Impaired health-related quality of life in long-COVID syndrome after mild to moderate COVID-19

Abstract

A growing number of patients with SARS-CoV-2 infections experience long-lasting symptoms. Even patients who suffered from a mild acute infection show a variety of persisting and debilitating neurocognitive, respiratory, or cardiac symptoms (Long-Covid syndrome), consequently leading to limitations in everyday life. Because data on health-related quality of life (HRQoL) is scarce, we aimed to characterize the impact of Long-Covid symptoms after a mild or moderate acute infection on HRQoL. In this observational study, outpatients seeking counseling in the interdisciplinary Post-Covid consultation of the University Hospital Zurich with symptoms persisting for more than 4 weeks were included. Patients who received an alternative diagnosis or suffered from a severe acute Covid-19 infection were excluded. St. George's Respiratory Questionnaire (SGRQ), Euroquol-5D-5L (EQ-5D-5L), and the Short form 36 (SF-36) were distributed to assess HRQoL. 112 patients were included, 86 (76.8%) were female, median (IQR) age was 43 (32.0, 52.5) years with 126 (91, 180) days of symptoms. Patients suffered frequently from fatigue (81%), concentration difficulties (60%), and dyspnea (60%). Patients mostly stated impairment in performing usual activities and having pain/discomfort or anxiety out of the EQ-5D-5L. EQ index value and SGRQ activity score component were significantly lower in females. SF-36 scores showed remarkably lower scores in the physical health domain compared to the Swiss general population before and during the COVID-19 pandemic. Long-Covid syndrome has a substantial impact on HRQoL. Long-term surveillance of patients must provide clarity on the duration of impairments in physical and mental health.Trial registration: The study is registered on www.ClinicalTrials.gov , NCT04793269.

Figure 1

Study flow. Figure was created using MS Office professional plus 2016 Powerpoint.

Figure 2

Distribution of EQ-5D-5L dimension responses. Figure shows the level of impairment frequency (n = 110) in the sub-dimensions mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Rating goes from “no problems” to “extreme problems”. Frequently reported moderate to extreme impairments are shown in the sub-dimensions usual activities, pain/discomfort and anxiety/depression. Figure was created using Stata version 16.1 (StataCorp. 2019, Texas, TX, USA, https://www.stata.com/products).

Figure 3

Mean PCS and MCS T-Scores of the SF-36. Figure shows mean physical component summary (PCS) and mental component summary (MCS) T-scores of the SF-36 in pre-pandemic Swiss general population (n = 1209), in the CoWell study population (n = 1581) and in Long-Covid patients (n = 107). Higher values indicate better health-related quality of life. PCS T-Scores are impaired in Long-Covid patients compared to participants in the CoWell study, whereas MCS T-Scores show a similar reduction compared to the pre-pandemic Swiss general population. Figure was created using Stata version 16.1 (StataCorp. 2019, Texas, TX, USA, https://www.stata.com/products).