Determinants of persistent post-COVID-19 symptoms: value of a novel COVID-19 symptom score

Galal, Islam; Hussein, Aliae A. R. Mohamed; Amin, Mariam T.; Saad, Mahmoud M.; Zayan, Hossam Eldeen E.; Abdelsayed, Mustafa Z.; Moustafa, Mohamed M.; Ezzat, Abdel Rahman; Helmy, Radwa E. D.; Abd_Elaal, Howida K.; Al Massry, Nasrallah A.; Soliman, Mohamed A.; Ismail, Asmaa M.; Kholief, Karima M. S.; Fathy, Enas; Hashem, Maiada K.

BACKGROUND: Being a newly emerging disease, little is known about its long-lasting post-COVID-19 consequences. The aim of this work is to assess the frequency, patterns, and determinants of persistent post-COVID-19 symptoms and to evaluate the value of a proposed novel COVID-19 symptom score. Patients with confirmed COVID-19 in a hospital-based registry were included in a cross-sectional study (the hospitals including Assiut University Hospital, Assiut Chest Hospital, Aswan University Hospital, and Aswan Specialized Hospital). The patient demographics, comorbid disorders, the mean duration since the onset of the symptoms, history of hospital or ICU admittance, and the treatment taken during the acute state, as well as symptom score before and after convalescence, were recorded. RESULTS: The most frequent constitutional and neurological symptoms were myalgia (60.0%), arthralgia (57.2%), restriction of daily activities (57.0%), and sleeping troubles (50.9%), followed by anorexia (42.6%), chest pain (32.6%), gastritis (32.3%), cough (29.3%), and dyspnea (29.1%). The mean total score of acute stage symptoms was 31.0 ± 16.3 while post-COVID 19 symptom score was 13.1 ± 12.6 (P < 0.001). The main determinants of the persistent post-COVID-19 symptoms were the need for oxygen therapy (P < 0.001), pre-existing hypertension (P = 0.039), chronic pulmonary disorders (P = 0.012), and any chronic comorbidity (P = 0.004). There was a correlation between the symptom score during the acute attack and post-COVID-19 stage (P < 0.001, r = 0.67). The acute phase score had 83.5% sensitivity and 73.3% specificity for the cutoff point > 18 to predict occurrence of post-COVID-19 symptoms. CONCLUSIONS: COVID-19 can present with a diverse spectrum of long-term post-COVID-19 symptoms. Increased acute phase symptom severity and COVID-19 symptom score > 18 together with the presence of any comorbid diseases increase the risk for persistent post-COVID-19 manifestations and severity.