Cardiopulmonary, Functional, Cognitive and Mental Health Outcomes Post-COVID-19, Across the Range of Severity of Acute Illness, in a Physically Active, Working-Age Population

O’Sullivan, Oliver; Holdsworth, David; Ladlow, Peter; Barker-Davies, Robert M; Chamley, Rebecca; Houston, Andrew; May, Samantha; Dewson, Dominic; Mills, Daniel S.; Pierce, Kayleigh; Mitchell, James; Xie, Cheng; Sellon, Edward; Naylor, Jon; Mulae, Joseph; Cranley, Mark; Talbot, Nick P.; Rider, Oliver J; Nicol, Edward; Bennett, Alexander N.

doi:10.1186/s40798-023-00552-0

Cited by 14 publications

(10 citation statements)

References 75 publications

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“…Another study encompassing 547 patients evaluated through an online questionnaire nearly 300 days after the SARS-CoV-2 infection showed that >80% of people still reported lower quality of life, that was associated with pain, discomfort, or impairment of usual activities, and that was significantly more prevalent than in normative population [32]. Decreased quality of life compared to general population was also revealed among UK patients after 5 months since initial hospitalization due to COVID-19 and, interestingly, these individuals expressed higher fatigue rates with no significant accompanying differences during cognitive testing [33]. Finally, in authors' previous study related to non-hospitalized patients with COVID-19, some specific symptoms of brain fog were found to be associated with QoL-W impairment after 3 months since the onset of the SARS-CoV-2 infection [15].…”

Section: Discussionmentioning

confidence: 90%

Association between brain fog, cardiac injury, and quality of life at work after hospitalization due to COVID-19

Chatys-Bogacka,

Mazurkiewicz,

Słowik

et al. 2024

Med Pr Work Health Saf.

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Background: To evaluate incidence and search for possible predictors of brain fog and quality of life at work (QoL-W) among low-to-moderate risk subjects previously hospitalized due to COVID-19. Material and Methods: Participants aged ≥18 retrospectively reported 8 brain fog symptoms pre-COVID-19, at 0-4, 4-12 and >12 weeks post-infection via validated clinical questionnaire. The QoL-W was assessed with a 4-point Likert scale where 0, 1, 2, and 3 meant no, mild, moderate, and severe impairment in performing activities at work, respectively. Data on age, sex, comorbidities, and laboratory results (including first in-hospital high-sensitivity cardiac troponin I [hs-cTnI] measurement) were gathered. Results: The study included 181 hospitalized subjects (age Me = 57 years), 37.02% women. Most had low disease severity (Modified Early Warning Score = 1, 77.90%) and low comorbidity (Charlson Comorbidity Index 0: 28.72%, 1-2: 34.09%), with no intensive care unit treatment needed. COVID-19 led to almost 3-fold increased brain fog symptoms, with incidence of 58.56%, 53.59%, and 49.17% within 4, 4-12, and >12 weeks, respectively (p < 0.001). First in-hospital hs-cTnI levels were 47.3% higher in participants who later presented with brain fog at median follow-up of 26.7 weeks since the diagnosis of the SARS-CoV-2 infection. Individuals who experienced at least one brain fog symptom at follow-up, had elevated hs-cTnI, less often presented with atrial fibrillation, and used anticoagulants during initial hospitalization due to COVID-19. The hs-cTnI >11.90 ng/l predicted brain fog symptoms in multivariable model. COVID-19 was associated with 3.6-fold, 3.0-fold, and 2.4-fold QoL-W deterioration within 4, 4-12, and >12 weeks post-infection (p < 0.05). Subjects with QoL-W decline >12 weeks were younger, mostly women, had more brain fog symptoms, and higher platelet counts. Multivariable models with self-reported brain fog symptoms (responding coherently and recalling recent information), age, and sex exhibited good discriminatory power for QoL-W impairment (area under the receiver operating characteristic curve 0.846, 95% CI: 0.780-0.912). Conclusions: This study highlighted that in non-high-risk subjects hospitalized during the first 2 pandemic's waves: 1) brain fog was common, affecting nearly half of individuals, and impacting QoL-W >12 weeks after initial infection, 2) after 3 months of COVID-19 onset, the decline in QoL-W was primarily attributed to brain fog symptoms rather than demographic factors, health conditions, admission status, and laboratory findings, 3) components of brain fog, such as answering in an understandable way or recalling new information increased the likelihood of significantly lower QoL-W up to tenfold, 4) biochemical indicators, such as the first hs-cTnI level, might predict the risk of experiencing brain fog symptoms and indirectly decreased QoL-W >12 weeks after COVID-19 onset. Occupational medicine practitioners should pay particular attention to younger and female subjects after COVID-19 complainin...

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Section: Discussionmentioning

confidence: 90%

Association between brain fog, cardiac injury, and quality of life at work after hospitalization due to COVID-19

Chatys-Bogacka,

Mazurkiewicz,

Słowik

et al. 2024

Med Pr Work Health Saf.

