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. 2023 Mar;33(3):341-352.
doi: 10.1111/sms.14265. Epub 2022 Nov 20.

Short and mid-term characteristics of COVID-19 disease course in athletes: A high-volume, single-center study

Vencel Juhász  1 , Liliána Szabó  1 , Attila Pavlik  2 , András Tállay  2 , Dorottya Balla  1 , Orsolya Kiss  1   2 , Máté Babity  1 , Nóra Sydó  1   2 , Emese Csulak  1 , András Benczúr  3 , Anna Országh  3 , Zsófia Gregor  1 , Dávid Becker  1 , Béla Merkely  1   2 , Hajnalka Vágó  1   2
Affiliations

Short and mid-term characteristics of COVID-19 disease course in athletes: A high-volume, single-center study

Vencel Juhász et al. Scand J Med Sci Sports. 2023 Mar.

Abstract

Introduction: At the pandemic's beginning, significant concern has risen about the prevalence of myocardial involvement after SARS-CoV-2 infection. We assessed the cardiovascular burden of SARS-CoV-2 in a large cohort of athletes and identified factors that might affect the disease course. We included 633 athletes in our study on whom we performed extensive cardiology examinations after recovering from SARS-CoV-2 infection. More than half of the athletes (n = 322) returned for a follow-up examination median of 107 days after the commencement of their infection.

Results: Troponin T positivity was as low as 1.4% of the athletes, where the subsequently performed examinations did not show definitive, ongoing myocardial injury. Altogether, 31% of the athletes' rapid training rebuild was hindered by persistent or reoccurring symptoms. Female athletes reported a higher prevalence of return to play (RTP) symptoms than their male counterparts (34% vs. 19%, p = 0.005). The development of long COVID symptoms was independently predicted by increasing age and acute symptoms' severity in a multiple regression model (AUC 0.75, CI 0.685-0.801). Athletes presenting with either or both cough and ferritin levels higher than >150 μg/L had a 4.1x (CI 1.78-9.6, p = 0.001) higher odds ratio of developing persistent symptoms.

Conclusion: While SARS-CoV-2 rarely affects the myocardium in athletes, about one in three of them experience symptoms beyond the acute phase. Identifying those athletes with a predisposition to developing long-standing symptoms may aid clinicians and trainers in finding the optimal return-to-play timing and training load rebuild pace.

Keywords: COVID-19; SARS-CoV-2 infection; athletes; long COVID; post-acute COVID syndrome; return to play.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Full examination protocol flowchart. Our final examination group comprised 633 athletes. After carrying out the baseline examination protocol, 82% of the athletes immediately cleared to restart training. Of the 48 (6%) suspended subjects, everyone was able to continue sports activity after the recommended rest period or additional examinations.
FIGURE 2
FIGURE 2
Distribution of return to play (RTP) and long COVID symptom frequency among different athlete groups after follow‐up. There was a significant difference between male and female subjects in RTP symptom frequency and between symptom severity categories. Long COVID symptom frequency showed similar significant differences in symptom severity classification.
FIGURE 3
FIGURE 3
Forest plot showing the association between different acute symptoms and subsequent RTP or long COVID symptom development. In terms of Long COVID syndrome occurrence, cough, palpitation and chest pain carried the highest odds ratios. RTP symptoms showed the strongest association with chest pain, dyspnea and fatigue. An asymptomatic infection had a significantly lower odds ratio in the RTP symptom analysis. A similar tendency was observable in long COVID syndrome occurrence. OR, odds ratio; RTP, return to play.
See this image and copyright information in PMC

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