Long COVID Symptoms in Non-Hospitalised Patients: A Retrospective Study

Authors

DOI:

https://doi.org/10.20344/amp.19566

Keywords:

COVID-19/complications, Post-Acute COVID-19 Syndrome, Primary Health Care

Abstract

Introduction: The COVID-19 pandemic has presented numerous challenges to healthcare systems. As the number of affected individuals continues to rise, it is crucial to find preventive, diagnostic, and therapeutic approaches. This study aims to describe different COVID-19 sequelae within a Primary Health Care population.

Methods: A retrospective cohort study was conducted in adults diagnosed with COVID-19 from March 2020 to April 2022, excluding pregnant women, minors, nursing home residents, hospitalizations, and deaths. Data was gathered from surveillance records on the Trace COVID-19® platform, a pre-set original questionnaire (which included the Portuguese version of the World Health Organization’s Quality of Life Assessment Instrument), and, if needed, patient electronic health records. Information on sociodemographic and clinical characteristics of acute COVID-19 was collected along with long COVID symptoms.

Results: This study included 284 patients, aged 19 to 99 years old. The five most prevalent acute COVID-19 symptoms were fever (50.0%), tiredness (48.2%), myalgias (44.7%), dry cough (37.7%) and odynophagia (36.3%). Symptoms related to the neurological system (23.2%) and tiredness (22.9%) were the most prevalent in long COVID symptoms. Acute tiredness and arthralgia were associated with all long COVID outcomes. The associations between acute COVID-19 symptoms with long COVID outcomes were stronger for anosmia [OR = 5.07, 95% confidence interval (CI) 2.49 - 10.36, p < 0.001] on a neurological chapter, acute tiredness for long lasting tiredness (OR = 4.07, 95% CI 2.07 - 8.02, p = 0.041), fatigue for muscles and/or bones chapter (OR = 7.55, 95% CI 3.06 - 18.66, p < 0.001), tiredness on an endocrine/hormonal chapter (OR = 6.54, 95% CI 2.37 - 18.04, p < 0.001), dyspnea for respiratory symptoms (OR = 5.67, 95% CI 1.92 - 16.74, p = 0.002) and fever for stomach or intestine symptoms (OR = 8.06, 95% CI 2.55 - 25.47, p < 0.001). Almost all quality of life dimensions were negatively associated with the number of long COVID symptoms.

Conclusion: A higher number of acute symptoms, as well as the presence of specific COVID-19 symptoms were associated with reported symptoms ≥ 12 weeks after infection. In the studied population, an increased number of symptoms in both acute and long COVID had a significant negative impact on the perception of overall quality of life. The identification of these relationships could provide a new perspective for post-COVID care.

Downloads

Download data is not yet available.

References

Stafie CS, Solomon SM, Sufaru IG, Manaíra M, Stafie I, Melinte G, et al. Pathogenic connections in post-COVID conditions: what do we know in the large unknown? A narrative review. Viruses. 2022;14:1686. DOI: https://doi.org/10.3390/v14081686

World Health Organization. Coronavirus (COVID-19) Dashboard. WHO Coronavirus (COVID-19) Dashboard with vaccination data. [cited 2022 Nov 12]. Available from: https://covid19.who.int/?adgroupsurvey={adgroupsurvey}&gclid=CjwKCAiA7IGcBhA8EiwAFfUDsUmVPO6H6MdGsxoL8lUELV10aUc7aHN8ThMhRbbsmGmPX 9Ld2wdBRBoC-ngQAvD_BwEGitHub - CSSEGISandData/COVID-19: Novel Coronavirus (COVID-19) Cases, provided by JHU CSSE.

