High Prevalence of Persistent Symptoms and Reduced Health-Related Quality of Life 6 Months after COVID-19

Background: The long-term sequelae after COVID-19 constitute a challenge to public health and increased knowledge is needed. We investigated the prevalence of self-reported persistent symptoms and reduced health-related quality of life (HRQoL) in relation to functional exercise capacity, six months after infection, and explored risk factors for COVID-19 sequalae. Methods: This was a prospective, multicentre, cohort study including 434 patients. At 6 months, physical exercise capacity was assessed by a 1-minute sit-to-stand test (1MSTST) and persistent symptoms were reported and HRQoL was evaluated through the EuroQol 5-level 5-dimension (EQ-5D-5L) questionnaire. Patients with both persistent symptoms and reduced HRQoL were classified into a new definition of post-acute COVID syndrome, PACS+. Risk factors for developing persistent symptoms, reduced HRQoL and PACS+ were identified by multivariable logistic regression. Findings: Persistent symptoms were experienced by 78% of hospitalised, and 58% of non-hospitalised patients at 6 months. Hospitalised patients had a higher prevalence of self-assessed reduced overall health (27% vs. 11%) and PACS+ (31% vs. 11%). PACS+ was associated with reduced exercise capacity but not with abnormal pulse/desaturation during 1MSTST. Hospitalisation was the most important independent risk factor for developing persistent symptoms, reduced overall health and PACS+. Interpretation: Persistent symptoms and reduced HRQoL are common among COVID-19 survivors, but abnormal pulse and peripheral saturation during exercise could not distinguish patients with PACS+. Patients with severe infection requiring hospitalisation were more likely to develop PACS+, hence these patients should be prioritized for clinical follow-up after COVID-19.