Prevalence and predictors of Post-Acute COVID-19 Syndrome (PACS) after hospital discharge: A cohort study with 4 months median follow-up

Abstract

Background Post-acute COVID-19 syndrome (PACS) is an emerging healthcare burden. The risk factors associated with PACS remain largely unclear. The aim of this study was to evaluate the frequency of new or persistent symptoms in COVID-19 patients post hospital discharge and identify associated risk factors. Methods Our prospective cohort comprised of PCR-confirmed COVID-19 patients admitted to King Fahad Medical City, Riyadh, Saudi Arabia between May and July 2020. The patients were interviewed through phone calls by trained physicians from 6 weeks up to 6 months post hospital discharge. Multivariate Cox proportional hazards and logistic regression models were used to examine for predictors associated with persistence of symptoms and non-return to baseline health. Results 222 COVID-19 patients responded to follow-up phone interviews after a median of 122 days post discharge. The majority of patients were men (77%) with mean age of 52.47 (± 13.95) years. 56.3% of patients complained of persistent symptoms; 66 (29.7%) experiencing them for >21 days and 64 (28.8%) reporting not having returned to their baseline health. Furthermore, 39 patients (17.6%) reported visiting an emergency room post discharge for COVID-19-related symptoms while 16 (7.2%) had required re-hospitalization. Shortness of breath (40.1%), cough (27.5%) and fatigue (29.7%) were the most frequently reported symptoms at follow-up. After multivariable adjustments, female gender, pre-existing hypertension and length of hospital stay were associated with an increased risk of new or persistent symptoms. Age, pre-existing lung disease and emergency room visits increased the likelihood of not fully recovering from acute COVID-19. Patients who were treated with interferon β-1b based triple antiviral therapy during hospital stay were less likely to experience new or persistent symptoms and more likely to return to their baseline health. Conclusions COVID-19 survivors continued to suffer from dyspnea, cough and fatigue at 4 months post hospital discharge. Several risk factors could predict which patients are more likely to experience PACS and may benefit from individualized follow-up and rehabilitation programs.

Persistent COVID-19 symptoms at least one month after diagnosis: A national survey

“…The most common symptoms were fatigue (45.2%) and muscle aches (38.2%). These findings are consistent with our previous findings from a smaller cohort of hospitalized COVID-19 patients where fatigue was reported by almost 30% of patients at longer follow-up of 4 months [15] . These findings are also similar to previous reports from different parts of the world.…”

“…Our study contributes to the international efforts trying to understand the long-term effects of COVID-19 disease [13] , [14] . Previous studies from Saudi Arabia were relatively small, single center and included only hospitalized patients [15] .…”

Post‐COVID-19 syndrome: assessment of short- and long-term post-recovery symptoms in recovered cases in Saudi Arabia

“…Our study also supports this result as 10–15% of participants claimed that they are suffering from chest pain and palpitation. A study conducted in Saudi Arabia between May and July 2020 among patients discharged from hospital, showed shortness of breath, cough and fatigue in 40.1%, 27.5%, and 29.7%, respectively [ 42 ]. Another cohort study, in the same period, using a standardized telephone assessment between 6 weeks and 6 months post-hospital discharge, confirmed that age, dyslipidemia, hypertension, pre-existing lung disease and duration of symptoms were negatively associated with the WHO's five well-being index [ 43 ].…”

Identification of Distinct Long COVID Clinical Phenotypes Through Cluster Analysis of Self-Reported Symptoms

“…Studies on long COVID to date are heterogeneous. Those derived from in-person assessments are often focused on symptomatic recovery in individuals who required hospitalization in the acute phase of COVID-19 [ 5–7 ], while fewer have described patients who had mild initial illness managed in the community. Those that do include individuals with an initial mild illness tend to involve data from online surveys, remote assessment, or analyses of healthcare databases, which lack objective data [ 1 , 8 , 9 ].…”