Factors Associated with Post-Acute Sequelae of SARS-CoV-2 (PASC) After Diagnosis of Symptomatic COVID-19 in the Inpatient and Outpatient Setting in a Diverse Cohort

Abstract

Background: The incidence of persistent clinical symptoms and risk factors in Post-Acute Sequelae of SARS-CoV-2 (PASC) in diverse US cohorts is unclear. While there are a disproportionate share of COVID-19 deaths in older patients, ethnic minorities, and socially disadvantaged populations in the USA, little information is available on the association of these factors and PASC.

Objective: To evaluate the association of demographic and clinical characteristics with development of PASC.

Design: Prospective observational cohort of hospitalized and high-risk outpatients, April 2020 to February 2021.

Participants: One thousand thirty-eight adults with laboratory-confirmed symptomatic COVID-19 infection.

Main measures: Development of PASC determined by patient report of persistent symptoms on questionnaires conducted 60 or 90 days after COVID-19 infection or hospital discharge. Demographic and clinical factors associated with PASC.

Key results: Of 1,038 patients with longitudinal follow-up, 309 patients (29.8%) developed PASC. The most common persistent symptom was fatigue (31.4%) followed by shortness of breath (15.4%) in hospitalized patients and anosmia (15.9%) in outpatients. Hospitalization for COVID-19 (odds ratio [OR] 1.49, 95% [CI] 1.04-2.14), having diabetes (OR, 1.39; 95% CI 1.02-1.88), and higher BMI (OR, 1.02; 95% CI 1-1.04) were independently associated with PASC. Medicaid compared to commercial insurance (OR, 0.49; 95% CI 0.31-0.77) and having had an organ transplant (OR 0.44, 95% CI, 0.26-0.76) were inversely associated with PASC. Age, race/ethnicity, Social Vulnerability Index, and baseline functional status were not associated with developing PASC.

Conclusions: Three in ten survivors with COVID-19 developed a subset of symptoms associated with PASC in our cohort. While ethnic minorities, older age, and social disadvantage are associated with worse acute COVID-19 infection and greater risk of death, our study found no association between these factors and PASC.

Figure 1

Symptoms described by patients with PASC who received COVID-19 care in the outpatient (a) or inpatient (b) settings. Symptoms reported refer to the acute phase of illness, 30 days after discharge or diagnosis, and 60–90 days after discharge or diagnosis. Acute symptoms and symptoms persistent at 30 days were reported in the 30-day survey (N=849), and symptoms persistent 60+ days were reported in the 60-day or 90-day survey (N=879).

Figure 2

Multivariate logistic regression for assessing factors associated with PASC. Scale for the OR in Figure 2 is represented on a log scale.