Predictors of Long-COVID-19 and its Impact on Quality of Life: Longitudinal Analysis at 3, 6 and 9 Months after Discharge from a Portuguese Centre

Authors

  • Pedro Gaspar * Co-first author. Internal Medicine Department 2. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Instituto de Semiótica Clínica. Faculdade de Medicina. Universidade de Lisboa. Lisbon; Instituto de Medicina Molecular João Lobo Antunes. Faculdade de Medicina. Universidade de Lisboa. Centro Académico de Medicina de Lisboa. Lisbon. https://orcid.org/0000-0002-6965-3435
  • Mariana Dias * Co-first author. Internal Medicine Department 2. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon.
  • Inês Parreira Internal Medicine Department 2. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon.
  • Hélder Diogo Gonçalves Internal Medicine Department 2. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon.
  • Federica Parlato Internal Medicine Department 2. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon.
  • Valeria Maione Pneumology Department. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon.
  • Henrique Atalaia Barbacena Internal Medicine Department 2. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon.
  • Carolina Carreiro Internal Medicine Department 2. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon.
  • Leila Duarte Internal Medicine Department 2. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Clínica Universitária de Medicina 2. Faculdade de Medicina. Universidade de Lisboa. Lisbon.

DOI:

https://doi.org/10.20344/amp.19047

Keywords:

COVID-19, Portugal, Post-Acute COVID-19 Syndrome, Quality of Life

Abstract

Introduction: Long-COVID-19 impacts health-related quality of life (HR-QoL) but data is scarce. The aim of this study was to describe and prospectively assess the prevalence and risk factors for long-COVID-19 after hospital discharge, and to evaluate its impact on patient HR-QoL.
Methods: Single-centre longitudinal study including all COVID-19 patients discharged between December 2020 and February 2021. Patients were contacted remotely at three, six and nine months. Data were collected as follows: 1) Long-COVID-19 symptoms were self-reported; 2) HRQoL were assessed using the 3-level EuroQoL-5D (EQ-5D-3L) questionnaire. Pregnant women, demented, bedridden, and non-Portuguese-speaking patients were excluded.
Results: The three-, six- and nine-month assessments were completed by 152, 117 and 110 patients (median age: 61 years; male sex: 56.6%). Long-COVID-19 (≥ 1 symptom) was reported by 66.5%, 62.4% and 53.6% of patients and HR-QoL assessment showed impairment of at least some domain in 65.8%, 69.2% and 55.4% of patients at three, six and nine months, respectively. Fatigue was the most common long-COVID-19 symptom. Anxiety/depression domain was the most frequently affected in all three time-points, peaking at six months (39%), followed by pain/discomfort and mobility domains. Long-COVID-19 was associated with the impairment of all EQ-5D-3L domains except for self-care domain at each time-point. Neither intensive care unit admission nor disease severity were associated with long-COVID-19 nor with impairment of any EQ-5D-3L domain. After adjusting for sex, age, frailty status, and comorbid conditions, long-COVID-19 remained significantly associated with HR-QoL impairment at three (OR 4.27, 95% CI 1.92 – 9.52, p < 0.001), six (OR 3.46, 95% CI 1.40 – 8.57, p = 0.007) and nine months (OR 4.13, 95% CI 1.62 – 10.55, p = 0.003) after hospital discharge. In a
longitudinal analysis, patients reporting long-COVID-19 at three months had an EQ-5D-3L index value decreased by 0.14 per visit (p < 0.001) compared to those without long-COVID-19 and both groups had a non-significant change in mean EQ-5D-3L index over the nine-month period (time-point assessment, Z = 0.91, p = 0.364).
Conclusion: Clinical sequelae associated with long-COVID-19 can persist for at least nine months after hospital discharge in most patients and can impair long-term HR-QoL in more than half of patients regardless of disease severity, and clinicodemographic characteristics.

