/data.who.int\/dashboards\/covid19\/vaccines."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/S1473-3099(22)00801-5","article-title":"Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the Omicron variant and severe disease: A systematic review and meta-regression","volume":"23","author":"Bobrovitz","year":"2023","journal-title":"Lancet Infect. Dis."},{"key":"ref_4","unstructured":"World Health Organization (2022). Severity of Disease Associated with Omicron Variant as Compared with Delta Variant, WHO."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.1056\/NEJMsb2408466","article-title":"Long COVID Defined","volume":"391","author":"Ely","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Nurchis, M.C., Pascucci, D., Sapienza, M., Villani, L., D\u2019Ambrosio, F., Castrini, F., Specchia, M.L., Laurenti, P., and Damiani, G. (2020). Impact of the burden of COVID-19 in Italy: Results of disability-adjusted life years (DALYs) and productivity loss. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17124233"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"n913","DOI":"10.1136\/bmj.n913","article-title":"COVID-19 has redefined airborne transmission","volume":"373","author":"Tang","year":"2021","journal-title":"BMJ"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1093\/gerona\/glaa320","article-title":"Age, Multiple Chronic Conditions, and COVID-19: A Literature Review","volume":"77","author":"Tisminetzky","year":"2022","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0140-6736(20)30211-7","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study","volume":"395","author":"Chen","year":"2020","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"342","DOI":"10.4103\/ijri.IJRI_469_16","article-title":"Follow-up chest radiographic findings in patients with MERS-CoV after recovery","volume":"27","author":"Das","year":"2017","journal-title":"Indian J. Radiol. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.1164\/rccm.201908-1590ST","article-title":"Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement","volume":"200","author":"Graham","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2018.06.004","article-title":"Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography","volume":"32","author":"Mitchell","year":"2019","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Strumiliene, E., Urbonien\u0117, J., Jurgauskiene, L., Zeleckiene, I., Bliudzius, R., Malinauskiene, L., Zablockiene, B., Samuilis, A., and Jancoriene, L. (2024). Long-Term Pulmonary Sequelae and Immunological Markers in Patients Recovering from Severe and Critical COVID-19 Pneumonia: A Comprehensive Follow-Up Study. Medicina, 60.","DOI":"10.3390\/medicina60121954"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e695","DOI":"10.1093\/cid\/ciaa1419","article-title":"Risk factors for COVID-19\u2013associated hospitalization","volume":"72","author":"Ko","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Raimondi, F., Novelli, L., Ghirardi, A., Russo, F.M., Pellegrini, D., Biza, R., Trapasso, R., Giuliani, L., Anelli, M., and Amoroso, M. (2021). COVID-19 and gender: Lower rate but same mortality of severe disease in women. BMC Pulm. Med., 21.","DOI":"10.1186\/s12890-021-01455-0"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Nguyen, N.T., Chinn, J., De Ferrante, M., Kirby, K.A., Hohmann, S.F., and Amin, A. (2021). Male gender is a predictor of higher mortality in hospitalized adults with COVID-19. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0254066"},{"key":"ref_17","unstructured":"Stein, D.F., Manson, J.J., Kerr, S., Arnold, D.T., Woolston, A., Jackson, C., Dunning, J., Openshaw, P.J.M., Semple, M.G., and Ho, A. (2023). Biological sex is associated with heterogeneous responses to SARS-CoV-2 infection. Front. Immunol., 14."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"00542-2020","DOI":"10.1183\/23120541.00542-2020","article-title":"Persistent symptoms 3 months after a SARS-CoV-2 infection: The post-COVID-19 syndrome?","volume":"6","author":"Delbressine","year":"2020","journal-title":"ERJ Open Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.1016\/j.jinf.2020.08.029","article-title":"Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19","volume":"81","author":"Garrigues","year":"2020","journal-title":"J. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.3390\/microorganisms9081719","article-title":"Post-COVID-19 syndrome: Nine months after SARS-CoV-2 infection in a cohort of 354 patients","volume":"9","author":"Zayet","year":"2021","journal-title":"Microorganisms"},{"key":"ref_21","first-page":"336","article-title":"Long COVID and the cardiovascular system","volume":"119","author":"Alcaide","year":"2023","journal-title":"Cardiovasc. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"621","DOI":"10.5152\/dir.2020.20212","article-title":"Chest CT findings in patients with COVID-19: A comprehensive review","volume":"27","author":"Li","year":"2020","journal-title":"Diagn. Interv. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1097\/RLI.0000000000000670","article-title":"Chest CT findings in patients with COVID-19 and its relationship with clinical features","volume":"55","author":"Wu","year":"2020","journal-title":"Investig. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1148\/radiol.2021211746","article-title":"CT lung abnormalities after COVID-19 at 3 months and 1 year after hospital discharge","volume":"303","author":"Vijayakumar","year":"2022","journal-title":"Radiology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1001\/jama.2021.3331","article-title":"Four-month clinical status of a cohort of patients after hospitalization for COVID-19","volume":"325","author":"Morin","year":"2021","journal-title":"JAMA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1111\/resp.14311","article-title":"One-year follow-up CT findings in COVID-19 patients: A systematic review and meta-analysis","volume":"27","author":"Watanabe","year":"2022","journal-title":"Respirology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1136\/thoraxjnl-2021-218275","article-title":"Parenchymal lung abnormalities following hospitalisation for COVID-19 and viral pneumonitis: A systematic review and