Post-COVID syndrome in non-hospitalised patients with COVID-19: a longitudinal prospective cohort study

Augustin, Max; Schommers, Philipp; Stecher, Melanie; Dewald, Felix; Gieselmann, Lutz; Gruell, Henning; Horn, Carola; Vanshylla, Kanika; Cristanziano, Veronica Di; Osebold, Luise; Roventa, Maria; Riaz, Toqeer; Tschernoster, Nikolai; Altmueller, Janine; Rose, Leonard; Salomon, Susanne; Priesner, Vanessa; Lüers, Jan Christoffer; Albus, Christian; Rosenkranz, Stephan; Gathof, Birgit; Fätkenheuer, Gerd; Hallek, Michael; Klein, Florian; Suárez, Isabelle; Lehmann, Clara

doi:10.1016/j.lanepe.2021.100122

Cited by 496 publications

(476 citation statements)

References 38 publications

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“…Despite these differences and the markedly lower risk of long COVID diagnosis in primary care versus LS, several risk factor associations were consistent between various LS and in EHR. Findings that long COVID was more common with each decade of age from age 20 to age 70, and was 50% higher in women than men, are consistent with reports from most 4,[29][30][31][32][33] but not all previous studies. (34,35) There was an approximate linear increase in risk with age between 18 and 70 years.…”

Section: Reports On the Proportions Of Infected Individuals Going On To Experience Long Covid Have Variedsupporting

confidence: 89%

“…Over the age of 70, we observed a sharp decline in risk in most LS and EHR. This decline in risk for older adults which has been observed in other studies, 4,29,32 may be explained by selective competing risk of mortality, non-response bias, individuals misattributing long COVID to other illnesses, or a combination of these factors.…”

Section: Reports On the Proportions Of Infected Individuals Going On To Experience Long Covid Have Variedsupporting

confidence: 54%

“…Our finding of a greater risk of long COVID related to adverse prior mental health, has been reported elsewhere, 26 but pre-pandemic general health has not previously been highlighted. 29,31,36 These findings were robust in all analyses including inverse probability weighting for risk of COVID-19. The finding of an excess risk of long COVID in association with asthma across cohorts and primary care records resolves previous conflicting and limited findings, 26,29,35 and provides considerable support for focusing on asthma as a high-risk condition, for example by investigating into whether immune processes seen in asthma play a role in the development of long COVID.…”

Section: Reports On the Proportions Of Infected Individuals Going On To Experience Long Covid Have Variedmentioning

confidence: 67%

“…29,31,36 These findings were robust in all analyses including inverse probability weighting for risk of COVID-19. The finding of an excess risk of long COVID in association with asthma across cohorts and primary care records resolves previous conflicting and limited findings, 26,29,35 and provides considerable support for focusing on asthma as a high-risk condition, for example by investigating into whether immune processes seen in asthma play a role in the development of long COVID. In our analysis weighted for risk of COVID-19 onset, high cholesterol measures were associated with a greater risk of long COVID which has not been reported previously, although only two LS contributed data for metaanalyses of this factor and further studies will be required to confirm or refute this finding.…”

Section: Reports On the Proportions Of Infected Individuals Going On To Experience Long Covid Have Variedmentioning

confidence: 67%

“…26,31,35,37 Findings for overweight/obesity were suggestive of an increased risk again resolving previous uncertainty. 29,35,36 The markedly lower reporting of long COVID in primary care compared to LS suggests only a minority of people with long COVID seek care and subsequently receive a code. Diagnostic codes for long COVID have only recently been instituted and uptake by primary care practitioners has not been uniform.…”

Section: Reports On the Proportions Of Infected Individuals Going On To Experience Long Covid Have Variedmentioning

confidence: 99%

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Risk factors for long COVID: analyses of 10 longitudinal studies and electronic health records in the UK