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References

Borges do Nascimento IJ, O’Mathúna DP, von Groote TC, Abdulazeem HM, Weerasekara I, Marusic A, et al. Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews. BMC Infect Dis. 2021;21:525. DOI: https://doi.org/10.1186/s12879-021-06214-4

Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2022;22:e102–7. DOI: https://doi.org/10.1016/S1473-3099(21)00703-9

Chen C, Haupert SR, Zimmermann L, Shi X, Fritsche LG, Mukherjee B. Global prevalence of post-coronavirus disease 2019 (COVID-19) condition or long COVID: a meta-analysis and systematic review. J Infect Dis. 2022;226:1593-607. DOI: https://doi.org/10.1093/infdis/jiac136

Malik P, Patel K, Pinto C, Jaiswal R, Tirupathi R, Pillai S, et al. Post-acute COVID-19 syndrome (PCS) and health-related quality of life (HRQoL)—a systematic review and meta-analysis. J Med Virol. 2022;94:253–62. DOI: https://doi.org/10.1002/jmv.27309

Batawi S, Tarazan N, Al-Raddadi R, Al Qasim E, Sindi A, AL Johni S, et al. Quality of life reported by survivors after hospitalization for Middle East respiratory syndrome (MERS). Health Qual Life Outcomes. 2019;17:101. DOI: https://doi.org/10.1186/s12955-019-1165-2

Lee AM, Wong JG, McAlonan GM, Cheung V, Cheung C, Sham PC, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry. 2007;52:233–40. DOI: https://doi.org/10.1177/070674370705200405

Hui DS. Impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors. Thorax. 2005;60:401–9. DOI: https://doi.org/10.1136/thx.2004.030205

Moldofsky H, Patcai J. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a casecontrolled study. BMC Neurol. 2011;11:37. DOI: https://doi.org/10.1186/1471-2377-11-37

Ahmed H, Patel K, Greenwood D, Halpin S, Lewthwaite P, Salawu A, et al. Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: a systematic review and meta-analysis. J Rehabil Med. 2020;52:jrm00063. DOI: https://doi.org/10.2340/16501977-2694

Huang L, Li X, Gu X, Zhang H, Ren L, Guo L, et al. Health outcomes in people 2 years after surviving hospitalisation with COVID-19: a longitudinal cohort study. Lancet Respir Med. 2022;S2213260022001266. DOI: https://doi.org/10.1016/S2213-2600(22)00126-6

Ferreira LN, Ferreira PL, Pereira LN, Oppe M. The valuation of the EQ-5D in Portugal. Qual Life Res. 2014;23:413–23. DOI: https://doi.org/10.1007/s11136-013-0448-z

Marshall JC, Murthy S, Diaz J, Adhikari NK, Angus DC, Arabi YM, et al. A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect Dis. 2020;20:e192–7. DOI: https://doi.org/10.1016/S1473-3099(20)30483-7

Rivera-Izquierdo M, Láinez-Ramos-Bossini AJ, de Alba IG, Ortiz-González-Serna R, Serrano-Ortiz Á, Fernández-Martínez NF, et al. Long COVID 12 months after discharge: persistent symptoms in patients hospitalised due to COVID-19 and patients hospitalised due to other causes—a multicentre cohort study. BMC Med. 2022;20:92. DOI: https://doi.org/10.1186/s12916-022-02292-6

Wu X, Liu X, Zhou Y, Yu H, Li R, Zhan Q, et al. 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. Lancet Respir Med. 2021;9:747–54. DOI: https://doi.org/10.1016/S2213-2600(21)00174-0

Seeßle J, Waterboer T, Hippchen T, Simon J, Kirchner M, Lim A, et al. Persistent symptoms in adult patients 1 year after coronavirus disease 2019 (COVID-19): a prospective cohort study. Clin Infect Dis. 2022;74:1191–8. DOI: https://doi.org/10.1093/cid/ciab611

Fumagalli C, Zocchi C, Tassetti L, Silverii MV, Amato C, Livi L, et al. Factors associated with persistence of symptoms 1 year after COVID-19: a longitudinal, prospective phone-based interview follow-up cohort study. Eur J Intern Med. 2022;97:36–41. DOI: https://doi.org/10.1016/j.ejim.2021.11.018

