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. 2021 Jul:6:100122.
doi: 10.1016/j.lanepe.2021.100122. Epub 2021 May 18.

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

Max Augustin  1   2   3 , Philipp Schommers  1   3   4 , Melanie Stecher  1   3 , Felix Dewald  4 , Lutz Gieselmann  4 , Henning Gruell  4 , Carola Horn  1   2   3 , Kanika Vanshylla  4 , Veronica Di Cristanziano  4 , Luise Osebold  1 , Maria Roventa  1 , Toqeer Riaz  1 , Nikolai Tschernoster  5 , Janine Altmueller  5 , Leonard Rose  6 , Susanne Salomon  4 , Vanessa Priesner  1 , Jan Christoffer Luers  7 , Christian Albus  8 , Stephan Rosenkranz  2   9   10 , Birgit Gathof  6 , Gerd Fätkenheuer  1   3 , Michael Hallek  1   2   11   12 , Florian Klein  2   4 , Isabelle Suárez  1   3 , Clara Lehmann  1   2   3
Affiliations

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

Max Augustin et al. Lancet Reg Health Eur. 2021 Jul.

Abstract

Background: While the leading symptoms during coronavirus disease 2019 (COVID-19) are acute and the majority of patients fully recover, a significant fraction of patients now increasingly experience long-term health consequences. However, most data available focus on health-related events after severe infection and hospitalisation. We present a longitudinal, prospective analysis of health consequences in patients who initially presented with no or minor symptoms of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection. Hence, we focus on mild COVID-19 in non-hospitalised patients.

Methods: 958 Patients with confirmed SARS-CoV-2 infection were observed from April 6th to December 2nd 2020 for long-term symptoms and SARS-CoV-2 antibodies. We identified anosmia, ageusia, fatigue or shortness of breath as most common, persisting symptoms at month 4 and 7 and summarised presence of such long-term health consequences as post-COVID syndrome (PCS). Predictors of long-term symptoms were assessed using an uni- and multivariable logistic regression model.

Findings: We observed 442 and 353 patients over four and seven months after symptom onset, respectively. Four months post SARS-CoV-2 infection, 8•6% (38/442) of patients presented with shortness of breath, 12•4% (55/442) with anosmia, 11•1% (49/442) with ageusia and 9•7% (43/442) with fatigue. At least one of these characteristic symptoms was present in 27•8% (123/442) and 34•8% (123/353) at month 4 and 7 post-infection, respectively. A lower baseline level of SARS-CoV-2 IgG, anosmia and diarrhoea during acute COVID-19 were associated with higher risk to develop long-term symptoms.

Interpretation: The on-going presence of either shortness of breath, anosmia, ageusia or fatigue as long-lasting symptoms even in non-hospitalised patients was observed at four and seven months post-infection and summarised as post-COVID syndrome (PCS). The continued assessment of patients with PCS will become a major task to define and mitigate the socioeconomic and medical long-term effects of COVID-19.

Funding: COVIM:"NaFoUniMedCovid19"(FKZ: 01KX2021).

Keywords: Ageusia; Anosmia; COVID-19; Fatigue; Long COVID; Long-term health consequences; PCS; Post infectious syndrome; Post-COVID syndrome; SARS-CoV-2; Shortness of breath.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Total visits at the post-COVID outpatient clinic of the UHC April 6th till December 2nd 2020. Median time (months) of the respective visit (T1, T2 and T3) after the onset of symptoms (T0): T1 1.7 (IQR 1•4–2•1), T2 4•3 (IQR 3•7–4•9) and T3 6•8 (IQR 6•2–7•8). UHC, University Hospital Cologne; IQR, interquartile range; T0, symptom onset; T1, first study visit; T2 s study visit; T3, third study visit.
Fig. 2
Fig. 2
Distribution of post-COVID (PCS) syndrome amongst SARS-CoV-2 convalescent patients. UHC, University Hospital Cologne; T0, symptom onset; T1, first study visit; T2, second study visit; T3, third study visit; LTFU, lost to follow-up.
Fig. 3
Fig. 3
IgG levels at first visit are predictors for post-COVID syndrome (PCS) Bars show percentage of patients that reported the respective symptom at their third visit. Patients have been stratified by IgG levels at their first visit (IgG strata: low: ≤1•1, medium (med) 1•2–4, high >4, values are the ratio of extinction value of patient sample/extinction value of calibrator).
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