Long-term post-COVID symptoms and associated risk factors in previously hospitalized patients: A multicenter study

Fernández‐de‐las‐Peñas, César; Palacios‐Ceña, Domingo; Gómez‐Mayordomo, Víctor; Rodríuez-Jiménez, Jorge; Palacios‐Ceña, María; Arribas, María Velasco; Guijarro, Carlos; de-la-Llave-Rincón, Ana I; Fuensalida‐Novo, Stella; Elvira-Martínez, Carlos M; Cuadrado, M.L.; Navalón, José Antonio Arias; Florêncio, Lidiane Lima; Ortega‐Santiago, Ricardo; Molina-Trigueros, Luis J; Viana, Tomás Sebastián; Torres‐Macho, Juan; Canto-Diez, Gabriela; Plaza-Canteli, Susana; Cigarán‐Méndez, Margarita; Ambite-Quesada, Silvia; Hernández‐Barrera, Valentín; Arias-Buría, José Luis; Arendt-Nielsen, Lars

doi:10.1016/j.jinf.2021.04.036

Cited by 51 publications

(63 citation statements)

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“…We asked about presence of symptoms rather than Long COVID to reduce potential reporting bias. However, it is clear that a wide spectrum of symptoms and clinical presentations post-COVID-19 may be involved; for example, our open free-text question identified a number of symptoms not included in our questionnaire including “brain fog”, “palpitations” and “hair loss”, which were subsequently included in round 6 33 . As the study was based on self-reported data and many of the symptoms are common and not specific to COVID-19, we compared our estimates with those obtained in the general population from people testing negative in the REACT-1 study.…”

Section: Discussionmentioning

confidence: 99%

Persistent COVID-19 symptoms in a community study of 606,434 people in England

et al. 2022

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Long COVID remains a broadly defined syndrome, with estimates of prevalence and duration varying widely. We use data from rounds 3–5 of the REACT-2 study (n = 508,707; September 2020 – February 2021), a representative community survey of adults in England, and replication data from round 6 (n = 97,717; May 2021) to estimate the prevalence and identify predictors of persistent symptoms lasting 12 weeks or more; and unsupervised learning to cluster individuals by reported symptoms. At 12 weeks in rounds 3–5, 37.7% experienced at least one symptom, falling to 21.6% in round 6. Female sex, increasing age, obesity, smoking, vaping, hospitalisation with COVID-19, deprivation, and being a healthcare worker are associated with higher probability of persistent symptoms in rounds 3–5, and Asian ethnicity with lower probability. Clustering analysis identifies a subset of participants with predominantly respiratory symptoms. Managing the long-term sequelae of COVID-19 will remain a major challenge for affected individuals and their families and for health services.

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Section: Discussionmentioning

confidence: 99%

Persistent COVID-19 symptoms in a community study of 606,434 people in England

et al. 2022

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“…3,5 However, it is clear that a wide spectrum of symptoms and clinical presentations post-COVID-19 may be involved; our open free-text question identified a number of symptoms not included in our questionnaire including "brain fog", "palpitations" and "hair loss". 29 However, as the study was based on self-reported data and because many of the symptoms are common and not specific to COVID-19, we may, as noted, have overestimated the prevalence of persistent symptoms.…”