Franco JV, Garegnani LI, Oltra GV, Metzendorf M, Trivisonno L, Sgarbossa N, et al. Long-term health symptoms and sequelae following SARS-CoV-2 infection: an evidence map. Int J Environ Res Public Health. 2022;19:9915. DOI: https://doi.org/10.3390/ijerph19169915

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:e1027. DOI: https://doi.org/10.1016/S1473-3099(21)00703-9

Serviços Partilhados do Ministério da Saúde. Trace COVID-19: gestão de vigilâncias. Manual de utilizador. Version 1.1. 2020. [cited 2022 Nov 23]. Available from: https://www.arscentro.min-saude.pt/wp-content/uploads/sites/6/2020/05/TraceCOVID-deck-V1.pdf

Michelen M, Manoharan L, Elkheir N, Cheng V, Dagens A, Hastie C, et al. Characterising long COVID: a living systematic review. BMJ Glob Health. 2021;6:e005427. DOI: https://doi.org/10.1136/bmjgh-2021-005427

Nalbandian A, Sehgal K, Gupta A, Madhavan M, McGroder C, Stevens J, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27:601-15. DOI: https://doi.org/10.1038/s41591-021-01283-z

Greenhalgh T, Knight M, A’Court C, Buxton M, Husain L. Management of post- acute covid-19 in primary care. BMJ. 2020;370:m3026. DOI: https://doi.org/10.1136/bmj.m3026

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

Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo P, Cuapio A, et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep. 2021;11:16144. DOI: https://doi.org/10.1038/s41598-021-95565-8

Rello J, James A, Reyes LF. Post-acute COVID-19 syndrome (PACS): a public health emergency. Anaesth Crit Care Pain Med. 2021;40:100882. DOI: https://doi.org/10.1016/j.accpm.2021.100882

Wong FY, Yang L, Yuen JW, Chang KK, Wong FK. Assessing quality of life using WHOQOL-BREF: a cross-sectional study on the association between quality of life and neighborhood environmental satisfaction, and the mediating effect of health-related behaviors. BMC Public Health. 2018;18:1113. DOI: https://doi.org/10.1186/s12889-018-5942-3

Serra AV, Canavarro MC, Simões MR, Pereira M, Gameiro S, Quartilho MJ, et al. Estudos psicométricos do instrumento avaliação da qualidade de vida da Organização Mundial de Saúde (WHOQOL-Bref) para português de Portugal. Psiquiatria Clínica. 2006;27:41-9.

Nunnally J. Psychometric theory. 2nd ed. New York: McGraw-Hill; 1978.

Gelman A, Hill J. Data analysis using regression and multilevel/hierarchical models. Cambridge: Cambridge University Press; 2006. DOI: https://doi.org/10.1017/CBO9780511790942

Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: a systematic review and meta-analysis. J Infect. 2020;80:656-65. DOI: https://doi.org/10.1016/j.jinf.2020.03.041

Fernández-de-las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Florencio L, Cuadrado M, Plaza-Manzano G, et al. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: a systematic review and meta-analysis. Eur J Intern Med. 2021;92:55-70. DOI: https://doi.org/10.1016/j.ejim.2021.06.009

Talukder A, Razu SR, Alif SM, Rahman MA, Islam SM. Association between symptoms and severity of disease in hospitalised novel coronavirus (COVID- 19) patients: a systematic review and meta-analysis. J Multidiscip Healthc. 2022;15:1101-10. DOI: https://doi.org/10.2147/JMDH.S357867

Munsch N, Gruarin S, Nateqi J, Lutz T, Binder M, Aberle J, et al. Symptoms associated with a COVID-19 infection among a non-hospitalized cohort in Vienna. Wien Klin Wochenschr. 2022;134:344-50. DOI: https://doi.org/10.1007/s00508-022-02028-9

Fernández-de-las-Peñas C, Pellicer-Valero OJ, Navarro-Pardo E, Palacios-Ceña D, Florencio L, Guijarro C, et al. Symptoms experienced at the acute phase of SARS-CoV-2 infection as risk factor of long-term post-COVID symptoms: The LONG-COVID-EXP-CM multicenter study. Int J Infect Dis. 2022;116:241-4. DOI: https://doi.org/10.1016/j.ijid.2022.01.007

