Life Stressors Exacerbate Long COVID Symptoms in Patients Post-Hospitalization

Life stressors can exacerbate long COVID symptoms in adults hospitalized with COVID-19.

Poor long-term outcomes after hospitalization for COVID-19 associated with life stressors, older age, female gender, baseline disability, and COVID-19 severity. These findings, from a prospective, longitudinal cohort study, were published in the Journal of the Neurological Sciences.

Long-term sequelae after COVID-19 has become a major public health issue worldwide. However, little is known about prognostic factors.

Researchers conducted the study at 4 hospitals in New York City between March and May 2020 with follow-up interviews performed at 6 and 12 months. Demographic and clinical characteristics were evaluated as potential biomarkers for COVID-19 sequelae. Abnormal or poor modified Rankin Scale (mRS) was defined as 4-6 points, Barthel Index as <100, telephone Montreal Cognitive Assessment (t-MoCA) score as ≤18 points and neurological quality of life (NeuroQoL) anxiety, depression, fatigue, and sleep scores as ≥60 points.

A total of 382 patients attended the follow-up at 6 months and 242 patients at 12 months. The 6- and 12-month follow-up cohorts were mean age, 69 and 65 years, 65% and 64% were men, and 69% and 68% were White, respectively. During COVID-19 hospitalization, 47%-50% had neurological complications, 34% received mechanical ventilation, and the worst Sequential Organ Failure Assessment (SOFA) score was a median of 4 points.

[T]raditional predictors of poor outcome, including older age, poor pre-COVID functional status and index severity of illness, were independently associated with worse mRS, Barthel Index, t-MoCA scores and persistent COVID-19 symptoms.

At 6 months, the following was observed:

  • abnormal or poor mRS score among 50%
  • Barthel Index among 44%,
  • t-MOCA among 49%,
  • sleep among 10%,
  • anxiety among 8%,
  • fatigue among 5%, and
  • depression among 3%.

At 12 months, the following was observed:

  • abnormal or poor mRS among 34%
  • Barthel Index among 36%,
  • T-MoCA among 41%,
  • sleep among 10%,
  • anxiety among 7%,
  • fatigue among 9%, and
  • depression among 4%.

Abnormal or poor mRS at 6 and 12 months was predicted by age, pre-COVID-19 mRS score, and dementia status (all P ≤.011); Barthel Index at 6 and 12 months by age, gender, and pre-COVID-19 mRS score (all P ≤.009); and T-MoCA at 6 and 12 months by age (both P ≤..009). In addition, psychiatric history predicted abnormal mRS (P =.040) and Barthel Index (P =.032) at 6 months.

At the 12-month follow-up, several life stressors were significant contributors to abnormal scores, including increased caregiver responsibilities, new disability, social isolation, financial insecurity, food insecurity, and the number of stressors.

In the multivariate model, significant associations were used to formulate predictive models for abnormal outcome scores at 6 and 12 months. The models had area under the curve (AUC) scores ranging from 0.664-0.903. The best predictive models were for NeuroQoL depression scores at 12 months (AUC, 0.903) which was predicted by age, education, and death of a close contact and Barthel Index scores at 12 months (AUC, 0.882) which was predicted by age, baseline mRS score, gender, and new disability.

This study may have been limited by not including some important predictors, such as SARS-CoV-2 viral load or autoantibody levels.

“In adults hospitalized with COVID-19, we found that traditional predictors of poor outcome, including older age, poor pre-COVID functional status and index severity of illness, were independently associated with worse mRS, Barthel Index, t-MoCA scores and persistent COVID-19 symptoms,” the researchers concluded.

This article originally appeared on Neurology Advisor

References:

Frontera JA, Sabadia S, Yang D, et al. Life stressors significantly impact long-term outcomes and post-acute symptoms 12-months after COVID-19 hospitalization. J Neurol Sci. Published online November 5, 2022. doi:10.1016/j.jns.2022.120487