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High Prevalence of Persistent Symptoms and Reduced Health-Related Quality of Life 6 Months after COVID-19

25 Pages Posted: 1 Nov 2022

See all articles by Irma Ahmad

Irma Ahmad

Örebro University - Department of Infectious Diseases

Alicia Edin

Umeå University - Department of Surgical and Perioperative Sciences

Christoffer Granvik

Umeå University - Department of Clinical Microbiology

Lowa Kumm Persson

Umeå University - Department of Surgical and Perioperative Sciences

Staffan Tevell

Karlstad Hospital - Department of Infectious Diseases

Emeli Månsson

Örebro University - Department of Infectious Diseases

Ingela Marklund

Centre for Clinical Research and Education

Ida-Lisa Persson

Umeå University - Department of Clinical Microbiology

Anna Kauppi

Umeå University - Department of Clinical Microbiology

Clas Ahlm

Umeå University - Department of Clinical Microbiology

Mattias N.E. Forsell

Umeå University - Department of Clinical Microbiology

Josefin Sundh

Örebro University - Department of Respiratory Medicine

Anna Lange

Örebro University - Department of Infectious Diseases

Sara Cajander

Örebro University - Department of Infectious Diseases

Johan Normark

Umeå University - Department of Clinical Microbiology

More...

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, six months after infection, and explored risk factors for COVID-19 sequalae.

Methods: This was a prospective, multicentre, 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 logistic regression. 

Findings: Persistent symptoms were experienced by 78% of hospitalised, and 58% of non-hospitalised patients at 6 months. Hospitalised patients had a higher prevalence of self-assessed reduced overall health (27% vs. 11%) and PACS+ (31% vs. 11%). PACS+ was associated with reduced exercise capacity but not with abnormal pulse/desaturation during 1MSTST. Hospitalisation was the most important independent risk factor for developing persistent symptoms, reduced overall health and PACS+.

Interpretation: 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 hospitalisation were more likely to develop PACS+, hence these patients should be prioritized for clinical follow-up after COVID-19.

Funding: Grants from Nyckelfonden Örebro (OLL-938628, OLL-961416), Regional Research Council Mid Sweden (RFR-968856, RFR-940474 to S.C), Swedish Research Council (2020-06235 to M.N.E.F., 2016-06514 to J.N.), Swedish Heart-Lung Foundation (20200325 & 20210078 to C.A.), SciLife Lab COVID-19 research program funded by the Knut and Alice Wallenberg Foundation (VC-2020-0015 to C.A.), Umeå University and County Council of Västerbotten (RV-938855 to C.A.), Region Värmland (LIVFOU-939646), Region Västmanland (20201009 to E.M.) and ALF funding Region Örebro County. J.N. is a Wallenberg Centre for Molecular Medicine Associated Researcher.

Declartion of Interest: We declare no competing interests.

Ethical Approval: Ethical approval for the study was granted from Swedish Ethical Review Authority, Uppsala, (approval number: 2020-01557).

Keywords: COVID-19, Post acute COVID syndrome, health related quality of life

Suggested Citation

Ahmad, Irma and Edin, Alicia and Granvik, Christoffer and Kumm Persson, Lowa and Tevell, Staffan and Månsson, Emeli and Marklund, Ingela and Persson, Ida-Lisa and Kauppi, Anna and Ahlm, Clas and Forsell, Mattias N.E. and Sundh, Josefin and Lange, Anna and Cajander, Sara and Normark, Johan, High Prevalence of Persistent Symptoms and Reduced Health-Related Quality of Life 6 Months after COVID-19. Available at SSRN: https://ssrn.com/abstract=4264310 or http://dx.doi.org/10.2139/ssrn.4264310

Irma Ahmad

Örebro University - Department of Infectious Diseases ( email )

Alicia Edin

Umeå University - Department of Surgical and Perioperative Sciences ( email )

Christoffer Granvik

Umeå University - Department of Clinical Microbiology ( email )

Lowa Kumm Persson

Umeå University - Department of Surgical and Perioperative Sciences ( email )

Staffan Tevell

Karlstad Hospital - Department of Infectious Diseases ( email )

Emeli Månsson

Örebro University - Department of Infectious Diseases ( email )

Ingela Marklund

Centre for Clinical Research and Education ( email )

Ida-Lisa Persson

Umeå University - Department of Clinical Microbiology ( email )

Anna Kauppi

Umeå University - Department of Clinical Microbiology ( email )

Clas Ahlm

Umeå University - Department of Clinical Microbiology

Mattias N.E. Forsell

Umeå University - Department of Clinical Microbiology ( email )

Josefin Sundh

Örebro University - Department of Respiratory Medicine ( email )

Anna Lange

Örebro University - Department of Infectious Diseases ( email )

Sara Cajander

Örebro University - Department of Infectious Diseases ( email )

Johan Normark (Contact Author)

Umeå University - Department of Clinical Microbiology ( email )