High prevalence of persistent symptoms and reduced health-related quality of life 6 months after COVID-19

Irma Ahmad, Alicia Edin, Christoffer Granvik, Lowa Kumm Persson, Staffan Tevell, Emeli Månsson, Anders Magnuson, Ingela Marklund, Ida-Lisa Persson, Anna Kauppi, Clas Ahlm, Mattias N E Forsell, Josefin Sundh, Anna Lange, Sara Cajander, Johan Normark, Irma Ahmad, Alicia Edin, Christoffer Granvik, Lowa Kumm Persson, Staffan Tevell, Emeli Månsson, Anders Magnuson, Ingela Marklund, Ida-Lisa Persson, Anna Kauppi, Clas Ahlm, Mattias N E Forsell, Josefin Sundh, Anna Lange, Sara Cajander, Johan Normark

Abstract

Background: The long-term sequelae after COVID-19 constitute a challenge to public health and increased knowledge is needed. We investigated the prevalence of self-reported persistent symptoms and reduced health-related quality of life (HRQoL) in relation to functional exercise capacity, 6 months after infection, and explored risk factors for COVID-19 sequalae.

Methods: This was a prospective, multicenter, cohort study including 434 patients. At 6 months, physical exercise capacity was assessed by a 1-minute sit-to-stand test (1MSTST) and persistent symptoms were reported and HRQoL was evaluated through the EuroQol 5-level 5-dimension (EQ-5D-5L) questionnaire. Patients with both persistent symptoms and reduced HRQoL were classified into a new definition of post-acute COVID syndrome, PACS+. Risk factors for developing persistent symptoms, reduced HRQoL and PACS+ were identified by multivariable Poisson regression.

Results: Persistent symptoms were experienced by 79% of hospitalized, and 59% of non-hospitalized patients at 6 months. Hospitalized patients had a higher prevalence of self-assessed reduced overall health (28 vs. 12%) and PACS+ (31 vs. 11%). PACS+ was associated with reduced exercise capacity but not with abnormal pulse/desaturation during 1MSTST. Hospitalization was the most important independent risk factor for developing persistent symptoms, reduced overall health and PACS+.

Conclusion: Persistent symptoms and reduced HRQoL are common among COVID-19 survivors, but abnormal pulse and peripheral saturation during exercise could not distinguish patients with PACS+. Patients with severe infection requiring hospitalization were more likely to develop PACS+, hence these patients should be prioritized for clinical follow-up after COVID-19.

Keywords: COVID-19; EQ-5D; PACS; Post COVID-19 condition (PCC); SARS-CoV-2; long-COVID; post-acute COVID syndrome (PACS).

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2023 Ahmad, Edin, Granvik, Kumm Persson, Tevell, Månsson, Magnuson, Marklund, Persson, Kauppi, Ahlm, Forsell, Sundh, Lange, Cajander and Normark.

Figures

Figure 1
Figure 1
Flowchart of included patients.
Figure 2
Figure 2
(A–F) Results from 1MSTST presented by number of sit-to-stands, oxygen saturation and heart rate. (A) Number of sit-to-stands at 30 s for the whole cohort. Age in years presented on the x-axis. Numbers presented are the minimum values observed for each study participant between 4 weeks and 6 months. PACS+, black, non-PACS+, yellow and values for patients with no recorded HRQoL data, in gray. Women, large dot; men, small dot. Median values were 14 (range: 5–27) for PACS+, vs. 17 (range: 6–38) for non-PACS+, p = 0.021 (Mann-Whitney U-test). (B) Number of sit-to-stands at 60 s for the whole cohort. Age in years presented on the x-axis. Numbers presented are the minimum values observed for each study participant between 4 weeks and 6 months. PACS+, black, non-PACS+, yellow and values for patients with no recorded HRQoL data, in gray. Women, large dot; Men, small dot. Medians: 26 (range: 9–55) for PACS, vs. 33 (range: 10–73) for non-PACS+, p = 0.005 (Mann-Whitney U-test). (C, D) Values of delta-SpO2 after 1MSTST, divided by hospitalized (C) and non-hospitalized (D). PACS+, black, non-PACS+, yellow and values for patients with no recorded HRQoL data, in gray. Women, large dot; men, small dot. Age in years presented at x-axis, with a dotted line at 50 years. Another dotted line at delta-SpO2 −4, with values on or below this line regarded as pathological. Forty-two participants (15%) had a pathological decrease in oxygen saturation during the test, of which six participants (14%) were also defined as PACS+, (p = 0.664) (Fisher's exact test). (E, F) Values of delta-Heart rate in percent after 1MSTST, presented as maximum values (E) and minimum values (F) observed for each study participant between 4 weeks and 6 months. PACS, black, non-PACS+, yellow values for patients with no recorded HRQoL data, in gray. Women, large dot; men, small dot. Age in years presented at x-axis, with a dotted line at 50 years. The Gray dotted areas in the graphs represent pathological values. The limit is set at 0% for minimum values and at +2SD from the mean at maximum values, 146%. Twenty-four participants (8%) had a pathological change in heart rate. Of these, three participants (13%) were also defined as PACS (p = 0.779) (Fisher's exact test).

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