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Introduction: Many individuals hospitalised with COVID-19 experience persistent symptoms following acute infection, known as long COVID or post-acute sequelae of COVID-19 (PASC). Objective(s): To conduct a de novo SLR and meta-analysis to identify PASC-associated symptoms in patients that required hospitalisation, and to determine frequency and temporal nature of PASC. Method(s): Searches of MEDLINE, Embase, the Cochrane Library (from 2019-2021), WHO ICTRP and reference lists were performed. Articles were assessed by two reviewers against eligibility criteria and a risk-of-bias tool. Symptom data were synthesised by random-effects meta-analyses. Result(s): Of 6,942 records found, 52 studies with >100 patients were included in this analysis, ~70% of which were Europe-based. Most collected data from the first wave of the pandemic. PASC symptoms were analysed from 28 days to 1 year after hospital discharge. At 1-4 months post-acute COVID, the most frequent symptoms were fatigue (29%;95% CI: 20-41) and dyspnea (20%;13-29). Symptom burden persisted at 4-8 and 8-12 months (Fig 1). Conclusion(s): Lasting symptoms of COVID-19 can result in clinical and societal burden long after acute infection. Further research with longer follow-up is needed to better define the duration of PASC and whether factors such as vaccination, hospitalisation status and prior treatments have an impact on PASC.
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Background: Persisting breathlessness after COVID-19 infection is common and debilitating. We aimed to characterise and identify risk factors for patients with persistent breathlessness following COVID-19 hospitalisation. Method(s): PHOSP-COVID is a multi-centre prospective cohort study of UK adults hospitalised for COVID-19. Clinical data were collected during hospitalisation and at a research visit. Breathlessness was measured by a numeric rating scale of 0-10. We defined post-COVID breathlessness as an increase in score of 1 or more compared to the preCOVID-19 level. Multivariable logistic regression was used to identify risk factors. Result(s): We included 1,226 participants (37% female, median age 59 years, 22% mechanically ventilated). At a median five months after discharge, 50% reported post-COVID breathlessness. Risk factors for post-COVID breathlessness were socio-economic deprivation (adjusted odds ratio, 1.67;95% confidence interval, 1.14-2.44), pre-existing depression/anxiety (1.58;1.06-2.35), female sex (1.56;1.21-2.00) and admission duration (1.01;1.00- 1.02). Black ethnicity (0.56;0.35-0.89) and older age groups (0.31;0.14-0.66) were less likely to report post-COVID breathlessness. Post-COVID breathlessness was associated with worse performance on the shuttle walk test and forced vital capacity, but not with obstructive airflow limitation. Conclusion(s): Half of this national cohort of patients hospitalised for COVID-19 experienced persistent breathlessness at follow up. The risk factors identified for post-COVID breathlessness should inform mechanistic work to understand causal processes and develop future interventions to improve outcomes in this growing population.