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

  1. Islam Galal
  2. Aliae A. R. Mohamed Hussein
  3. Mariam T. Amin
  4. Mahmoud M. Saad
  5. Hossam Eldeen E. Zayan
  6. Mustafa Z. Abdelsayed
  7. Mohamed M. Moustafa
  8. Abdel Rahman Ezzat
  9. Radwa E. D. Helmy
  10. Howida K. Abd_Elaal
  11. Nasrallah A. Al Massry
  12. Mohamed A. Soliman
  13. Asmaa M. Ismail
  14. Karima M. S. Kholief
  15. Enas Fathy
  16. Maiada K. Hashem

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Abstract

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.

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  1. Version published to 10.1186/s43168-020-00049-4
  2. ScreenIT

    SciScore for 10.1101/2020.11.11.20230052: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIACUC: The study was approved by the ethical committee of Aswan Faculty of Medicine, Egypt (IRB number: aswu /469/7/2020) and registered in Clinicaltrial.gov: NCT04479293. Statistical Analysis: Statistical analyses were performed using IBM SPSS Statistics version 20 (SPSS Inc., Chicago, IL, USA).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The study was approved by the ethical committee of Aswan Faculty of Medicine, Egypt (IRB number: aswu /469/7/2020) and registered in Clinicaltrial.gov: NCT04479293. Statistical Analysis: Statistical analyses were performed using IBM SPSS Statistics version 20 (SPSS Inc., Chicago, IL, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Finally, the results of this study are challenged by some limitations. First, the designated sample of post-COVID-19 cases is not entirely illustrative of the all post-COVID-19 patients. Second, symptoms that initiated after the date of analysis were not verified in this survey. Third, random selection bias may be present and an inability for personal face-to-face interview in some cases. Finally, our results were made as a single point of follow-up and further follow up at 3, 6, or 12 months would aid further understanding of the progression of symptoms post-COVID-19. So, more studies and researches are desired to better appreciate, describe, and identify the persistent post-COVID symptoms in various sceneries and residents.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04479293RecruitingPost COVID-19 Functional Status in Egypt

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.11.11.20230052 on medRxiv