Characteristics and predictors of Long COVID among diagnosed cases of COVID-19

PLOS ONE RESEARCH ARTICLE Characteristics and predictors of Long COVID among diagnosed cases of COVID-19 M. C. Arjun ID1, Arvind Kumar Singh ID1*, Debkumar Pal ID1, Kajal Das1, Alekhya G.1, Mahalingam Venkateshan2, Baijayantimala Mishra3, Binod Kumar Patro1, Prasanta Raghab Mohapatra ID4, Sonu Hangma Subba1 1 Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 2 College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 3 Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 4 Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 * Abstract Background Citation: Arjun MC, Singh AK, Pal D, Das K, G. A, Venkateshan M, et al. (2022) Characteristics and predictors of Long COVID among diagnosed cases of COVID-19. PLoS ONE 17(12): e0278825. https:// doi.org/10.1371/journal.pone.0278825 Long COVID or long-term symptoms after COVID-19 has the ability to affect health and quality of life. Knowledge about the burden and predictors could aid in their prevention and management. Most of the studies are from high-income countries and focus on severe acute COVID-19 cases. We did this study to estimate the incidence and identify the characteristics and predictors of Long COVID among our patients. Editor: Vipa Thanachartwet, Mahidol University, Faculty of Tropical Medicine, THAILAND Methodology OPEN ACCESS Received: January 22, 2022 Accepted: November 23, 2022 Published: December 20, 2022 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0278825 Copyright: © 2022 Arjun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The anonymized data set has been uploaded to the public repository (figshare). The dataset can be accessed using the DOI: 10.6084/m9.figshare.21665618 We recruited adult (�18 years) patients who were diagnosed as Reverse Transcription Polymerase Chain Reaction (RTPCR) confirmed SARS-COV-2 infection and were either hospitalized or tested on outpatient basis. Eligible participants were followed up telephonically after four weeks and six months of diagnosis of SARS-COV-2 infection to collect data on sociodemographic, clinical history, vaccination history, Cycle threshold (Ct) values during diagnosis and other variables. Characteristics of Long COVID were elicited, and multivariable logistic regression was done to find the predictors of Long COVID. Results We have analyzed 487 and 371 individual data with a median follow-up of 44 days (Inter quartile range (IQR): 39,47) and 223 days (IQR:195,251), respectively. Overall, Long COVID was reported by 29.2% (95% Confidence interval (CI): 25.3%,33.4%) and 9.4% (95% CI: 6.7%,12.9%) of participants at four weeks and six months of follow-up, respectively. Incidence of Long COVID among patients with mild/moderate disease (n = 415) was 23.4% (95% CI: 19.5%,27.7%) as compared to 62.5% (95% CI: 50.7%,73%) in severe/critical cases(n = 72) at four weeks of follow-up. At six months, the incidence among mild/moderate (n = 319) was 7.2% (95% CI:4.6%,10.6%) as compared to 23.1% (95% CI:12.5%,36.8%) in severe/critical (n = 52). The most common Long COVID symptom was PLOS ONE | https://doi.org/10.1371/journal.pone.0278825 December 20, 2022 1 / 14 PLOS ONE Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Prevalence of long COVID and its factors fatigue. Statistically significant predictors of Long COVID at four weeks of follow-up were— Pre-existing medical conditions (Adjusted Odds ratio (aOR) = 2.00, 95% CI: 1.16,3.44), having a higher number of symptoms during acute phase of COVID-19 disease (aOR = 11.24, 95% CI: 4.00,31.51), two doses of COVID-19 vaccination (aOR = 2.32, 95% CI: 1.17,4.58), the severity of illness (aOR = 5.71, 95% CI: 3.00,10.89) and being admitted to hospital (Odds ratio (OR) = 3.89, 95% CI: 2.49,6.08). Conclusion A considerable proportion of COVID-19 cases reported Long COVID symptoms. More research is needed in Long COVID to objectively assess the symptoms and find the biological and radiological markers. Introduction COVID-19 was declared a pandemic in March 2020 [1]. Globally, 625 million people have been diagnosed, and around 6 million are reported dead due to COVID-19 [2]. Health systems worldwide are striving to stop the spread of the SAR-COV-2 virus and prevent death and complication due to COVID-19. Apart from acute illness, dialogues on the chronic effect of COVID-19 gained momentum as medical practitioners worldwide started reporting on post COVID complications even in mild cases [3]. It was observed that symptoms of COVID-19 either persist or new symptoms arise after a patient has recovered. Multiple nomenclatures began to appear to describe this condition which includes Long COVID, chronic COVID syndrome, long hauler COVID, post-acute sequelae of COVID-19, post-acute COVID19 syndrome etc [4,5]. Long COVID was discussed widely, and research was initiated to understand this phenomenon [6]. But there was no widely accepted definition for Long COVID, making it difficult to diagnose and treat the condition [7]. The National Institute for Health and Care Excellence (NICE) was among the first to come out with a rapid guideline to define Long COVID [8]. NICE defines Long COVID as signs and symptoms that continue or develop after acute COVID-19, including both ongoing symptomatic COVID-19 (from 4 to 12 weeks) and post-COVID-19 syndrome (12 weeks or more) [9]. Similarly, the Centers for Disease Control and Prevention (CDC) define Long COVID as a Post-COVID condition with a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19 [10]. WHO recently published a document defining the Long COVID based on the Delphi method [11]. Studies have shown that Long COVID can affect almost all systems in the body [12]. The most described in the literature are respiratory disorders, cardiovascular disorders, neurocognitive disorders, mental health disorders, metabolic disorders etc. Symptoms are in multitudes: including fatigue, breathlessness, cough, anxiety, depression, palpitation, chest main, myalgia, cognitive dysfunction (“brain fog”), loss of smell, etc. [12]. Newe (...truncated)