Thompson

Williams

Walker

et al. 2021

Preprint

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The impact of long COVID is increasingly recognised, but risk factors are poorly characterised. We analysed questionnaire data on symptom duration from 10 longitudinal study (LS) samples and electronic healthcare records (EHR) to investigate sociodemographic and health risk factors associated with long COVID, as part of the UK National Core Study for Longitudinal Health and Wellbeing.MethodsAnalysis was conducted on 6,899 adults self-reporting COVID-19 from 45,096 participants of the UK LS, and on 3,327 cases assigned a long COVID code in primary care EHR out of 1,199,812 adults diagnosed with acute COVID-19. In LS, we derived two outcomes: symptoms lasting 4+ weeks and symptoms lasting 12+ weeks. Associations of potential risk factors (age, sex, ethnicity, socioeconomic factors, smoking, general and mental health, overweight/obesity, diabetes, hypertension, hypercholesterolaemia, and asthma) with these two outcomes were assessed, using logistic regression, with meta-analyses of findings presented alongside equivalent results from EHR analyses.ResultsFunctionally limiting long COVID for 12+ weeks affected between 1.2% (age 20), and 4.8% (age 63) of people reporting COVID-19 in LS. The proportion reporting symptoms overall for 12+ weeks ranged from 7.8 (mean age 28) to 17% (mean age 58) and for 4+ weeks 4.2% (age 20) to 33.1% (age 56). Age was associated with a linear increase in long COVID between age 20-70. Being female (LS: OR=1.49; 95%CI:1.24-1.79; EHR: OR=1.51 [1.41-1.61]), poor pre-pandemic mental health (LS: OR=1.46 [1.17-1.83]; EHR: OR=1.57 [1.47-1.68]) and poor general health (LS: OR=1.62 [1.25-2.09]; EHR: OR=1.26; [1.18-1.35]) were associated with higher risk of long COVID. Individuals with asthma also had higher risk (LS: OR=1.32 [1.07-1.62]; EHR: OR=1.56 [1.46-1.67]), as did those categorised as overweight or obese (LS: OR=1.25 [1.01-1.55]; EHR: OR=1.31 [1.21-1.42]) though associations for symptoms lasting 12+ weeks were less pronounced. Non-white ethnic minority groups had lower 4+ week symptom risk (LS: OR=0.32 [0.22-0.47]), a finding consistent in EHR. Associations were not observed for other risk factors. Few participants in the studies had been admitted to hospital (0.8-5.2%).ConclusionsLong COVID is clearly distributed differentially according to several sociodemographic and pre-existing health factors. Establishing which of these risk factors are causal and predisposing is necessary to further inform strategies for preventing and treating long COVID.

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Section: Reports On the Proportions Of Infected Individuals Going On To Experience Long Covid Have Variedsupporting

confidence: 89%

Section: Reports On the Proportions Of Infected Individuals Going On To Experience Long Covid Have Variedsupporting

confidence: 54%

Section: Reports On the Proportions Of Infected Individuals Going On To Experience Long Covid Have Variedmentioning

confidence: 67%

Section: Reports On the Proportions Of Infected Individuals Going On To Experience Long Covid Have Variedmentioning

confidence: 67%

Section: Reports On the Proportions Of Infected Individuals Going On To Experience Long Covid Have Variedmentioning

confidence: 99%

See 3 more Smart Citations

Risk factors for long COVID: analyses of 10 longitudinal studies and electronic health records in the UK

Thompson

Williams

Walker

et al. 2021

Preprint

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One-Year Trajectory of Cognitive Changes in Older Survivors of COVID-19 in Wuhan, China

