Seven Months after Mild COVID-19: A Single-Centre Controlled Follow-Up Study in the District of Constance (FSC19-KN)

Abstract

Importance. Viral infections can lead to prolonged recovery and secondary diseases among the survivors. Therefore, the management of post-coronavirus infectious disease 2019 (COVID-19) patients needs to be planned efficiently based on significant data. Despite numerous follow-up studies, there still is a lack of knowledge in this field. Objective. The primary aim of the study was to investigate the rate of hospitalization and admission diagnoses in severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) positive patients seven months after initial infection. Secondarily, measurement of long-term effects on physical performance, quality of life, and functional outcome was intended. Design. The study is designed as a controlled follow-up of COVID-19 cases in the district of Constance (FSC19-KN). Setting. A controlled setting is provided due to the recruitment of an equally sized cohort consisting of age- and gender-matched subjects featuring similar cardiovascular risk profiles and negative SARS-CoV-2 antibody titers. Participants. The study examines 206 subjects after polymerase chain reaction (PCR) confirmed SARS-CoV-2 infection seven months after initial infection. Exposure. Infection in the SARS-CoV-2 positive group occurred between March and December 2020. Main Outcome and Measures. The frequency of inpatient admission during the observational period including the related diagnosis was defined as the primary endpoint. Secondary endpoints were health-related quality of life, physical performance, and functional outcome measured by European Quality of Life-5-Dimensions-5-Level (EQ-5D-5L), Short Form Health 36 (SF-36), Six-Minute Walk Test (6MWT), and Post-COVID-19 Functional Status (PCFS). Results. The study population consisted of mainly nonhospitalized subjects. During the first seven months of observation, frequency of inpatient admission was low and did not differ significantly between both groups (2.4% vs. 2.9% controls: OR 0.8, 95% CI 0.2 to 2.8). Calculation of six-minute walk distance ratios showed no significant difference between both cohorts (0.97 ± 0.17 vs. 0.98 ± 0.16 controls; mean difference −0.01; 95% CI −0.04 to 0.02). However, SARS-CoV-2-positive subjects achieved significantly lower EQ-5D-5L index scores (0.92 ± 0.12 vs. 0.95 ± 0.1 controls; mean difference −0.03, 95% CI −0.05 to −0.01) and SF-36 subscores. Reduced PCFS was reported significantly more often in the SARS-CoV-2 positive cohort (30.6% vs 14.6% controls: OR 2.6, 95% CI 1.6 to 4.2). Conclusion. The results suggest that mild COVID-19 has no impact on the hospitalization rate during the first seven months after infection. Despite unimpaired performance in cardiopulmonary exercise, SARS-CoV-2-positive subjects reported reduced quality of life and functional sequelae. Underlying psychoneurological mechanisms need further investigation. Trial Registration. This trial is registered with clinicaltrials.gov (identifier: NCT04724434) and German Clinical Trials Register (identifier: DKRS00022409).

Sex differences of post-Covid patients undergoing outpatient pulmonary rehabilitation

“…On the other hand, an Italian study stratifying 75 PCS patients by Covid-19 symptom load reported mostly unimpaired 6MWD, even in the severe symptoms group [ 34 ]. Another study comparing PCS patients to Covid-19 negative patients matched by sex, age and cardiovascular profile also observed similar performance in 6MWD [ 35 ]. A comprehensive study on all confirmed cases with desaturated oxygen below 94% in Iceland drew a more distinct picture with lowered 6MWD observed only in patients treated in intensive care during Covid-19 [ 36 ].…”

“…Furthermore, other follow-up studies at various time points after Covid-19 observed improvement of physical performance and to some extent of typical PCS symptoms as a function of time rather than rehabilitation [ 30 ]. While controlled trials are exceedingly rare, a study matching confirmed Covid-19 cases to patients without Covid-19 but similar other risk factors observed no differences in standard assessments such as 6MWD [ 35 ]. Hence, we cannot verify that the observed improvement was in fact caused by the rehabilitation program alone.…”

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

“…The meta-analysis of the five studies reporting the EQ-5D indicated a small 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); I 2 =93.81%; figure 2). [32][33][34][35][36] One small study with 113 predominantly male (86%), working age (mean 39 (standard deviation 9)) participants provided outlier results in this meta-analysis indicating lower quality of life in individuals with documented symptomatic infection versus noninfected individuals. 37 Nonetheless, when pooling studies with different scales assessing subdomains of quality of life, we found little to no difference, for example, for mental health (Hedges's g −0.07 (95% confidence interval −0.61 to 0.47)) and for physical health (−0.31 (−1.25 to 0.63), figure 3).…”

“…Quality of life in covid-19 cases versus controls of studies reporting EQ-5D [32][33][34][35][36]. Symptomatic and asymptomatic groups of Pell and colleagues36 were merged for the analysis.…”

Quality of life and mental disorders in the post-COVID period (systematic review)

“…Частота госпитализаций в обеих группах была низкой и сопоставимой (2,4% в группе пациентов, перенесших COVID-19, против 2,9% в контрольной группе). Однако анализ показал снижение КЖ по шкале EQ-5D-5L у пациентов, перенесших COVID-19 (средние значения VAS 83,6 ± 15,2 против 88,6 ± 12,4 мм в группе контроля, р < 0,05) [32].…”