A Retrospective Study of Post-COVID Recovery Clinic's Screening Data to Determine Prevalence of Frailty And Pre-Frailty Among COVID-19 Survivors

To determine the prevalence of pre-frailty and frailty among COVID-19 survivors treated at a hospital system-based Post-COVID Recovery Clinic. Retrospective study using Post-COVID Recovery Clinic screening data. A hospital system-based Post-COVID Recovery Clinic. COVID-19 survivors ≥18 years old (n=287) seen at a Post-COVID Recovery Clinic between July 2020 to May 2021. Descriptive statistics were used to describe demographics and patient-reported information. Differences in frailty status by demographics and patient-reported information were assessed with Chi-square test and analysis of variance. Frailty and pre-frail status were determined based on five pre-defined criteria described by Fried and colleagues. Our modified criteria were drawn from clinic screening questions on significant weight loss, exhaustion, activity level, walking difficulty as a surrogate measure of walking speed, and ability to open jars or grip and open things. COVID-19 survivors (Mage 52.6 ± 14.8 years old, 64.5% female) had ≥ 1 comorbidity, average of 70.82 ± 60 days from COVID diagnosis to follow-up, 6±4 symptoms at the clinic visit, and 2.79±1.06 special care referrals. Of those previously hospitalized, the average length of stay was 7.28 ± 7.89 days. About 53.1% of COVID-19 survivors were pre-frail, and 30.0% were frail. The age group with the highest proportion of frailty was 40-65 years (61%), followed by ages 65+ (23.2%) and 18-39 (15.9%). Our preliminary results indicate that about 1 in 3 COVID-19 survivors met frailty criteria with the majority in the middle age range. Most experienced multiple symptoms 3 months post-diagnosis and needed an average of 3 referrals. Our results warrant further investigation and may indicate targeted interventions to prevent development of permanent disability among COVID-19 survivors. None.

Impact of COVID-19 Infection and Persistent Lingering Symptoms on Patient Reported Indicators of Nutritional Risk and Malnutrition.

Persistent malnutrition after COVID-19 infection may worsen outcomes, including delayed recovery and increased risk of rehospitalization. This study aimed to determine dietary intakes and nutrient distribution patterns after acute COVID-19 illness. Findings were also compared to national standards for intake of energy, protein, fruit, and vegetables, as well as protein intake distribution recommendations. Participants (≥18 years old, n = 92) were enrolled after baseline visit at the Post-COVID Recovery Clinic. The broad screening battery included nutritional assessment and 24-h dietary recall. Participants were, on average, 53 years old, 63% female, 69% non-Hispanic White, and 59% obese/morbidly obese. Participants at risk for malnutrition (48%) experienced significantly greater symptoms, such as gastric intestinal issues, loss of smell, loss of taste, or shortness of breath; in addition, they consumed significantly fewer calories. Most participants did not meet recommendations for fruit or vegetables. Less than 39% met the 1.2 g/kg/day proposed optimal protein intake for recovery from illness. Protein distribution throughout the day was skewed; only 3% met the recommendation at all meals, while over 30% never met the threshold at any meal. Our findings highlight the need for nutritional education and support for patients to account for lingering symptoms and optimize recovery after COVID-19 infection.

Characterizing Long COVID: Deep Phenotype of a Complex Condition.

BACKGROUND: Numerous publications describe the clinical manifestations of post-acute sequelae of SARS-CoV-2 (PASC or "long COVID"), but they are difficult to integrate because of heterogeneous methods and the lack of a standard for denoting the many phenotypic manifestations. Patient-led studies are of particular importance for understanding the natural history of COVID-19, but integration is hampered because they often use different terms to describe the same symptom or condition. This significant disparity in patient versus clinical characterization motivated the proposed ontological approach to specifying manifestations, which will improve capture and integration of future long COVID studies. METHODS: The Human Phenotype Ontology (HPO) is a widely used standard for exchange and analysis of phenotypic abnormalities in human disease but has not yet been applied to the analysis of COVID-19. FUNDING: We identified 303 articles published before April 29, 2021, curated 59 relevant manuscripts that described clinical manifestations in 81 cohorts three weeks or more following acute COVID-19, and mapped 287 unique clinical findings to HPO terms. We present layperson synonyms and definitions that can be used to link patient self-report questionnaires to standard medical terminology. Long COVID clinical manifestations are not assessed consistently across studies, and most manifestations have been reported with a wide range of synonyms by different authors. Across at least 10 cohorts, authors reported 31 unique clinical features corresponding to HPO terms; the most commonly reported feature was Fatigue (median 45.1%) and the least commonly reported was Nausea (median 3.9%), but the reported percentages varied widely between studies. INTERPRETATION: Translating long COVID manifestations into computable HPO terms will improve analysis, data capture, and classification of long COVID patients. If researchers, clinicians, and patients share a common language, then studies can be compared/pooled more effectively. Furthermore, mapping lay terminology to HPO will help patients assist clinicians and researchers in creating phenotypic characterizations that are computationally accessible, thereby improving the stratification, diagnosis, and treatment of long COVID. FUNDING: U24TR002306; UL1TR001439; P30AG024832; GBMF4552; R01HG010067; UL1TR002535; K23HL128909; UL1TR002389; K99GM145411.