et al. 2022

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IMPORTANCE Determining the long-term impact of COVID-19 on cognition is important to inform immediate steps in COVID-19 research and health policy.OBJECTIVE To investigate the 1-year trajectory of cognitive changes in older COVID-19 survivors.DESIGN, SETTING, AND PARTICIPANTS This cohort study recruited 3233 COVID-19 survivors 60 years and older who were discharged from 3 COVID-19-designated hospitals in Wuhan, China, from February 10 to April 10, 2020. Their uninfected spouses (N = 466) were recruited as a control population. Participants with preinfection cognitive impairment, a concomitant neurological disorder, or a family history of dementia were excluded, as well as those with severe cardiac, hepatic, or kidney disease or any kind of tumor. Follow-up monitoring cognitive functioning and decline took place at 6 and 12 months. A total of 1438 COVID-19 survivors and 438 control individuals were included in the final follow-up. COVID-19 was categorized as severe or nonsevere following the American Thoracic Society guidelines. MAIN OUTCOMES AND MEASURES The main outcome was change in cognition 1 year after patient discharge. Cognitive changes during the first and second 6-month follow-up periods were assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the Telephone Interview of Cognitive Status-40, respectively. Based on the cognitive changes observed during the 2 periods, cognitive trajectories were classified into 4 categories: stable cognition, early-onset cognitive decline, late-onset cognitive decline, and progressive cognitive decline. Multinomial and conditional logistical regression models were used to identify factors associated with risk of cognitive decline.RESULTS Among the 3233 COVID-19 survivors and 1317 uninfected spouses screened, 1438 participants who were treated for COVID-19 (691 male [48.05%] and 747 female [51.95%]; median [IQR] age, 69 [66-74] years) and 438 uninfected control individuals (222 male [50.68%] and 216 female [49.32%]; median [IQR] age, 67 [66-74] years) completed the 12-month follow-up. The incidence of cognitive impairment in survivors 12 months after discharge was 12.45%. Individuals with severe cases had lower Telephone Interview of Cognitive Status-40 scores than those with nonsevere cases and control individuals at 12 months (median [IQR]: severe, 22.50 [16.00-28.00]; nonsevere, 30.00 [26.00-33.00]; control , 31.00 [26.00-33.00]). Severe COVID-19 was associated with a higher risk of early-onset cognitive decline (odds ratio [OR], 4.87; 95% CI, 3.30-7.20), late-onset cognitive decline (OR, 7.58; 95% CI, 3.58-16.03), and progressive cognitive decline (OR, 19.00; 95% CI, 9.14-39.51), while nonsevere COVID-19 was associated with a higher risk of early-onset cognitive decline (OR, 1.71; 95% CI, 1.30-2.27) when adjusting for age, sex, education level, body mass index, and comorbidities. CONCLUSIONS AND RELEVANCEIn this cohort study, COVID-19 survival was associated with an increase in risk of longitudinal cognitive decline, highlighting the import...

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Evolution of neurologic symptoms in non‐hospitalized COVID‐19 “long haulers”

Ali

Kang

Patel

et al. 2022

Ann Clin Transl Neurol

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Objective We characterized the evolution of neurologic symptoms and self‐perceived recovery of non‐hospitalized COVID‐19 “long haulers” 6–9 months after their initial Neuro‐COVID‐19 clinic evaluation. Methods In this follow‐up study on the first 100 patients, 50 SARS‐CoV‐2 laboratory‐positive (SARS‐CoV‐2 + ), and 50 laboratory‐negative (SARS‐CoV‐2 − ), evaluated at our Neuro‐COVID‐19 clinic between May and November 2020, patients completed phone questionnaires on their neurologic symptoms, subjective impression of recovery and quality of life. Results Of 52 patients who completed the study (27 SARS‐CoV‐2 + , 25 SARS‐CoV‐2 − ) a median 14.8 (range 11–18) months after symptom onset, mean age was 42.8 years, 73% were female, and 77% were vaccinated for SARS‐CoV‐2. Overall, there was no significant change in the frequency of most neurologic symptoms between first and follow‐up evaluations, including “brain fog” (81 vs. 71%), numbness/tingling (69 vs. 65%), headache (67 vs. 54%), dizziness (50 vs. 54%), blurred vision (34 vs. 44%), tinnitus (33 vs. 42%), and fatigue (87 vs. 81%). However, dysgeusia and anosmia decreased overall (63 vs. 27%, 58 vs. 21%, both p < 0.001). Conversely, heart rate and blood pressure variation (35 vs. 56%, p = 0.01) and gastrointestinal symptoms (27 vs. 48%, p = 0.04) increased at follow‐up. Patients reported improvements in their recovery, cognitive function, and fatigue, but quality of life measures remained lower than the US normative population ( p < 0.001). SARS‐CoV‐2 vaccination did not have a positive or detrimental impact on cognitive function or fatigue. Interpretation Non‐hospitalized COVID‐19 “long haulers” continue to experience neurologic symptoms, fatigue, and compromised quality of life 14.8 months after initial infection.

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Post-COVID syndrome in non-hospitalised patients with COVID-19: a longitudinal prospective cohort study

Cited by 496 publications

References 38 publications

Risk factors for long COVID: analyses of 10 longitudinal studies and electronic health records in the UK

Risk factors for long COVID: analyses of 10 longitudinal studies and electronic health records in the UK

One-Year Trajectory of Cognitive Changes in Older Survivors of COVID-19 in Wuhan, China

Evolution of neurologic symptoms in non‐hospitalized COVID‐19 “long haulers”

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