Severity, predictors and clinical correlates of post-COVID syndrome (PCS) in Germany: A prospective, multi-centre, population-based cohort study
Summary: Background: Post-COVID syndrome (PCS) is an important sequela of COVID-19, characterised by symptom persistence for >3 months, post-acute symptom development, and worsening of pre-existing comorbidities. The causes and public health impact of PCS are still unclear, not least for the lac...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Language: | English |
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Elsevier
2022-09-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537022002796 |
| _version_ | 1818474723688841216 |
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| author | Thomas Bahmer Christoph Borzikowsky Wolfgang Lieb Anna Horn Lilian Krist Julia Fricke Carmen Scheibenbogen Klaus F. Rabe Walter Maetzler Corina Maetzler Martin Laudien Derk Frank Sabrina Ballhausen Anne Hermes Olga Muljukov Karl Georg Haeusler Nour Eddine El Mokhtari Martin Witzenrath Jörg Janne Vehreschild Dagmar Krefting Daniel Pape Felipe A. Montellano Mirjam Kohls Caroline Morbach Stefan Störk Jens-Peter Reese Thomas Keil Peter Heuschmann Michael Krawczak Stefan Schreiber |
| author_facet | Thomas Bahmer Christoph Borzikowsky Wolfgang Lieb Anna Horn Lilian Krist Julia Fricke Carmen Scheibenbogen Klaus F. Rabe Walter Maetzler Corina Maetzler Martin Laudien Derk Frank Sabrina Ballhausen Anne Hermes Olga Muljukov Karl Georg Haeusler Nour Eddine El Mokhtari Martin Witzenrath Jörg Janne Vehreschild Dagmar Krefting Daniel Pape Felipe A. Montellano Mirjam Kohls Caroline Morbach Stefan Störk Jens-Peter Reese Thomas Keil Peter Heuschmann Michael Krawczak Stefan Schreiber |
| author_sort | Thomas Bahmer |
| collection | DOAJ |
| description | Summary: Background: Post-COVID syndrome (PCS) is an important sequela of COVID-19, characterised by symptom persistence for >3 months, post-acute symptom development, and worsening of pre-existing comorbidities. The causes and public health impact of PCS are still unclear, not least for the lack of efficient means to assess the presence and severity of PCS. Methods: COVIDOM is a population-based cohort study of polymerase chain reaction (PCR) confirmed cases of SARS-CoV-2 infection, recruited through public health authorities in three German regions (Kiel, Berlin, Würzburg) between November 15, 2020 and September 29, 2021. Main inclusion criteria were (i) a PCR confirmed SARS-CoV-2 infection and (ii) a period of at least 6 months between the infection and the visit to the COVIDOM study site. Other inclusion criteria were written informed consent and age ≥18 years. Key exclusion criterion was an acute reinfection with SARS-CoV-2. Study site visits included standardised interviews, in-depth examination, and biomaterial procurement. In sub-cohort Kiel-I, a PCS (severity) score was developed based upon 12 long-term symptom complexes. Two validation sub-cohorts (Würzburg/Berlin, Kiel-II) were used for PCS score replication and identification of clinically meaningful predictors. This study is registered at clinicaltrials.gov (NCT04679584) and at the German Registry for Clinical Studies (DRKS, DRKS00023742). Findings: In Kiel-I (n = 667, 57% women), 90% of participants had received outpatient treatment for acute COVID-19. Neurological ailments (61·5%), fatigue (57·1%), and sleep disturbance (57·0%) were the most frequent persisting symptoms at 6–12 months after infection. Across sub-cohorts (Würzburg/Berlin, n = 316, 52% women; Kiel-II, n = 459, 56% women), higher PCS scores were associated with lower health-related quality of life (EQ-5D-5L-VAS/-index: r = -0·54/ -0·56, all p < 0·0001). Severe, moderate, and mild/no PCS according to the individual participant's PCS score occurred in 18·8%, 48·2%, and 32·9%, respectively, of the Kiel-I sub-cohort. In both validation sub-cohorts, statistically significant predictors of the PCS score included the intensity of acute phase symptoms and the level of personal resilience. Interpretation: PCS severity can be quantified by an easy-to-use symptom-based score reflecting acute phase disease burden and general psychological predisposition. The PCS score thus holds promise to facilitate the clinical diagnosis of PCS, scientific studies of its natural course, and the development of therapeutic interventions. Funding: The COVIDOM study is funded by the Network University Medicine (NUM) as part of the National Pandemic Cohort Network (NAPKON). |
| first_indexed | 2024-04-14T04:40:55Z |
| format | Article |