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“… Quality of life in covid-19 cases versus controls of studies reporting EQ-5D. 32–36 Symptomatic and asymptomatic groups of Pell and colleagues 36 were merged for the analysis. A negative mean difference value indicates lower quality of life in the covid-19 group.…”

Section: Resultsmentioning

confidence: 99%

Post-covid-19 conditions in adults: systematic review and meta-analysis of health outcomes in controlled studies

Franco,

Garegnani,

Metzendorf

et al. 2024

bmjmed

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ObjectiveTo assess the impact of post-covid-19 conditions among adults.DesignSystematic review and meta-analysis of health outcomes in controlled studies.Data sourcesTwo sources were searched from database inception to 20 October 2022: Cochrane covid‐19 study register (comprising Cochrane Central Register of Controlled Trials, Medline, Embase, clinicalTrials.gov, World Health Organization's International Clinical Trials Registry Platform, medRxiv) and WHO's covid-19 research database.Eligibility criteriaCohort studies recruiting more than 100 participants with a control group and a follow-up of at least 12 weeks were included. Adults who were documented to have SARS-CoV-2 infection based on clinical, imaging, or laboratory criteria were included.Data extraction and synthesisTwo independent reviewers extracted data. The main outcomes included quality of life, functionality in daily activities, use of resources, recovery rates (cluster of symptoms), and the incidence of new medical diagnoses. Data were pooled using a random effects model. The risk of bias was assessed with the Joanna Briggs Institute critical appraisal tool for cohort studies.ResultsWe included 63 controlled cohort studies, encompassing more than 96 million participants. Based on five studies, we found a reduction in overall quality of life between individuals with confirmed SARS-CoV-2 infection versus controls at six to 24 months follow-up, although heterogeneity was very high (mean difference in EQ-5D scale −5.28 (95% confidence interval −7.88 to 2.68; I2=93.81%). Evidence from ten studies, which could not be pooled in a meta-analysis, indicated that an increased rate of functional impairment associated with SARS-CoV-2 infection. Use of care increased compared with controls at six to 24 months follow-up at intensive care units (risk ratio 2.00 (95% confidence interval 0.69 to 5.80), five studies, I2=91.96%) and in outpatient care (1.12 (1.01 to 1.24), seven studies, I2=99.51%). Regarding persistent symptoms, individuals with documented SARS-CoV-2 infection had an increased risk of having two or more persistent symptoms at follow-up, especially those related to neurological clusters (ie, risk ratio 1.51 (95% confidence interval 1.17 to 1.93), I2=98.91%). Evidence also showed an increased incidence of a wide variety of metabolic, cardiovascular, neurological, respiratory, haematological and other incident diagnoses.ConclusionEvidence suggests functional impairment after SARS-CoV-2 infection, in addition to a higher use of resources and a higher incidence of widely varying medical diagnoses. These results should be interpreted with caution, considering the high heterogeneity across studies and study limitations related to outcome measurement and attrition of participants.Systematic review registrationOpen Science Framework,osf.io/drm39

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“…For the first time in this population, this study has been able to offer some limited predictive value in the development of post-COVID-19 symptomology. The value of these predictions will be explored further during the longitudinal M-COVID cohort study (1061/MODREC/20) 30…”

Section: Discussionmentioning

confidence: 99%

Changing characteristics of post-COVID-19 syndrome: Cross-sectional findings from 458 consultations using the Stanford Hall remote rehabilitation assessment tool

Houston¹,

Tovey²,

Rogers-Smith³

et al. 2023

BMJ Mil Health

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BackgroundIn the UK, there have been multiple waves of COVID-19, with a five-tier alert system created to describe the transmission rate and appropriate restrictions. While acute mortality decreased, there continued to be a significant morbidity, with individuals suffering from persistent, life-restricting symptoms for months to years afterwards. A remote rehabilitation tool was created at the Defence Medical Rehabilitation Centre (DMRC) Stanford Hall to assess post-COVID-19 symptoms and their impact on the UK military.This study aims to understand changes in post-COVID-19 syndrome between wave 1 and wave 2, identify interactions between alert level and symptoms and investigate any predictive nature of acute symptoms for postacute symptomology in a young, physically active population.MethodsCross-sectional study of 458 consecutive remote rehabilitation assessments performed at DMRC Stanford Hall between 2 April 2020 and 29 July 2021. Consultations were coded, anonymised, and statistical analysis was performed to determine associations between acute and postacute symptoms, and between symptoms, alert levels and waves.Results435 assessments were eligible; 174 in wave 1 and 261 in wave 2. Post-COVID-19 syndrome prevalence reduced from 43% to 2% between the waves. Acutely, widespread pain was more prevalent in wave 2 (p<0.001). Postacutely, there was increased anxiety (p=0.10) in wave 1 and increased sleep disturbance (p<0.001), memory/concentration issues (p<0.001) and shortness of breath/cough (p=0.017) in wave 2. Increasing alert level was associated with increased postacute symptom prevalence (p=0.046), with sleep disturbance increasing at higher alert level (p=0.016). Acute symptoms, including fatigue, sleep disturbance and myalgia, were associated with multiple postacute symptoms.ConclusionsThis study reports the overall prevalence and symptom burden in the UK military in the first two waves of COVID-19. By reporting differences in COVID-19 in different waves and alert level, this study highlights the importance of careful assessment and contextual understanding of acute and postacute illnesses for individual management plans.

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Cardiopulmonary, Functional, Cognitive and Mental Health Outcomes Post-COVID-19, Across the Range of Severity of Acute Illness, in a Physically Active, Working-Age Population

Cited by 14 publications

References 75 publications

Association between brain fog, cardiac injury, and quality of life at work after hospitalization due to COVID-19

Association between brain fog, cardiac injury, and quality of life at work after hospitalization due to COVID-19

Post-covid-19 conditions in adults: systematic review and meta-analysis of health outcomes in controlled studies

Changing characteristics of post-COVID-19 syndrome: Cross-sectional findings from 458 consultations using the Stanford Hall remote rehabilitation assessment tool

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