Subramanian A, Nirantharakumar K, Hughes S, Myles P, Williams T, Gokhale K, et al. Symptoms and risk factors for long COVID in non-hospitalized adults. Nat Med. 2022;28:1706-14. DOI: https://doi.org/10.1038/s41591-022-01909-w

Silva Andrade B, Siqueira S, de Assis Soares WR, de Souza Rangel F, Santos N, dos Santos Freitas A, et al. Long-COVID and post- COVID health complications: an up-to-date review on clinical conditions and their possible molecular mechanisms. Viruses. 2021;13:700. DOI: https://doi.org/10.3390/v13040700

Bell ML, Catalfamo CJ, Farland L, Ernest K, Jacobs E, Klimentidis Y, et al. Post-acute sequelae of COVID-19 in a non-hospitalized cohort: results from the Arizona CoVHORT. PLoS One. 2021;16:e0254347. DOI: https://doi.org/10.1371/journal.pone.0254347

Salari N, Khodayari Y, Hosseinian-Far A, Zarei H, Rasoulpoor S, Akbari H, et al. Global prevalence of chronic fatigue syndrome among long COVID-19 patients: a systematic review and meta- analysis. Biopsychosoc Med. 2022;16:21. DOI: https://doi.org/10.1186/s13030-022-00250-5

Sykes DL, Holdsworth L, Jawad N, Gunasekera P, Morice AH, Crooks MG. Post- COVID-19 symptom burden: what is long-COVID and how should we manage it? Lung. 2021;199:113-9. DOI: https://doi.org/10.1007/s00408-021-00423-z

van Kessel SA, Olde Hartman TC, Lucassen PL, van Jaarsveld CH. Post- acute and long-COVID-19 symptoms in patients with mild diseases: a systematic review. Fam Pract. 2022;39:159-67. DOI: https://doi.org/10.1093/fampra/cmab076

Pavli A, Theodoridou M, Maltezou HC. Post-COVID syndrome: incidence, clinical spectrum, and challenges for primary healthcare professionals. Arch Med Res. 2021;52:575-81. DOI: https://doi.org/10.1016/j.arcmed.2021.03.010

Ayuso García B, Pérez López A, Besteiro Balado Y, Romay Lema E, García País M, Marchán-López Á, et al. Calidad de vida relacionada con la salud en pacientes recuperados de COVID-19. J Healthc Qual Res. 2022;37:208-15. DOI: https://doi.org/10.1016/j.jhqr.2022.01.001

Han Q, Zheng B, Daines L, Sheikh A. Long-term sequelae of COVID-19: a systematic review and meta-analysis of one-year follow-up studies on post-COVID symptoms. Pathogens. 2022;11:269. DOI: https://doi.org/10.3390/pathogens11020269

Crook H, Raza S, Nowell J, Young M, Edison P. Long covid—mechanisms, risk factors, and management. BMJ. 2021:n1648. DOI: https://doi.org/10.1136/bmj.n1648

Pérez-González A, Araújo-Ameijeiras A, Fernández-Villar A, Crespo M, Poveda E, Cabrera J, et al. Long COVID in hospitalized and non-hospitalized patients in a large cohort in Northwest Spain, a prospective cohort study. Sci Rep. 2022;12:3369. DOI: https://doi.org/10.1038/s41598-022-18023-z

Choudhury A, Tarij R, Jena A, Vesely E, Singh S, Khanna S, et al. Gastrointestinal manifestations of long COVID: a systematic review and meta-analysis. Therap Adv Gastroenterol. 2022;15:17562848221118403. DOI: https://doi.org/10.1177/17562848221118403

Liu Q, Mak JW, Su Q, Yeoh Y, Lui G, Ng S, et al. Gut microbiota dynamics in a prospective cohort of patients with post-acute COVID-19 syndrome. Gut. 2022;71:544-52. DOI: https://doi.org/10.1136/gutjnl-2021-325989

