Post-COVID-19 Symptoms Not Worse Among Hospitalized Patients Compared to Non-hospitalized Patients

Post-COVID-19 symptoms, also referred to as long COVID-19, do not appear to correlate with COVID-19 severity, according to authors of a recent study published in JAMA Network Open. At 2 years post-infection, 59.7% of hospitalized patients still experienced 1 post-COVID-19 symptom, while 67.5% of non-hospitalized patients still experienced 1 symptom as well.

Among the symptoms that appeared in both patient groups, fatigue was the most common, affecting 44.7% of hospitalized patients and 47.7% of non-hospitalized patients. According to the study authors, this suggests that fatigue “represents the most prevalent and the most long-lasting post–COVID-19 symptom.” The data further suggested that the number of preexisting comorbidities were also associated with post-COVID-19 fatigue.

The study authors noted that post-COVID-19 is defined as the persistence of symptoms after acute SARS-CoV-2 infection. Experts have identified more than 100 post-COVID-19 symptoms that impact multiple systems and may directly worsen health-related quality of life.

The primary objective of this study was to compare the prevalence of post-COVID-19 symptoms (at a 2-year follow-up period) between hospitalized and non-hospitalized patients, since most prior studies had focused on patients requiring hospitalization alone, the study authors explained.

A secondary endpoint in the study was to compare the potential risk factors that could contribute to post-COVID-19 symptoms among both patient groups. The cross-sectional analysis identified 360 hospitalized patients and 308 non-hospitalized patients. The researchers then assessed these patients’ symptoms of dyspnea, fatigue, anosmia, ageusia, hair loss, pain symptoms, diarrhea, skin rashes, palpitations, brain fog, visual disorders, cough, and loss of concentration. The researchers also evaluated symptoms of anxiety or depression using the Hospital Anxiety and Depression Scale (HADS).

The results showed that hospitalized patients did not experience post-COVID-19 symptoms more than non-hospitalized patients—but nearly 20% more of hospitalized patients experienced the more “bothersome” dyspnea as an initial COVID-19 symptom (it could be one of the main symptoms attributed to hospitalizations), and it was also a prevalent post-COVID-19 symptom.

The data also showed that more patients hospitalized with COVID-19 had preexisting comorbid diabetes, and preexisting comorbidities may predate post-COVID-19 fatigue. Additionally, the number of symptoms in the infection’s acute phase may also increase risk of post-COVID-19 symptoms, particularly among non-hospitalized patients.

Additionally, the study authors observed that data on emotional wellbeing showed that individuals with post-COVID-19 symptoms exhibit anxiety and depression. However, the HADS scores were not significantly different between hospitalized and non-hospitalized patients.

Previous reviews and meta-analyses pooled data from hospitalized and non-hospitalized patients within 6 months of initial infection—one such meta-analysis showed that more hospitalized patients suffer from post-COVID-19 symptoms, while current data shows the opposite of this prior analysis.

“The identification of risk factors for identifying who might develop long COVID, how long the symptoms last, and whether COVID-19 prompts the presentation of other chronic diseases is crucial for developing treatment strategies,” study authors wrote in the report.

Reference

Fernández-de-las-Peñas C, Rodríguez-Jiménez J, Cancela-Cilleruelo I, et al. Post–COVID-19 Symptoms 2 Years After SARS-CoV-2 Infection Among Hospitalized vs Nonhospitalized Patients. JAMA Netw Open. 2022;5(11):e2242106. doi:10.1001/jamanetworkopen.2022.42106