| id | doaj.art-7641c051e8cd443b85c2da10ed36efbe |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-04-14T04:40:55Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-7641c051e8cd443b85c2da10ed36efbe2022-12-22T02:11:41ZengElsevierEClinicalMedicine2589-53702022-09-0151101549Severity, predictors and clinical correlates of post-COVID syndrome (PCS) in Germany: A prospective, multi-centre, population-based cohort studyThomas Bahmer0Christoph Borzikowsky1Wolfgang Lieb2Anna Horn3Lilian Krist4Julia Fricke5Carmen Scheibenbogen6Klaus F. Rabe7Walter Maetzler8Corina Maetzler9Martin Laudien10Derk Frank11Sabrina Ballhausen12Anne Hermes13Olga Muljukov14Karl Georg Haeusler15Nour Eddine El Mokhtari16Martin Witzenrath17Jörg Janne Vehreschild18Dagmar Krefting19Daniel Pape20Felipe A. Montellano21Mirjam Kohls22Caroline Morbach23Stefan Störk24Jens-Peter Reese25Thomas Keil26Peter Heuschmann27Michael Krawczak28Stefan Schreiber29Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany; Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927 Großhansdorf, Germany; Corresponding authors at: Internal Medicine Department I, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24103 Kiel, Germany.Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein, Brunswiker Straße 10, 24105 Kiel, GermanyInstitute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Niemannsweg 11, 24105 Kiel, GermanyInstitute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, GermanyInstitute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, GermanyInstitute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, GermanyInstitute of Medical Immunology, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, GermanyAirway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927 Großhansdorf, Germany; LungenClinic Grosshansdorf, Pneumology, Wöhrendamm 80, 22927 Großhansdorf, GermanyNeurology Department, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, GermanyNeurology Department, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, GermanyENT Department, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, GermanyInternal Medicine Department III, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, GermanyInternal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, GermanyInstitute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Niemannsweg 11, 24105 Kiel, GermanyInstitute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, GermanyDepartment of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, GermanyImland Klinik Rendsburg, Lilienstraße 20-48, 24768 Rendsburg, GermanyDepartment of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, GermanyMedical Department 2, Hematology/ Oncology and Infectious Diseases, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, Kerpener Straße 62, 50937 Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Kerpener Straße 62, 50937 Cologne, GermanyInstitute for Medical Informatics, University Medical Center Göttingen, Von-Siebold-Straße 3, 37075 Göttingen, GermanyInternal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, GermanyInstitute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Department of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, 97080 Würzburg, GermanyInstitute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, GermanyComprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, 97080 Würzburg, Germany; Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, GermanyComprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, 97080 Würzburg, Germany; Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, GermanyInstitute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, GermanyInstitute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany; State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, GermanyInstitute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, 97080 Würzburg, Germany; Clinical Trial Center Würzburg (CTC/ZKS), University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, GermanyInstitute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein, Brunswiker Straße 10, 24105 Kiel, GermanyInternal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany; Corresponding authors at: Internal Medicine Department I, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24103 Kiel, Germany.Summary: Background: Post-COVID syndrome (PCS) is an important sequela of COVID-19, characterised by symptom persistence for >3 months, post-acute symptom development, and worsening of pre-existing comorbidities. The causes and public health impact of PCS are still unclear, not least for the lack of efficient means to assess the presence and