Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study

Oscar Moreno-Pérez, Esperanza Merino, Jose-Manuel Leon-Ramirez, Mariano Andres, Jose Manuel Ramos, Juan Arenas-Jiménez, Santos Asensio, Rosa Sanchez, Paloma Ruiz-Torregrosa, Irene Galan, Alexander Scholz, Antonio Amo, Pilar González-delaAleja, Vicente Boix, Joan Gil, COVID19-ALC research group, Oscar Moreno-Pérez, Esperanza Merino, Jose-Manuel Leon-Ramirez, Mariano Andres, Jose Manuel Ramos, Juan Arenas-Jiménez, Santos Asensio, Rosa Sanchez, Paloma Ruiz-Torregrosa, Irene Galan, Alexander Scholz, Antonio Amo, Pilar González-delaAleja, Vicente Boix, Joan Gil, COVID19-ALC research group

Abstract

Objectives: This study aims to analyze the incidence of Post-acute COVID-19 syndrome (PCS) and its components, and to evaluate the acute infection phase associated risk factors.

Methods: A prospective cohort study of adult patients who had recovered from COVID-19 (27th February to 29th April 2020) confirmed by PCR or subsequent seroconversion, with a systematic assessment 10-14 weeks after disease onset. PCS was defined as the persistence of at least one clinically relevant symptom, or abnormalities in spirometry or chest radiology. Outcome predictors were analyzed by multiple logistic regression (OR; 95%CI).

Results: Two hundred seventy seven patients recovered from mild (34.3%) or severe (65.7%) forms of SARS-CoV-2 infection were evaluated 77 days (IQR 72-85) after disease onset. PCS was detected in 141 patients (50.9%; 95%CI 45.0-56.7%). Symptoms were mostly mild. Alterations in spirometry were noted in 25/269 (9.3%), while in radiographs in 51/277 (18.9%). No baseline clinical features behaved as independent predictors of PCS development.

Conclusions: A Post-acute COVID-19 syndrome was detected in a half of COVID19 survivors. Radiological and spirometric changes were mild and observed in less than 25% of patients. No baseline clinical features behaved as independent predictors of Post-acute COVID-19 syndrome development.

Keywords: Associated factors; COVID-19; Cohort study; Diagnostic imaging; Health-related quality of life; Life quality; Sequelae; Spirometry; Symptoms; Syndrome.

Conflict of interest statement

Declaration of Competing Interest The authors declare no conflict of interest.

Copyright © 2021. Published by Elsevier Ltd.

Figures

Graphical abstract
Graphical abstract
Fig. 1
Fig. 1
Post-acute COVID-19 syndrome associated factors. Variables were included as covariates if shown significant associations in simple models. Some covariates could be excluded in case of been highly correlated, >20% of missing values or number of events was too small to calculate odds ratios. The 95% confidence intervals (CIs) of the odds ratios have been adjusted for multiple testing. In bold, independent predictors associated with the outcomes. For the purpose of logistic regression, variables were categorized regarding their 75-percentiles within each subpopulation, to show the impact of severe extreme values in the outcomes – except for those in which severity is defined by lowest levels, such as lymphocyte counts, where 25-percentiles were used. For the following variables, standard categorizations were followed: age ≥65 years, Oximetry at room air <94%, respectively.

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