Trajectories Of Persisting Covid-19 Symptoms Up To 24 Months After Acute Infection: Findings From The Predi-Covid Cohort Study

Abstract

Introduction : Long COVID is a multisystemic, fluctuating condition inducing a high burden on affected people. Despite the existence of some guidelines, its management remains complicated. We aimed to demonstrate that Long COVID evolution follows different trajectories from the initial infection until 24 months after and to identify the determinants of these trajectories. Methods Study participants from the Predi-COVID cohort included between May 2020 and September 2021 were digitally followed from their acute SARS-CoV-2 infection until a maximum of 24 months. Data from 10 common symptoms were collected at study inclusion, and months 12, 15, and 24 and used to create a total symptom score. Impact of symptoms on quality of life (sleep, respiratory quality of life, anxiety, stress, and fatigue) was assessed at month 24 using standardized questionnaires and ad-hoc questions. Latent classes mixed models were used to identify total score symptom trajectories and individual symptoms trajectories. Results We included 555 participants with at least 2 different time points available during follow-up. We identified 2 trajectories: T1 “Mild symptoms, fast resolution” (N = 376; 67.7%), and T2 “Elevated and persisting symptoms” (N = 179; 32.3%). Symptom severity was worse in T2 than in T1 at 24 months (high fatigue level: 64.8% vs 19.5%, altered respiratory quality of life: 42.6% vs 4.6%, anxiety: 24.1% vs 4.6%, stress: 57.4% vs 35.6%, and bad sleep: 75.9% vs 51.1%). Fatigue and pain-related symptom frequencies in T2 increased between acute infection and month 12, and remained elevated until 24 months. Women, elevated body mass index, diabetes, and chronic medications were associated with T2. Conclusion A third of our study population was in the T2 “Elevated and persisting symptoms” trajectory, presenting high symptom frequencies up to 24 months after initial infection, with a significant impact on quality of life. This work underlined the urgent need to better identify individuals most vulnerable to long-term complications to develop tailored interventions for them.