severity of PCS. Methods: COVIDOM is a population-based cohort study of polymerase chain reaction (PCR) confirmed cases of SARS-CoV-2 infection, recruited through public health authorities in three German regions (Kiel, Berlin, Würzburg) between November 15, 2020 and September 29, 2021. Main inclusion criteria were (i) a PCR confirmed SARS-CoV-2 infection and (ii) a period of at least 6 months between the infection and the visit to the COVIDOM study site. Other inclusion criteria were written informed consent and age ≥18 years. Key exclusion criterion was an acute reinfection with SARS-CoV-2. Study site visits included standardised interviews, in-depth examination, and biomaterial procurement. In sub-cohort Kiel-I, a PCS (severity) score was developed based upon 12 long-term symptom complexes. Two validation sub-cohorts (Würzburg/Berlin, Kiel-II) were used for PCS score replication and identification of clinically meaningful predictors. This study is registered at clinicaltrials.gov (NCT04679584) and at the German Registry for Clinical Studies (DRKS, DRKS00023742). Findings: In Kiel-I (n = 667, 57% women), 90% of participants had received outpatient treatment for acute COVID-19. Neurological ailments (61·5%), fatigue (57·1%), and sleep disturbance (57·0%) were the most frequent persisting symptoms at 6–12 months after infection. Across sub-cohorts (Würzburg/Berlin, n = 316, 52% women; Kiel-II, n = 459, 56% women), higher PCS scores were associated with lower health-related quality of life (EQ-5D-5L-VAS/-index: r = -0·54/ -0·56, all p < 0·0001). Severe, moderate, and mild/no PCS according to the individual participant's PCS score occurred in 18·8%, 48·2%, and 32·9%, respectively, of the Kiel-I sub-cohort. In both validation sub-cohorts, statistically significant predictors of the PCS score included the intensity of acute phase symptoms and the level of personal resilience. Interpretation: PCS severity can be quantified by an easy-to-use symptom-based score reflecting acute phase disease burden and general psychological predisposition. The PCS score thus holds promise to facilitate the clinical diagnosis of PCS, scientific studies of its natural course, and the development of therapeutic interventions. Funding: The COVIDOM study is funded by the Network University Medicine (NUM) as part of the National Pandemic Cohort Network (NAPKON).http://www.sciencedirect.com/science/article/pii/S2589537022002796COVID-19Post-COVID-Syndrome (PCS)LongCOVID, Post-acute sequelae of SARS-CoV-2 infection (PASC)SARS-CoV-2 infectionFatigueResilience |
| spellingShingle | Thomas Bahmer Christoph Borzikowsky Wolfgang Lieb Anna Horn Lilian Krist Julia Fricke Carmen Scheibenbogen Klaus F. Rabe Walter Maetzler Corina Maetzler Martin Laudien Derk Frank Sabrina Ballhausen Anne Hermes Olga Muljukov Karl Georg Haeusler Nour Eddine El Mokhtari Martin Witzenrath Jörg Janne Vehreschild Dagmar Krefting Daniel Pape Felipe A. Montellano Mirjam Kohls Caroline Morbach Stefan Störk Jens-Peter Reese Thomas Keil Peter Heuschmann Michael Krawczak Stefan Schreiber Severity, predictors and clinical correlates of post-COVID syndrome (PCS) in Germany: A prospective, multi-centre, population-based cohort study EClinicalMedicine COVID-19 Post-COVID-Syndrome (PCS) LongCOVID, Post-acute sequelae of SARS-CoV-2 infection (PASC) SARS-CoV-2 infection Fatigue Resilience |
| title | Severity, predictors and clinical correlates of post-COVID syndrome (PCS) in Germany: A prospective, multi-centre, population-based cohort study |
| title_full | Severity, predictors and clinical correlates of post-COVID syndrome (PCS) in Germany: A prospective, multi-centre, population-based cohort study |
| title_fullStr | Severity, predictors and clinical correlates of post-COVID syndrome (PCS) in Germany: A prospective, multi-centre, population-based cohort study |
| title_full_unstemmed | Severity, predictors and clinical correlates of post-COVID syndrome (PCS) in Germany: A prospective, multi-centre, population-based cohort study |
| title_short | Severity, predictors and clinical correlates of post-COVID syndrome (PCS) in Germany: A prospective, multi-centre, population-based cohort study |
| title_sort | severity predictors and clinical correlates of post covid syndrome pcs in germany a prospective multi centre population based cohort study |
| topic | COVID-19 Post-COVID-Syndrome (PCS) LongCOVID, Post-acute sequelae of SARS-CoV-2 infection (PASC) SARS-CoV-2 infection Fatigue Resilience |
| url | http://www.sciencedirect.com/science/article/pii/S2589537022002796 |
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