Carvalho-Schneider C, Laurent E, Lemaignen A, Beaufils E, Bourbao-Tournois C, Laribi S, et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect. 2021;27:258–63. DOI: https://doi.org/10.1016/j.cmi.2020.09.052

Arnold DT, Hamilton FW, Milne A, Morley AJ, Viner J, Attwood M, et al. Patient outcomes after hospitalisation with COVID-19 and implications for followup: results from a prospective UK cohort. Thorax. 2021;76:399–401. DOI: https://doi.org/10.1136/thoraxjnl-2020-216086

Moreno-Pérez O, Merino E, Leon-Ramirez JM, Andres M, Ramos JM, Arenas-Jiménez J, et al. Post-acute COVID-19 syndrome. Incidence and risk factors: a Mediterranean cohort study. J Infect. 2021;82:378–83. DOI: https://doi.org/10.1016/j.jinf.2021.01.004

Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397:220–32. DOI: https://doi.org/10.1016/S0140-6736(20)32656-8

Righi E, Mirandola M, Mazzaferri F, Dossi G, Razzaboni E, Zaffagnini A, et al. Determinants of persistence of symptoms and impact on physical and mental wellbeing in Long COVID: a prospective cohort study. J Infect. 2022;84:566–72. DOI: https://doi.org/10.1016/j.jinf.2022.02.003

Zhang X, Wang F, Shen Y, Zhang X, Cen Y, Wang B, et al. Symptoms and health outcomes among survivors of COVID-19 infection 1 year after discharge from hospitals in Wuhan, China. JAMA Netw Open. 2021;4:e2127403. DOI: https://doi.org/10.1001/jamanetworkopen.2021.27403

Boscolo-Rizzo P, Guida F, Polesel J, Marcuzzo AV, Capriotti V, D’Alessandro A, et al. Sequelae in adults at 12 months after mild-to-moderate coronavirus disease 2019 (COVID-19). Int Forum Allergy Rhinol. 2021;11:1685–8. DOI: https://doi.org/10.1002/alr.22832

Antunes Meireles P, Gaspar P, Parreira I, Abrantes AM, Dias Silva V, Bessa F, et al. Caracterização demográfica, curso clínico e fatores de risco para mortalidade em doentes hospitalizados com COVID-19: experiência de um hospital terciário Português na primeira vaga da pandemia. Med Interna. 2021;28:145-54. DOI: https://doi.org/10.24950/O/30/21/2/2021

Bellou V, Tzoulaki I, van Smeden M, Moons KG, Evangelou E, Belbasis L. Prognostic factors for adverse outcomes in patients with COVID-19: a fieldwide systematic review and meta-analysis. Eur Respir J. 2022;59:2002964. DOI: https://doi.org/10.1183/13993003.02964-2020

Sablerolles RS, Lafeber M, van Kempen JA, van de Loo BP, Boersma E, Rietdijk WJ, et al. Association between Clinical Frailty Scale score and hospital mortality in adult patients with COVID-19 (COMET): an international, multicentre, retrospective, observational cohort study. Lancet Healthy Longev. 2021;2:e163–70.

Chen Y, Almirall-Sánchez A, Mockler D, Adrion E, Domínguez-Vivero C, Romero-Ortuño R. Hospital-associated deconditioning: not only physical, but also cognitive. Int J Geriatr Psychiatry. 2022;37:gps.5687. DOI: https://doi.org/10.1002/gps.5687

Lam MH. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. Arch Intern Med. 2009;169:2142. DOI: https://doi.org/10.1001/archinternmed.2009.384

Ngai JC, Ko FW, Ng SS, To KW, Tong M, Hui DS. The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status. Respirology. 2010;15:543–50. DOI: https://doi.org/10.1111/j.1440-1843.2010.01720.x

Gaspar P, Cohen H, Isenberg DA. The assessment of patients with the antiphospholipid antibody syndrome: where are we now? Rheumatology. 2020;59:1489–94. DOI: https://doi.org/10.1093/rheumatology/keaa172

Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: a cross-sectional evaluation. J Med Virol. 2021;93:1013–22. DOI: https://doi.org/10.1002/jmv.26368

Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020;81:e4–6. DOI: https://doi.org/10.1016/j.jinf.2020.08.029

Fernandes J, Fontes L, Coimbra I, Paiva JA. Health-related quality of life in survivors of severe COVID-19 of a university hospital in northern Portugal. Acta Médica Port. 2021;34:601. DOI: https://doi.org/10.20344/amp.16277

Huang L, Yao Q, Gu X, Wang Q, Ren L, Wang Y, et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet. 2021;398:747–58. DOI: https://doi.org/10.1016/S0140-6736(21)01755-4

Ursini F, Ciaffi J, Mancarella L, Lisi L, Brusi V, Cavallari C, et al. Fibromyalgia: a new facet of the post-COVID-19 syndrome spectrum? Results from a web-based survey. RMD Open. 2021;7:e001735. DOI: https://doi.org/10.1136/rmdopen-2021-001735

Schaefer C, Chandran A, Hufstader M, Baik R, McNett M, Goldenberg D, et al. The comparative burden of mild, moderate and severe fibromyalgia: results from a cross-sectional survey in the United States. Health Qual Life Outcomes. 2011;9:71. DOI: https://doi.org/10.1186/1477-7525-9-71

Nyberg J, Henriksson M, Wall A, Vestberg T, Westerlund M, Walser M, et al. Anxiety severity and cognitive function in primary care patients with anxiety disorder: a cross-sectional study. BMC Psychiatry. 2021;21:617. DOI: https://doi.org/10.1186/s12888-021-03618-z

Zhang X, Gao R, Zhang C, Chen H, Wang R, Zhao Q, et al. Evidence for cognitive decline in chronic pain: a systematic review and meta-analysis. Front Neurosci. 2021 22;15:737874. DOI: https://doi.org/10.3389/fnins.2021.737874

Antonelli M, Pujol JC, Spector TD, Ourselin S, Steves CJ. Risk of long COVID associated with delta versus omicron variants of SARS-CoV-2. Lancet. 2022;399:2263–4. DOI: https://doi.org/10.1016/S0140-6736(22)00941-2

Spinicci M, Graziani L, Tilli M, Nkurunziza J, Vellere I, Borchi B, et al. Infection with SARS-CoV-2 variants is associated with different long COVID phenotypes. Viruses. 2022 27;14:2367. DOI: https://doi.org/10.3390/v14112367

Notarte KI, Catahay JA, Velasco JV, Pastrana A, Ver AT, Pangilinan FC, et al. Impact of COVID-19 vaccination on the risk of developing long-COVID and on existing long-COVID symptoms: a systematic review. ClinicalMedicine. 2022;53:101624. DOI: https://doi.org/10.1016/j.eclinm.2022.101624

Instituto Nacional de Saúde Doutor Ricardo Jorge. Genetic diversity of the novel coronavirus SARS-CoV-2 (COVID-19) in Portugal. 2022. [cited 2022 Dec 22]. Available from: https://insaflu.insa.pt/covid19.

Direção-Geral da Saúde. COVID-19: Condição Pós-COVID-19. Norma de Orientação Clínica 002/2022. 2022. [cited 2022 Dec 23]. Available from: https://www.dgs.pt/normas-orientacoes-e-informacoes/normas-e-circulares-normativas/norma-n-0022022-de-17032022-pdf.aspx.

Published

2023-02-24

How to Cite

1.
Gaspar P, Dias M, Parreira I, Gonçalves HD, Parlato F, Maione V, Atalaia Barbacena H, Carreiro C, Duarte L. Predictors of Long-COVID-19 and its Impact on Quality of Life: Longitudinal Analysis at 3, 6 and 9 Months after Discharge from a Portuguese Centre. Acta Med Port [Internet]. 2023 Feb. 24 [cited 2024 Mar. 29];36(10):647-60. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/19047

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