COVID-19 disease severity to predict persistent symptoms: a systematic review and meta-analysis

Area of Science:

• Infectious Diseases
• Public Health
• Epidemiology

Background:

• The relationship between initial COVID-19 severity and the risk of developing persistent symptoms (long COVID) remains unclear.
• Understanding this association is crucial for identifying at-risk patients and managing post-acute COVID-19 syndrome.

Approach:

• A systematic literature search was performed across major databases (PubMed, Google Scholar, EMBASE, ProQuest) for studies published after January 2020.
• A random-effects meta-analysis was conducted on 20 observational studies involving 7840 patients to pool odds ratios (OR) and confidence intervals (CIs).

Key Points:

• Meta-analysis of 20 studies (7840 patients) found initial COVID-19 severity was associated with persistent dyspnea (OR 2.17) and fatigue (OR 1.30).
• No significant association was observed between initial disease severity and persistent cough, anosmia, chest pain, or palpitations.
• The phase of illness (acute vs. prolonged post-COVID) did not influence the risk of persistent symptoms.

Conclusions:

• Initial COVID-19 disease severity is not a reliable predictor for most long COVID symptoms, contrary to expectations.
• Persistent dyspnea and fatigue are exceptions, showing a link to more severe initial infections.
• Healthcare providers should remain vigilant for prevalent long COVID symptoms in all survivors, irrespective of their initial disease severity.