Risk Factors and Predictors for Persistent Dyspnea Post-COVID-19: A Systematic Review

The most frequently reported post-coronavirus disease of 2019 (COVID-19) symptoms include shortness of breath, fatigue, and cognitive disturbances, with reports of persistent dyspnea ranging between 26% and 41%. There is an urgent need to understand the risk factors and predictors for persistent COVID-19 dyspnea in individuals at all levels of COVID-19 illness severity, to enable the implementation of targeted interventions for those likely to be most affected with persistent dyspnea. Thus, the purpose of this systematic review is to explore the risk factors and predictors that are associated with persistent dyspnea in the post-COVID-19 population. This review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and registered prospectively in PROSPERO as CRD42023466713. A search strategy was conducted across PubMed, CINAHL, Web of Science, and EMBASE databases, that included studies conducted from 2020 to March 2024. The Covidence platform was used for screening studies, scoring methodologic quality, and performing data extraction using a two-step independent review process. This review included 33 studies, addressing 83,920 participants across 20 countries. The strongest predictive risk factors for persistent dyspnea included the following: female sex, elevated body mass index, pulmonary comorbidities, pre-existing anxiety and depression, pre-COVID-19 physical limitations, the severity of the COVID-19 illness, and socioeconomic differences. Potential risk factors included increased age, smoking history, and COVID-19 variant type. The presence of biomarkers for persistent dyspnea in the post-COVID-19 population can be used by clinicians to prospectively identify those individuals who should be flagged. Early identification may then be leveraged for timely referral for prophylactic and rehabilitative interventions for dyspnea. A personalized plan to target those risk factors that are modifiable should follow.