Long COVID profoundly affects patients' QoL

In a functional assessment of post-COVID long-term sequelae, individuals suffering from long COVID (having at least one symptom of post-COVID-19 syndrome) had poorer quality of life (QoL) than those unaffected by the syndrome.

“[Our study suggests that] long COVID is a complex clinical condition having a deep impact on patients’ QoL, affecting productivity, public health, and society,” noted Dr Elisa Gentilotti from the University of Verona, Italy, in her presentation at ECCMID 2023.

“We selected the SF-36* scale because it takes into account [both the physical and] mental wellbeing of patients … The COVID-19 pandemic had many social implications that may have impacted QoL from a mental perspective,” she continued. In a structured review, both PCS** and MCS** scores were below the normal range in people with long COVID. [PLoS One 2021;16:e0259164]

Indeed, in the current analysis, patients with long COVID had lower median PCS (47.67 vs 57.32; p<0.001) and MCS (46.77 vs 54.22; p<0.001) scores in the SF-36 scale at 12 months compared with those without long COVID. “[These suggest that] people with long COVID were performing worse than those in the control arm,” said Gentilotti.

On univariate analysis of factors associated with poor QoL (SF-36 PCS <50), there was a decreasing trend in PCS score as age increased; this was not observed with MCS. Both PCS and MCS scores dropped as the number of symptoms increased. [ECCMID 2023, abstract O0050]

There was also a trend towards lower PCS, but not MCS, score among hospitalized individuals. “This trend was evident especially for people transferred to the ICU,” said Gentilotti.

Median PCS score was higher in patients who have received monoclonal antibodies*** (mAb) during the acute infection as opposed to those who have not (57.81 vs 51.78; p=0.001). The same goes for median MCS score (51.19 vs 48.96; p=0.007).

Furthermore, vaccinated individuals had higher PCS score than unvaccinated ones (median 53.55 vs 48.06; p=0.000). This was not the case for MCS (median 49.00 vs 49.30; p=0.913).

On multivariate analysis, female sex appeared to be a risk factor for long COVID (odds ratio [OR], 1.81; p<0.001), as well as neurological symptoms during the acute infection (OR, 2.16; p<0.001). Conversely, mAb therapy during the acute infection presented a protective role against long COVID (OR, 0.19; p<0.001).

Risk factors for poor QoL were female sex (OR, 3.08; p<0.001), age (OR, 1.02; p=0.001), hospital admission (OR, 2.35; p<0.001), chronic respiratory disease (OR, 2.38; p<0.001), diabetes (OR, 1.83; p=0.043), respiratory symptoms (OR, 1.82; p=0.039), and renal events (OR, 2.33; p=0.029).

“[Altogether, these findings imply that] the scenario is quite more complex if we evaluate QoL of people with long COVID,” said Gentilotti.

The ORCHESTRA European cohort included 1,796 patients (mean age 57 years, 54 percent male) from 56 centres in five^# countries that are adopting the same shared protocol and procedure through a homogenized approach. Sixty-nine percent of participants were hospitalized, of whom 29 percent required ICU transfer.

Sixty-four percent were vaccinated (at least one dose); of these, nearly half had long COVID. “[This is] quite high,” noted Gentilotti. “[As per the WHO definition,] long COVID occurs typically 3 months after the acute infection, with symptoms that can be new onset [or those that] persist from the initial illness. Symptoms may also fluctuate or relapse over time.”

Gentilotti noted the inclusion of multiple countries as one of the study’s strong points. “This offered us the opportunity to generalize the results we have obtained. [However,] we were not able to assess QoL before and after COVID-19, thus limiting the possibility for comparisons.”

Long-term follow-up, support needed

“Given the global spread of SARS-CoV-2 infection worldwide, we expect an increasing demand for long-term follow-up and support … Long COVID research needs to focus on multiple aspects including clinical evaluation, laboratory analysis, immunologic and virologic assessment, and QoL measurements, thus reflecting the multidimensional nature of this disease,” said Gentilotti.

“Together with QoL, a cluster analysis of symptoms could give us an estimation of the severity of long COVID. This would also be important for selecting patients at higher risk of developing severe long COVID that could be included in clinical trials for discovering new therapeutic options,” she concluded.