Prognostic Factors for Persistent Fatigue after COVID-19: a Prospective Matched Cohort Study

Background: Persistent fatigue after COVID-19 is common; however, the exact incidence and prognostic factors differ between studies. Evidence suggests that age, female sex, high body mass index, and comorbidities are risk factors for long COVID. Aim: To investigate the prevalence of persistent fatigue after COVID-19 in patients with a mild infection (managed in primary care) during the first wave of the pandemic and to determine prognostic factors for persistent fatigue. Design and Setting: Prospective cohort study in Dutch general practice, combining online questionnaires with data from electronic health records. Method: We included patients who contacted their general practitioner (GP) between March and May, 2020, and were diagnosed with COVID-19 during the first wave of the pandemic. Patients were matched to controls without COVID-19 based on age, sex, and GP practice. Fatigue was measured at 3, 6, and 15 months, using the checklist of individual strength (CIS8R). Results: We included 179 COVID-19-suspected and 122 non-COVID-19 outpatients. Persistent fatigue was present in 35% of the COVID-19-suspected patients and 13% of the non-COVID-19 patients (Odds ratio: 3.65; 95% confidence interval: 1.82–7.32). Prognostic factors for persistent fatigue included low education level, absence of partner, high neuroticism, low resilience, high frequency of GP contact GP, medication use, and threatening experiences in the past. The latter three factors appeared to be prognostic factors for persistent fatigue specifically after COVID-19 infection. Conclusions: COVID-19 outpatients have a fourfold higher chance of developing persistent fatigue than non-COVID-19 outpatients. This risk is even higher in psychosocially vulnerable COVID-19 patients.