Course of fatigue among patients previously hospitalised due to COVID-19

Abstract

Introduction. Discrepancies exist regarding the clinical course and prognostic factors for post-COVID fatigue. Therefore, our aim was to assess the timely course of fatigue and its possible predictors in patients previously hospitalised due to SARS-CoV-2 infection. Material and methods.Patients and employees of the University Hospital in Krakow were assessed with the use of a validated neuropsychological questionnaire. Included were participants aged 18 or more, previously hospitalised due to COVID-19, who completed questionnaires only once > 3 months after the onset of infection. Individuals were retrospectively asked about the presence of eight symptoms of chronic fatigue syndrome at four timepoints: before COVID-19, within 0-4 weeks, 4-12 weeks, and > 12 weeks post-infection.Results. We enrolled 204 patients [40.2% women, median age 58 (46-66) years] evaluated after a median of 187 (156-220) days from the first positive nasal swab test for SARS-CoV-2. The most common comorbidities were hypertension (44.61%), obesity (36.27%), smoking (28.43%), and hypercholesterolemia (21.08%); none of the patients required mechanical ventilation during hospitalisation. Before COVID-19, 43.62% of patients reported at least one symptom of chronic fatigue. Within 4, 4-12, and > 12 weeks after COVID-19, the prevalence of chronic fatigue was 76.96%, 75.49%, and 66.17%, respectively (all p < 0.001). The frequency of chronic fatigue symptoms decreased within > 12 weeks following the onset of infection but did not return to baseline values, except for self-reported lymph node enlargement. In a multivariable linear regression model, the number of fatigue symptoms was predicted by female sex [β 0.25 (0.12; 0.39), p < 0.001 and 0.26 (0.13; 0.39), p < 0.001 for weeks 0-12 and > 12, respectively], and age [for < 4 weeks, β -0.12 (-0.28; -0.01), p = 0.029]. Conclusions.Most patients previously hospitalised due to COVID-19 suffer from fatigue > 12 weeks after infection onset. The presence of fatigue is predicted by female sex and -only for the acute phase -age.

Quality of life at work and fatigue after hospitalization due to COVID‐19

“…Our study has significant limitations that were previously addressed, 9 such as retrospective design, small sample size, and reliance on self‐reported outcomes given by patients few months after initial SARS‐CoV‐2 infection, with inability to confirm the validity of responses. Particularly, as fatigue symptoms were assessed by participants themselves and not by medical staff, the results of the current study may have been susceptible to bias.…”

“…The details of methodology of the current survey were presented in our previously published paper 9 . In brief, inclusion criteria for the current study were as follows: ≥18 years of age, >3 months since onset of COVID‐19 confirmed by detection of viral RNA using reverse transcription polymerase chain reaction (RT‐PCR) from a nasopharyngeal swab, ability to write and read, and previous hospitalization during acute phase of SARS‐CoV‐2 infection.…”

“…Furthermore, the survey was conducted in accordance with Declaration of Helsinki. Individuals recruited in the ambulatory for post‐COVID patients at the University Hospital in Krakow signed written informed consent before completing paper version of the NP‐COVID questionnaire 9 . As no written consent was required from patients who completed the online questionnaire, which also remained in accordance with Polish law, only full information on the purpose of the study was provided to these participants 9 …”

SARS-CoV-2 and the nervous system

“…However, there were no sex--related differences in experiencing problems with multitasking, remembering information from the past, determining the current date or field orientation [39]. Similarly, retrospectively assessing post-COVID fatigue in patients requiring prior hospitalisation due to COVID-19, Mazurkiewicz et al found this symptom in the majority of patients, and noted that the presence of fatigue was predicted by female sex [40].…”

Response to the Letter to the Editors on the article reviewing the complex subject of ‘Impact of SARS-CoV-2 on the nervous system’

“…a reduction in cerebrospinal fluid flow (reduced removal of brain metabolites); triggered and sustained neuroinflammation (activation of microglia, autoimmunisation, autoimmune mimicry); and impaired neurotransmission (e.g. GABAergic) [4].…”