meta-analysis","volume":"78","author":"Fabbri","year":"2023","journal-title":"Thorax"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e230535","DOI":"10.1148\/radiol.230535","article-title":"Chest CT Lung Abnormalities 1 Year after COVID-19: A Systematic Review and Meta-analysis","volume":"308","author":"Bocchino","year":"2023","journal-title":"Radiology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e243374","DOI":"10.1148\/radiol.243374","article-title":"Best Practice: International Multisociety Consensus Statement for Post\u2013COVID-19 Residual Abnormalities on Chest CT Scans","volume":"316","author":"Yoon","year":"2025","journal-title":"Radiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/S2213-2600(21)00174-0","article-title":"3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: A prospective study","volume":"9","author":"Wu","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1186\/s12931-022-02166-8","article-title":"Lung function and radiological findings 1 year after COVID-19: A prospective follow-up","volume":"23","author":"Tarraso","year":"2022","journal-title":"Respir. Res."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Tache-Codreanu, D.L., Bobocea, L., David, I., Burcea, C.C., and Sporea, C. (2024). The Role of the Six-Minute Walk Test in the Functional Evaluation of the Efficacy of Rehabilitation Programs After COVID-19. Life, 14.","DOI":"10.3390\/life14111514"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e244386","DOI":"10.1001\/jamanetworkopen.2024.4386","article-title":"Functional Limitations and Exercise Intolerance in Patients With Post-COVID Condition: A Randomized Crossover Clinical Trial","volume":"7","author":"Tryfonos","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/S0140-6736(21)01755-4","article-title":"1-year outcomes in hospital survivors with COVID-19: A longitudinal cohort study","volume":"398","author":"Huang","year":"2021","journal-title":"Lancet"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Sanhueza, S., Vidal, M.A., Hernandez, M.A., Henriquez-Beltran, M.E., Cabrera, C., Quiroga, R., Antilef, B.E., Aguilar, K.P., Castillo, D.A., and Llerena, F.J. (2023). Clinical and pulmonary function analysis in long-COVID revealed that long-term pulmonary dysfunction is associated with vascular inflammation pathways and metabolic syndrome. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1271863"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1038\/s41591-022-01689-3","article-title":"Long-term cardiovascular outcomes of COVID-19","volume":"28","author":"Xie","year":"2022","journal-title":"Nat. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1136\/heartjnl-2020-317355","article-title":"Pulmonary hypertension and right ventricular involvement in hospitalised patients with COVID-19","volume":"106","author":"Pagnesi","year":"2020","journal-title":"Heart"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Tudoran, C., Tudoran, M., Lazureanu, V.E., Marinescu, A.R., Pop, G.N., Pescariu, A.S., Enache, A., and Cut, T.G. (2021). Evidence of pulmonary hypertension after SARS-CoV-2 infection in subjects without previous significant cardiovascular pathology. J. Clin. Med., 10.","DOI":"10.3390\/jcm10020199"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Zhao, X., Jiang, L., Sun, W., Tang, S., Kang, X., Gao, Q., Li, Z., An, X., and Lian, F. (2025). Understanding the interplay between COVID-19 and diabetes: Insights for the post-pandemic era. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1599969"},{"key":"ref_40","first-page":"e196","article-title":"New-Onset Diabetes After COVID-19","volume":"46","author":"Kim","year":"2023","journal-title":"Diabetes Care"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"110898","DOI":"10.1016\/j.diabres.2023.110898","article-title":"Prevalence and risk of new-onset diabetes mellitus after COVID-19: A systematic review and meta-analysis","volume":"205","author":"Zilbermint","year":"2023","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1111\/dom.14099","article-title":"Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID-19","volume":"22","author":"Li","year":"2020","journal-title":"Diabetes Obes. Metab."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"108374","DOI":"10.1016\/j.diabres.2020.108374","article-title":"Newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration","volume":"168","author":"Fadini","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3127","DOI":"10.1093\/eurheartj\/ehab314","article-title":"Pulmonary embolism in patients with COVID-19: Incidence, risk factors, clinical characteristics, and outcome","volume":"42","author":"Mebazaa","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1186\/s13054-020-03175-z","article-title":"Incidence and mortality of pulmonary embolism in COVID-19: A systematic review and meta-analysis","volume":"24","author":"Liao","year":"2020","journal-title":"Crit. Care"},{"key":"ref_46","first-page":"20499361241242963","article-title":"Fungal infections in patients after recovering from COVID-19: A systematic review","volume":"11","year":"2024","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2000331","DOI":"10.1002\/bies.202000331","article-title":"Cancer as a prospective sequela of long COVID-19","volume":"43","author":"Saini","year":"2021","journal-title":"Bioessays"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2680","DOI":"10.1080\/22221751.2022.2133639","article-title":"Healthy outcomes of patients with COVID-19 two years after the infection: A prospective cohort study","volume":"11","author":"Li","year":"2022","journal-title":"Emerg. Microbes Infect."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"108891","DOI":"10.1016\/j.pharmthera.2025.108891","article-title":"Post-COVID pulmonary sequelae: Mechanisms and potential targets to reduce persistent fibrosis","volume":"272","author":"Vreeman","year":"2025","journal-title":"Pharmacol. Ther."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5202\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T09:33:13Z","timestamp":1783071193000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":49,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15135202"],"URL":"https:\/\/doi.org\/10.3390\/jcm15135202","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]}}}