Yan Z, Yang M, Lai CL. Long COVID-19 syndrome: a comprehensive review of its effect on various organ systems and recommendation on rehabilitation plans. Biomedicines. 2021;9:966. DOI: https://doi.org/10.3390/biomedicines9080966

Tomar BS, Singh M, Nathiya D, Sharma A, Sharma E, Bareth H, et al. prevalence of symptoms in patients discharged from COVID care facility of NIMS hospital: is RT PCR negativity truly reflecting recovery? A single-centre observational study. Int J Gen Med. 2021;14:1069-78. DOI: https://doi.org/10.2147/IJGM.S295499

Batiha GE, Al-kuraishy HM, Al-Gareeb AI, Welson NN. Pathophysiology of post-COVID syndromes: a new perspective. Virol J. 2022;19:158. DOI: https://doi.org/10.1186/s12985-022-01891-2

Antonelli M, Penfold RS, Merino J, Sudre C, Molteni E, Berry S, et al. Risk factors and disease profile of post- vaccination SARS-CoV-2 infection in UK users of the COVID symptom study app: a prospective, community-based, nested, case-control study. Lancet Infect Dis. 2022;22:43-55. DOI: https://doi.org/10.1016/S1473-3099(21)00460-6

Gao P, Liu J, Liu M. Effect of COVID-19 vaccines on reducing the risk of long COVID in the real world: a systematic review and meta-analysis. Int J Environ Res Public Health. 2022;19:12422. DOI: https://doi.org/10.3390/ijerph191912422

Ayoubkhani D, Bermingham C, Pouwels KB, Glickman M, Nafilyan V, Zaccardi f, et al. Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study. BMJ. 2022;377:e069676. DOI: https://doi.org/10.1136/bmj-2021-069676

Fischer A, Zhang L, Elbéji A, Wilmes P, Oustric P, Staub T, et al. Long COVID symptomatology after 12 months and its impact on quality of life according to initial coronavirus disease 2019 disease severity. Open Forum Infect Dis. 2022;9:ofac397. DOI: https://doi.org/10.1093/ofid/ofac397

Bryson WJ. Long-term health-related quality of life concerns related to the COVID- 19 pandemic: a call to action. Qual Life Res. 2021;30:643-5. DOI: https://doi.org/10.1007/s11136-020-02677-1

Tsuzuki S, Miyazato Y, Terada M, Morioka S, Ohmagari N, Beutels P. Impact of long-COVID on health-related quality of life in Japanese COVID-19 patients. Health Qual Life Outcomes. 2022;20:125. DOI: https://doi.org/10.1186/s12955-022-02033-6

Strain WD, Sherwood O, Banerjee A, van der Togt V, Hishmeh L, Rossman J. The impact of covid vaccination on symptoms of long COVID: an international survey of people with lived experience of long COVID. Vaccines. 2022;10:652. DOI: https://doi.org/10.3390/vaccines10050652

Sarda R, Kumar A, Chandra A, Bir M, Kumar S, Soneja M, et al. Prevalence of long COVID-19 and its impact on quality of life among outpatients with mild COVID-19 disease at tertiary care center in North India. J Patient Exp. 2022;9:237437352211173. DOI: https://doi.org/10.1177/23743735221117358

Downloads

Published

2023-08-29

How to Cite

1.
M. Oliveira A, Ferreira Coelho C, Lourenço F, Campos Pinto I, Atabão J, Cabrita R, Paraíso R, Mesquita E, Torrado D, Marquez P, Z. Guerreiro V. Long COVID Symptoms in Non-Hospitalised Patients: A Retrospective Study. Acta Med Port [Internet]. 2023 Aug. 29 [cited 2024 Jun. 21];36(10):618-30. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19566

Issue

Section

Original