Predictors of Long-COVID-19 and its Impact on Quality of Life: Longitudinal Analysis at 3, 6 and 9 Months after Discharge from a Portuguese Centre

Abstract

Introduction: Long-COVID-19 impacts health-related quality of life (HR-QoL) but data is scarce. The aim of this study was to describe and prospectively assess the prevalence and risk factors for long-COVID-19 after hospital discharge, and to evaluate its impact on patient HR-QoL.Material and Methods: Single-centre longitudinal study including all COVID-19 patients discharged between December 2020 and February 2021. Patients were contacted remotely at three, six and nine months. Data were collected as follows: 1) Long-COVID-19 symptoms were self-reported; 2) HRQoL were assessed using the 3-level EuroQoL-5D (EQ-5D-3L) questionnaire. Pregnant women, demented, bedridden, and non-Portuguese-speaking patients were excluded.Results: The three-, six- and nine-month assessments were completed by 152, 117 and 110 patients (median age: 61 years; male sex: 56.6%). Long-COVID-19 (≥ 1 symptom) was reported by 66.5%, 62.4% and 53.6% of patients and HR-QoL assessment showed impairment of at least some domain in 65.8%, 69.2% and 55.4% of patients at three, six and nine months, respectively. Fatigue was the most common long-COVID-19 symptom. Anxiety/depression domain was the most frequently affected in all three time-points, peaking at six months (39%), followed by pain/discomfort and mobility domains. Long-COVID-19 was associated with the impairment of all EQ-5D-3L domains except for self-care domain at each time-point. Neither intensive care unit admission nor disease severity were associated with long-COVID-19 nor with impairment of any EQ-5D-3L domain. After adjusting for sex, age, frailty status, and comorbid conditions, long-COVID-19 remained significantly associated with HR-QoL impairment at three (OR 4.27, 95% CI 1.92 – 9.52, p < 0.001), six (OR 3.46, 95% CI 1.40 – 8.57, p = 0.007) and nine months (OR 4.13, 95% CI 1.62 – 10.55, p = 0.003) after hospital discharge. In alongitudinal analysis, patients reporting long-COVID-19 at three months had an EQ-5D-3L index value decreased by 0.14 per visit (p < 0.001) compared to those without long-COVID-19 and both groups had a non-significant change in mean EQ-5D-3L index over the nine-month period (time-point assessment, Z = 0.91, p = 0.364).Conclusion: Clinical sequelae associated with long-COVID-19 can persist for at least nine months after hospital discharge in most patients and can impair long-term HR-QoL in more than half of patients regardless of disease severity, and clinicodemographic characteristics.

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

“…However, only 4% of our patients required admission to the ICU, whereas, in the study of Skinner et al, proportion of patients who needed intubation and stay in ICU was nearly ten times higher. A recent Portuguese study showed that long COVID with fatigue as the most common symptom was significantly associated with impaired QoL at 3, 6, and 9 months after discharge from hospital, and was not predicted by initial disease severity 18 that stayed in line with conclusions of our research. In an Italian study, during median observation of 15 months, 75% of individuals returned to their pre‐COVID status; however, one‐third felt a degree limitation in terms of working capacity 19 .…”

Longitudinal course and predictors of health-related quality of life, mental health, and fatigue, in non-hospitalized individuals with or without post COVID-19 syndrome

“…Overall, the results of the present study con rmed that PCS considerably affects mental health, fatigue and HRQOL even 2 years after the acute SARS-CoV-2 infection. Comparable associations were shown in studies with shorter follow-up times and/or in hospitalized patients [34,35].…”

“…For instance, Gaspar et al [34] reported that PCS was a signi cant predictor of impairment of at least one HRQOL domain (assessed by EQ-5D-3L) 3, 6 and 9 months after COVID-19 in hospitalized individuals.…”

“…Overall, these ndings are in line with some prior studies reporting a lack of improvement of an initially impaired mental health status after COVID-19. For instance, Gaspar et al [34] showed that the anxiety/depression domain from the EQ-5D-3L remained stable from 3 to 9 months post COVID-19 in persons with PCS and an increase of symptoms of depression and anxiety from 3-6 months to ≥ 6 months was reported by Pemrai et al [38]. However, these studies investigated an early post COVID-19 time interval, whereas the present study con rmed the persistance of mental health impairments in persons with PCS up to 2 years.…”

Impact of Long COVID on Health-Related Quality of Life Among Patients After Acute COVID-19 Infection: A Cross-Sectional Study

“…The study shows that, there was a higher proportion of older patients (56.79%) with long-COVID, consistent with the results of 1 study. 29 This may 30 be owing to older individuals being more susceptible to long-COVID because of their declining physical abilities. The presence of chronic disease was associated with having long COVID.…”