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Association of acute COVID-19 severity and long COVID fatigue and quality of life: prospective cohort multicenter observational study

2025-09-05Journal article Open access
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dc.contributor.authorPires, Ligia
dc.contributor.authorMarreiros, Ana
dc.contributor.authorSaraiva, Cátia
dc.contributor.authorReis, Cláudia
dc.contributor.authorNeves, Djamila
dc.contributor.authorGuerreiro, Cláudia
dc.contributor.authorTomé, José Boleo
dc.contributor.authorLuz, Maria Inês
dc.contributor.authorPereira, Margarida Isabel
dc.contributor.authorBarroso, Ana Sofia
dc.contributor.authorFerreira, Jorge
dc.contributor.authorGonzalez, Lucía Méndez
dc.contributor.authorMoniri, Armin
dc.contributor.authorDrummond, Marta
dc.contributor.authorBerger-Estilita, Joana
dc.date.accessioned2025-10-02T10:26:45Z
dc.date.available2025-10-02T10:26:45Z
dc.date.issued2025-09-05
dc.description.abstractLong COVID, or post-COVID-19 condition, is characterized by symptoms persisting beyond 12 weeks after severe acute respiratory syndrome coronavirus 2 infection, affecting individuals regardless of acute disease severity. Fatigue – often linked with depression and anxiety – is among its most debilitating manifestations. However, the associations between fatigue subtypes (physical vs mental), mental health symptoms, and acute disease severity on long-term health-related quality of life (HRQoL) remain unclear. This study examines the relationships between long COVID fatigue, depression, anxiety, acute disease severity, and HRQoL in a post-COVID-19 cohort. This prospective observational cohort study was conducted across 5 Portuguese hospitals between November 2020 and June 2022. Adults (≥18 years) with confirmed severe acute respiratory syndrome coronavirus 2 infection ≥6 months prior and fulfilling World Health Organization criteria for long COVID were included. Acute Coronavirus disease 2019 (COVID-19) severity was classified per World Health Organization definitions. The sampling strategy included patients across the severity spectrum. At 3 months postinfection (T1), patients received physician-led clinical assessments. At 6 months (T2), they attended in-person follow-up visits, completing standardized forms and validated questionnaires assessing post-acute sequelae. Fatigue was reported both binarily (yes/no) and via the chalder fatigue scale (11-item version). Anxiety and depression were assessed using the hospital anxiety and depression scale; post-traumatic stress disorder symptoms with the 14-item post-traumatic stress scale; and HRQoL with the EuroQol-5 dimensions. Descriptive statistics, analysis of variance, chi-square, and correlation analyses (Pearson’s or Spearman’s) were used to evaluate associations. Analyses were performed using SPSS (v27; IBM Corp., Amonk). Among 208 patients, fatigue was significantly associated with anxiety and depression (P < .001). Physical fatigue correlated more strongly with depression (r = 0.65, P < .001) and anxiety (r = 0.58, P < .001) than mental fatigue (r = 0.50 and R = 0.48, respectively; P < .001). Surprisingly, severe acute COVID-19 cases reported lower fatigue (CFQ: 13.3 ± 8.4) than mild (17.7 ± 7.2) or moderate (17.4 ± 8.0) cases (P < .005), and higher HRQoL (EuroQol visual analog scale: 74.3 ± 20.3, P = .002). Anxiety symptoms were more common in mild cases (P < .001); post-traumatic stress disorder symptoms did not differ by severity. Long COVID fatigue – especially physical – is strongly linked to depression and anxiety. Mild/moderate acute COVID-19 cases show greater fatigue and lower HRQoL than severe cases, highlighting the need for tailored long-term care regardless of initial severity.eng
dc.identifier.doi10.1097/md.0000000000042891
dc.identifier.issn1536-5964
dc.identifier.urihttp://hdl.handle.net/10400.1/27779
dc.language.isoeng
dc.peerreviewedyes
dc.publisherLippincott, Williams & Wilkins
dc.relation.ispartofMedicine
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectAnxiety
dc.subjectDepression
dc.subjectFatigue
dc.subjectLong COVID-19
dc.subjectPost-traumatic stress
dc.subjectQuality of life
dc.titleAssociation of acute COVID-19 severity and long COVID fatigue and quality of life: prospective cohort multicenter observational studyeng
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue36
oaire.citation.titleMedicine
oaire.citation.volume104
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameMarreiros
person.familyNameMoniri
person.givenNameAna
person.givenNameArmin
person.identifier.ciencia-id9A12-9450-7051
person.identifier.orcid0000-0001-9410-4772
person.identifier.orcid0000-0002-6054-5980
person.identifier.scopus-author-id57194785077
relation.isAuthorOfPublicationc0a8e5da-26ae-42a8-ab04-fa4df4356375
relation.isAuthorOfPublication0fab8330-d1aa-4210-b91c-5547de263033
relation.isAuthorOfPublication.latestForDiscoveryc0a8e5da-26ae-42a8-ab04-fa4df4356375

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