Section: Strengths and Limitationsmentioning

confidence: 92%

Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people

Whitaker

Elliott

Chadeau‐Hyam

et al. 2021

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Introduction Long COVID, describing the long-term sequelae after SARS-CoV-2 infection, remains a poorly defined syndrome. There is uncertainty about its predisposing factors and the extent of the resultant public health burden, with estimates of prevalence and duration varying widely. Methods Within rounds 3-5 of the REACT-2 study, 508,707 people in the community in England were asked about a prior history of COVID-19 and the presence and duration of 29 different symptoms. We used uni- and multivariable models to identify predictors of persistence of symptoms (12 weeks or more). We estimated the prevalence of symptom persistence at 12 weeks, and used unsupervised learning to cluster individuals by symptoms experienced. Results Among the 508,707 participants, the weighted prevalence of self-reported COVID-19 was 19.2% (95% CI: 19.1,19.3). 37.7% of 76,155 symptomatic people post COVID-19 experienced at least one symptom, while 14.8% experienced three or more symptoms, lasting 12 weeks or more. This gives a weighted population prevalence of persistent symptoms of 5.75% (5.68, 5.81) for one and 2.22% (2.1, 2.26) for three or more symptoms. Almost a third of people 8,771/28,713 (30.5%) with at least one symptom lasting 12 weeks or more reported having had severe COVID-19 symptoms ('significant effect on my daily life') at the time of their illness, giving a weighted prevalence overall for this group of 1.72% (1.69,1.76). The prevalence of persistent symptoms was higher in women than men (OR: 1.51 [1.46,1.55]) and, conditional on reporting symptoms, risk of persistent symptoms increased linearly with age by 3.5 percentage points per decade of life. Obesity, smoking or vaping, hospitalisation , and deprivation were also associated with a higher probability of persistent symptoms, while Asian ethnicity was associated with a lower probability. Two stable clusters were identified based on symptoms that persisted for 12 weeks or more: in the largest cluster, tiredness predominated, while in the second there was a high prevalence of respiratory and related symptoms. Interpretation A substantial proportion of people with symptomatic COVID-19 go on to have persistent symptoms for 12 weeks or more, which is age-dependent. Clinicians need to be aware of the differing manifestations of Long COVID which may require tailored therapeutic approaches. Managing the long-term sequelae of SARS-CoV-2 infection in the population will remain a major challenge for health services in the next stage of the pandemic.

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“…Fatigue is among the most commonly reported symptoms that patients experience following the resolution of acute COVID-19, while according to a recent meta-analysis, ~32% of individuals experienced fatigue at ≥12 weeks following COVID-19 diagnosis ( 84 ). Females are, in general, at a greater risk of experiencing persisting fatigue post-COVID ( 41 , 47 , 67 , 81 , 85 , 86 ), either when treated in a hospital ward or in the ICU ( 58 ), with differences being observed even at 1 year of follow-up ( 36 , 55 ). Nevertheless, other studies have reported no such associations ( 87 , 88 ).…”

Section: Neuropsychiatric Manifestations In Covid-19 Survivors With ‘...mentioning

confidence: 99%

Long COVID and neuropsychiatric manifestations (Review)

et al. 2022

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There is accumulating evidence in the literature indicating that a number of patients with coronavirus disease 2019 (COVID-19) may experience a range of neuropsychiatric symptoms, persisting or even presenting following the resolution of acute COVID-19. Among the neuropsychiatric manifestations more frequently associated with ‘long COVID’ are depression, anxiety, post-traumatic stress disorder, sleep disturbances, fatigue and cognitive deficits, that can potentially be debilitating and negatively affect patients' wellbeing, albeit in the majority of cases symptoms tend to improve over time. Despite variations in results obtained from studies using different methodological approaches to define ‘long COVID’ syndrome, the most widely accepted factors associated with a higher risk of developing neuropsychiatric manifestations include the severity of foregoing COVID-19, the female sex, the presence of comorbidities, a history of mental health disease and an elevation in the levels of inflammatory markers, albeit further research is required to establish causal associations. To date, the pathophysiological mechanisms implicated in neuropsychiatric manifestations of ‘long COVID’ remain only partially elucidated, while the role of the indirect effects of the COVID-19 pandemic, such as social isolation and uncertainty concerning social, financial and health recovery post-COVID, have also been highlighted. Given the alarming effects of ‘long-COVID’, interdisciplinary cooperation for the early identification of patients who are at a high risk of persistent neuropsychiatric presentations, beyond COVID-19 recovery, is crucial to ensure that appropriate integrated physical and mental health support is provided, with the aim of mitigating the risks of long-term disability at a societal and individual level.

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Long-term post-COVID symptoms and associated risk factors in previously hospitalized patients: A multicenter study

Cited by 51 publications

References 5 publications

Persistent COVID-19 symptoms in a community study of 606,434 people in England

Persistent COVID-19 symptoms in a community study of 606,434 people in England

Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people

Long COVID and neuropsychiatric manifestations (Review)

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