Incidence and Characterization of Post-COVID-19 Symptoms in Hospitalized COVID-19 Survivors to Recognize Syndemic Connotations in India: Single-Center Prospective Observational Cohort Study

Abstract

Background Long COVID, or post-COVID-19 syndrome, is the persistence of signs and symptoms that develop during or after COVID-19 infection for more than 12 weeks and are not explained by an alternative diagnosis. In spite of health care recouping to prepandemic states, the post-COVID-19 state tends to be less recognized from low- and middle-income country settings and holistic therapeutic protocols do not exist. Owing to the syndemic nature of COVID-19, it is important to characterize post-COVID-19 syndrome. Objective We aimed to determine the incidence of post-COVID-19 symptoms in a cohort of inpatients who recovered from COVID-19 from February to July 2021 at a tertiary-care center in South India. In addition, we aimed at comparing the prevalence of post-COVID-19 manifestations in intensive care unit (ICU) and non-ICU patients, assessing the persistence, severity, and characteristics of post-COVID-19 manifestations, and elucidating the risk factors associated with the presence of post-COVID-19 manifestations. Methods A total of 120 adult patients admitted with COVID-19 in the specified time frame were recruited into the study after providing informed written consent. The cohort included 50 patients requiring intensive care and 70 patients without intensive care. The follow-up was conducted on the second and sixth weeks after discharge with a structured questionnaire. The questionnaire was filled in by the patient/family member of the patient during their visit to the hospital for follow-up at 2 weeks and through telephone follow-up at 6 weeks. Results The mean age of the cohort was 55 years and 55% were men. Only 5% of the cohort had taken the first dose of COVID-19 vaccination. Among the 120 patients, 58.3% had mild COVID-19 and 41.7% had moderate to severe COVID-19 infection. In addition, 60.8% (n=73) of patients had at least one persistent symptom at the sixth week of discharge and 50 (41.7%) patients required intensive care during their inpatient stay. The presence of persistent symptoms at 6 weeks was not associated with severity of illness, age, or requirement for intensive care. Fatigue was the most common reported persistent symptom with a prevalence of 55.8%, followed by dyspnea (20%) and weight loss (16.7%). Female sex (odds ratio [OR] 2.4, 95% CI 1.03-5.58; P=.04) and steroid administration during hospital stay (OR 4.43, 95% CI 1.9-10.28; P=.001) were found to be significant risk factors for the presence of post-COVID-19 symptoms at 6 weeks as revealed by logistic regression analysis. Conclusions Overall, 60.8% of inpatients treated for COVID-19 had post-COVID-19 symptoms at 6 weeks postdischarge from the hospital. The incidence of post-COVID-19 syndrome in the cohort did not significantly differ across the mild, moderate, and severe COVID-19 severity categories. Female sex and steroid administration during the hospital stay were identified as predictors of the persistence of post-COVID-19 symptoms at 6 weeks.

Prevalence, predictors, and patient-reported outcomes of long COVID in hospitalized and non-hospitalized patients from the city of São Paulo, Brazil

“…Previous studies, including those conducted in low-and middle-income countries, have established a link between female gender and long COVID ( 12 , 13 , 21 – 23 ), However, it has not been previously reported that a positive depression screening at day 30 using a validated questionnaire could be a risk factor for diagnosing long COVID at day 90 ( 24 , 25 ). Additionally, few studies have examined depression as a risk factor for COVID-19 or long COVID ( 26 , 27 ).…”

“…In Malaysia, common symptoms observed in both outpatients and inpatients include fatigue, brain fog, depression, anxiety, insomnia, and joint or muscle pain ( 12 ). However, in India, a single-center prospective observational cohort study highlighted fatigue, dyspnea, and weight loss as the predominant symptoms among hospitalized patients ( 13 ). A study in China found that at 6-month follow-up, fatigue or muscle weakness and sleep difficulties were the main symptoms observed in COVID-19 patients who had recovered.…”

Early Biomarkers in Hospitalized Patients as Predictors of Long-Term Post- COVID-19 Conditions: A One-Year Cohort Study

“…In our prior prospective study involving the same cohort, we observed a 60% prevalence of PCC at the end of six weeks [12]. However, that study did not employ laboratory parameter analysis to investigate predictive risk factors for PCC.…”

Análise das características clínicas e dos aspectos físicos da qualidade de vida no pós-COVID-19

“…Indivíduos recuperados da COVID-19 podem apresentar sintomas persistentes por um longo período após a infecção aguda, bem como desenvolver novas alterações clínicas associados ao pós-COVID-19. A sintomatologia dessa condição inclui fadiga, artralgia, fraqueza muscular, dispneia, dor torácica, distúrbios do sono, dentre outros (Nalbandian et al, 2021;Malik et al, 2022;Halpin et al, 2021;Besnier et al, 2022, Saboia;.…”