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The Relationship between Post-COVID Syndrome and the Burden of Comorbidities Assessed Using the Charlson Comorbidity
Lorenzo Falsetti1, Vincenzo Zaccone2, Luca Santoro3
1Clinica Medica, Department of Clinical and Molecular Sciences, Marche Polytechnic University, 60126 Ancona, Italy.
Insights
The Charlson Comorbidity Index (CCI) significantly correlates with post-COVID-19 syndrome. Higher CCI scores indicate a greater burden of comorbidities and an increased risk of developing post-COVID-19 symptoms.
Area of Science:
- Medical research
- Infectious diseases
- Public health
Background:
- Post-COVID-19 syndrome presents persistent symptoms beyond 12 weeks post-infection.
- Individuals with chronic conditions face higher risks of developing post-COVID-19.
- The Charlson Comorbidity Index (CCI) quantifies comorbidity burden and predicts outcomes.
Purpose of the Study:
- To investigate the correlation between comorbidity burden, measured by CCI, and the incidence of post-COVID-19 syndrome.
- To assess the predictive value of CCI in identifying patients at risk for long-term COVID-19 symptoms.
Main Methods:
- A cohort of 3636 outpatients with prior COVID-19 admission was analyzed.
- Data collected included demographics, COVID-19 severity, and post-COVID-19 symptoms.
- Charlson Comorbidity Index (CCI) was calculated; its association with post-COVID-19 syndrome was evaluated using logistic regression.
Main Results:
- A significant association was found between the number of post-COVID-19 symptoms and CCI.
- Patients with post-COVID-19 syndrome exhibited a higher comorbidity burden (higher CCI).
- An increased risk of post-COVID-19 syndrome was observed for patients with CCI ≥ 1 (OR: 2.961) and CCI ≥ 4 (OR: 6.062).
Conclusions:
- Post-COVID-19 patients demonstrate greater clinical complexity and a higher comorbidity burden, reflected by elevated CCI scores.
- A higher CCI is linked to an increased risk of developing post-COVID-19 syndrome.
- The presence of one or more CCI points increases the risk threefold, while four or more points increase it sixfold.
Abstract:
Introduction: The post-COVID-19 syndrome is a clinical entity characterized by the manifestation of signs and symptoms that develop after the acute phase of COVID-19, which persist for a duration of more than 12 weeks and are not explained by any alternative diagnosis. It has been observed that individuals with pre-existing chronic diseases, including cardiovascular and pulmonary diseases, are at a greater risk of developing post-COVID-19 syndrome. The Charlson Comorbidity Index (CCI) is a useful tool employed to evaluate the burden of comorbidities and predict the prognosis of patients with post-COVID-19 syndrome. The present study aims to assess whether the burden of comorbidities, evaluated using the CCI, correlates with post-COVID-19 syndrome. Materials and Methods: Between 21 April 2020 and 15 May 2023, we enrolled all consecutive outpatients with previous COVID-19 admissions to a post-acute day-hospital service three months after a negative SARS-CoV-2 molecular test. We assessed age, sex, BMI, acute COVID-19 and post-COVID-19 signs, and symptoms and calculated CCI according to its current definition. Post-COVID-19 syndrome was defined as the persistence of at least one sign or symptom lasting more than 12 weeks after COVID-19 resolution and not explained by an alternative diagnosis. The relationship between post-COVID-19 and CCI was explored first with the chi-squared test, then with different binary logistic regression models. We considered significant values of p lower than 0.05. Results: We obtained a cohort of 3636 patients and observed a significant association between the number of post-COVID-19 symptoms and CCI. Patients developing post-COVID-19 were more commonly affected by a greater burden of comorbidities. Patients with at least one CCI point had an increased risk of post-COVID-19 syndrome (OR:2.961; 95%CI: 2.269-3.863; p < 0.0001), which increased further for CCI ≥ 4 (OR:6.062; 95%CI: 3.163-11.618; p < 0.0001). Conclusions: Patients affected by post-COVID-19 show a greater clinical complexity and a larger burden of comorbidities, synthesized by a higher CCI; moreover, a higher CCI seems to correlate with an increasing post-COVID-19 risk, being the presence of ≥1 or ≥4 CCI points associated with a 3-fold and 6-fold increased risk of post-COVID-19 syndrome, respectively.
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