Post–COVID-19 Symptoms 2 Years After SARS-CoV-2 Infection Among Hospitalized vs Nonhospitalized Patients

Abstract

ImportanceIdentification of long-term post–COVID-19 symptoms among hospitalized and nonhospitalized patients is needed.ObjectiveTo compare the presence of post–COVID-19 symptoms 2 years after acute SARS-CoV-2 infection between hospitalized and nonhospitalized patients.Design, Setting, and ParticipantsA cross-sectional cohort study was conducted at 2 urban hospitals and general practitioner centers from March 20 to April 30, 2020, among 360 hospitalized patients and 308 nonhospitalized patients with acute SARS-CoV-2 infection during the first wave of the pandemic. Follow-up was conducted 2 years later.Main Outcomes and MeasuresParticipants were scheduled for a telephone interview 2 years after acute infection. The presence of post–COVID-19 symptoms was systematically assessed, with particular attention to symptoms starting after infection. Hospitalization and clinical data were collected from medical records. Between-group comparisons and multivariate logistic regressions were conducted.ResultsA total of 360 hospitalized patients (162 women [45.0%]; mean [SD] age, 60.7 [16.1] years) and 308 nonhospitalized patients (183 women [59.4%]; mean [SD] age, 56.7 [14.7] years) were included. Dyspnea was more prevalent at the onset of illness among hospitalized than among nonhospitalized patients (112 [31.1%] vs 36 [11.7%]; P < .001), whereas anosmia was more prevalent among nonhospitalized than among hospitalized patients (66 [21.4%] vs 36 [10.0%]; P = .003). Hospitalized patients were assessed at a mean (SD) of 23.8 (0.6) months after hospital discharge, and nonhospitalized patients were assessed at a mean (SD) of 23.4 (0.7) months after the onset of symptoms. The number of patients who exhibited at least 1 post–COVID-19 symptom 2 years after infection was 215 (59.7%) among hospitalized patients and 208 (67.5%) among nonhospitalized patients (P = .01). Among hospitalized and nonhospitalized patients, fatigue (161 [44.7%] vs 147 [47.7%]), pain (129 [35.8%] vs 92 [29.9%]), and memory loss (72 [20.0%] vs 49 [15.9%]) were the most prevalent post–COVID-19 symptoms 2 years after SARS-CoV-2 infection. No significant differences in post–COVID-19 symptoms were observed between hospitalized and nonhospitalized patients. The number of preexisting medical comorbidities was associated with post–COVID-19 fatigue (odds ratio [OR], 1.93; 95% CI, 1.09-3.42; P = .02) and dyspnea (OR, 1.91; 95% CI, 1.04-3.48; P = .03) among hospitalized patients. The number of preexisting medical comorbidities (OR, 3.75; 95% CI, 1.67-8.42; P = .001) and the number of symptoms at the onset of illness (OR, 3.84; 95% CI, 1.33-11.05; P = .01) were associated with post–COVID-19 fatigue among nonhospitalized patients.Conclusions and RelevanceThis cross-sectional study suggested the presence of at least 1 post–COVID-19 symptom in 59.7% of hospitalized patients and 67.5% of nonhospitalized patients 2 years after infection. Small differences in symptoms at onset of COVID-19 were identified between hospitalized and nonhospitalized patients. Post–COVID-19 symptoms were similar between hospitalized and nonhospitalized patients; however, lack of inclusion of uninfected controls limits the ability to assess the association of SARS-CoV-2 infection with overall and specific post–COVID-19 symptoms 2 years after acute infection. Future studies should include uninfected control populations.

Assessment of Symptom, Disability, and Financial Trajectories in Patients Hospitalized for COVID-19 at 6 Months

“…Available reports have described the prevalence of some symptoms at follow-up but have generally not been designed to compare symptoms and other problems with prehospitalization baselines. 4 , 5 , 6 Second, national studies using prospective enrollment of patients across diverse hospitals and regions are limited; increased geographic and temporal representation may reduce the analytical impact of regional health resource strain, surge conditions, and practice patterns on observed outcomes. 7 , 8 Third, many early reports have been cross-sectional, providing little information on how symptoms and other sequelae evolve.…”

ACE1 rs1799752 polymorphism is not associated with long-COVID symptomatology in previously hospitalized COVID-19 survivors

“…The lack of association between these SNPs and long-COVID could be explained by the significant gene variability existing (i.e., ethnic differences) across populations [8] . Further, the lack of relationship among SNPs associated with COVID-19 severity and the presence of long-COVID reinforce the idea that the severity of the disease is not associated with the development of post-COVID symptoms since the presence of these symptoms is similar between hospitalized and non-hospitalized patients [9] . Similarly, the D allele of the ACE1 rs1799752 polymorphism has been associated with a higher risk of hospitalization in patients with co-morbidities at the acute phase of the infection since these individuals are at a higher risk for developing acute respiratory distress syndrome (ARDS) [10] .…”

Risk factors for long COVID among healthcare workers, Brazil, 2020–2022

“…Previous studies suggested that the Delta and Omicron variants caused less systemic inflammatory processes, severe illness, or death, resulting in less severe long COVID symptoms than the wild-type variant (Wuhan) [32, 33]. In addition, the prevalence of long COVID during the Omicron era has been reported as less than that of the other strains, and a milder process during the acute phase might have been contributing to the less frequent development of long COVID during the Delta and Omicron eras [33, 34].…”