Perception, Prevalence, and Prediction of Severe Infection and Post-acute Sequelae of COVID-19

Abstract

Background : The aim of the study was to assess, characterize, and describe the prevalence and predicting factors of patient-reported severe coronavirus disease 2019 (COVID-19) infection and post-acute sequelae of COVID-19 (PASC). Methods : We prospectively surveyed patients who received care in our outpatient clinic for COVID-19 from March 13, 2020, through August 17, 2020, and then retrospectively reviewed their electronic health records. We collected data for age, sex, and persistence of symptoms and compared data for hospitalized and nonhospitalized patients. Continuous and categorical variables were summarized, including time from COVID-19 onset, time to resuming normal activities, and length of time away from work. Results : Of those receiving the survey, 437 adult patients with different degrees of severity of COVID-19 illness responded: 77% were between 3 and 6 months from the onset of infection. In total, 34.9% had persistent symptoms, and 11.5% were hospitalized. The most common symptom was fatigue (75.9%), followed by poor sleep quality (60.3%), anosmia (56.8%), dysgeusia (55%), and dyspnea (54.6%). Predicting factors for PASC were female sex and a negative psychological impact of the disease. Age, hospitalization, persistent symptoms, psychological impact (eg, anxiety and depression), and time missed from work were significantly associated with perception of having severe COVID-19 illness. Hospitalization was not significantly associated with PASC. Conclusions : Over one-third of patients in our study had PASC. Persistent symptoms correlated with severity of disease and were significantly more common for women, for patients who had psychological symptoms (depression and/or anxiety), and for patients reporting inability to resume normal activities.

The associations of long-COVID symptoms, clinical characteristics and affective psychological constructs in a non-hospitalized cohort

“…They found that the acute phase symptom severity and any comorbid disease, including worsened mental health increase the risk of the manifestation of post-COVID symptoms. Another study also confirmed that female sex, depression, and anxiety symptoms increase the risk of the onset of persistent post-COVID symptoms [37]. Our findings partially confirm these results, as in our regression model acute symptomatology and depression might predict the number of long-covid symptoms.…”

Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study

“…We found that COVID-19 severity, even amongst a hospitalized cohort, was an overall predictor of PASC in the group of 242 patients that completed follow-up, as has been described in multiple other cohorts [ 33 – 35 ]. Although some studies have suggested that PASC may be more common in those with mild disease [ 36 ], we did not have a comparison group of non-hospitalized patients in our cohort to test this hypothesis. Among the subgroup of patients with PASC, the severity of index COVID-19 illness did not appear to predict which patients would have the most symptoms or disability.…”

Life stressors significantly impact long-term outcomes and post-acute symptoms 12-months after COVID-19 hospitalization

“…While there are several reports of predictors of short term outcomes during hospitalization or within the first months following COVID-19 (e.g. mortality or discharge disposition) [ [24] , [25] , [26] ], as well as reports describing qualitative subjective post-acute COVID symptoms [ 2 , 8 , 9 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] ], this study is distinct in that it prospectively explores the impact of life stressors along with demographic, comorbid, and neurological events as predictors of quantitative long-term cognitive, functional, quality of life and post-acute symptoms outcomes in a large population.…”

“…We identified female sex as an independent predictor of both anxiety and limitations in activities of daily living. Others have identified that female sex may be a predictor of post-acute COVID-19 symptoms [ 8 , 9 , 27 , 28 , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , 41 ]. In a survey of 999 community dwellers across the U.S, female sex, along with younger age, racial/ethnic minority status, baseline disability, fewer years of formal education, and/or a history of psychiatric disease were significant predictors of post-acute COVID-19 symptoms [ 12 , 32 ].…”