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. 2023 Dec;51(6):1679-1694.
doi: 10.1007/s15010-023-02043-6. Epub 2023 May 25.

Persistent symptoms and risk factors predicting prolonged time to symptom-free after SARS‑CoV‑2 infection: an analysis of the baseline examination of the German COVIDOM/NAPKON-POP cohort

Yanyan Shi  1   2 , Ralf Strobl  1   3 , Christian Apfelbacher  4 , Thomas Bahmer  5 , Ramsia Geisler  6 , Peter Heuschmann  7   8 , Anna Horn  7 , Hanno Hoven  9 , Thomas Keil  7   10   11 , Michael Krawczak  12 , Lilian Krist  10 , Christina Lemhöfer  13 , Wolfgang Lieb  14 , Bettina Lorenz-Depiereux  15 , Rafael Mikolajczyk  16   17 , Felipe A Montellano  7   18 , Jens Peter Reese  7 , Stefan Schreiber  5 , Nicole Skoetz  19 , Stefan Störk  20 , Jörg Janne Vehreschild  6   21   22 , Martin Witzenrath  23   24 , Eva Grill  25   26 ; NAPKON Study Group
Collaborators, Affiliations

Persistent symptoms and risk factors predicting prolonged time to symptom-free after SARS‑CoV‑2 infection: an analysis of the baseline examination of the German COVIDOM/NAPKON-POP cohort

Yanyan Shi et al. Infection. 2023 Dec.

Abstract

Purpose: We aimed to assess symptoms in patients after SARS-CoV-2 infection and to identify factors predicting prolonged time to symptom-free.

Methods: COVIDOM/NAPKON-POP is a population-based prospective cohort of adults whose first on-site visits were scheduled ≥ 6 months after a positive SARS-CoV-2 PCR test. Retrospective data including self-reported symptoms and time to symptom-free were collected during the survey before a site visit. In the survival analyses, being symptom-free served as the event and time to be symptom-free as the time variable. Data were visualized with Kaplan-Meier curves, differences were tested with log-rank tests. A stratified Cox proportional hazard model was used to estimate adjusted hazard ratios (aHRs) of predictors, with aHR < 1 indicating a longer time to symptom-free.

Results: Of 1175 symptomatic participants included in the present analysis, 636 (54.1%) reported persistent symptoms after 280 days (SD 68) post infection. 25% of participants were free from symptoms after 18 days [quartiles: 14, 21]. Factors associated with prolonged time to symptom-free were age 49-59 years compared to < 49 years (aHR 0.70, 95% CI 0.56-0.87), female sex (aHR 0.78, 95% CI 0.65-0.93), lower educational level (aHR 0.77, 95% CI 0.64-0.93), living with a partner (aHR 0.81, 95% CI 0.66-0.99), low resilience (aHR 0.65, 95% CI 0.47-0.90), steroid treatment (aHR 0.22, 95% CI 0.05-0.90) and no medication (aHR 0.74, 95% CI 0.62-0.89) during acute infection.

Conclusion: In the studied population, COVID-19 symptoms had resolved in one-quarter of participants within 18 days, and in 34.5% within 28 days. Over half of the participants reported COVID-19-related symptoms 9 months after infection. Symptom persistence was predominantly determined by participant's characteristics that are difficult to modify.

Keywords: COVID-19; Long COVID; Post-COVID syndrome; Risk factors; Time to symptom-free.

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Conflict of interest statement

TB reports personal fees from AstraZeneca, GlaxoSmithKline, Novartis, Roche, Chiesi, Boehringer Ingelheim, MSD and Pfizer outside the submitted work. SStö reports research grants of the Federal Ministry of Education and Research (#01EO1004; #01EO1504), speaker honoraria or advisory board honoraria of AstraZeneca, Boehringer Ingelheim, Novartis, Pfizer, Pharmacosmos, and case payment fees in clinical studies of Alnylam, AstraZeneca, Boehringer Ingelheim, IONIS, MSD, NovoNordisk, SOBI, Servier; all outside the submitted work. All other authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
COVID-19 related symptoms during acute infection and time of survey (N = 1175)
Fig. 2
Fig. 2
Study profile
Fig. 3
Fig. 3
Survival curves of time to symptom-free status for different patient groups (N = 1175). X-axis is the time to symptom-free in days, y-axis is the percentage of participants not reaching a symptom-free status. CRD/CID: chronic rheumatologic/immunologic disease
See this image and copyright information in PMC

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