Health outcomes in hospitalised and non-hospitalised individuals after COVID-19, an observational, cross-sectional study, 2025, Nygren-Bonnier,Brodin+

[SNT Gatchaman]

Health outcomes in hospitalised and non-hospitalised individuals after COVID-19, an observational, cross-sectional study

Spoiler: Authors / Karolinska

Nygren-Bonnier, Malin; Svensson-Raskh, Anna; Holmström, Linda; Törnberg, Anna; Svensson, Annie; Loewenstein, Daniel; Regardt, Malin; Björnson, Mikael; Hallberg, Carl; Kemani, Mike; Mc Allister, Anita; Körner Gustafsson, Joakim; Halvarsson, Alexandra; Ekman, Urban; Nordstrand, Linda; Guidetti, Susanne; Anmyr, Lena; Bragesjö, Maria; Åström Reitan, Jenny; Badinlou, Farzaneh; Dahl, Oili; Åkerman, Eva; Villner, Pär; Brodin, Petter; Caidahl, Kenneth; Ståhlberg, Marcus; Fedorowski, Artur; Sköld, Magnus; Runold, Michael; Bruchfeld, Judith; Rydwik, Elisabeth

BACKGROUND
Both hospitalised (H) and non-hospitalised (NH) individuals may have different symptoms and impairments after COVID-19. We aimed to explore symptoms, mental and physical health after initial COVID-19 for both groups of individuals and the association between physical and mental impairments in relation to self-rated health status and to identify different cluster profiles.

METHODS
Participants were recruited between June 2020 until December 2022 at the Karolinska University Hospital, Sweden. Data was collected at first assessment after COVID-19 and consisted of demographics, medical history, symptoms and results from physical function tests and self-reported questionnaires.

RESULTS
Here we show that among 931 participants, the H-group are older (mean age 56.7 years) and predominantly male (72%), while the NH-group are younger (mean age 44.4 years) and mostly female (84%). Fatigue, dyspnoea, joint pain, paraesthesia, and chest pressure are common symptoms reported across all participants. Physical function is lower than predicted in both groups and the NH-group have higher prevalence of depression and fatigue. These impairments together with dyspnoea, number of symptoms and sick leave are also associated with reduced self-rated health. Four specific cluster profiles have been identified, and 66.4% of the participants have severe to moderate impairments.

CONCLUSIONS
Regardless of the initial level of care approximately two-thirds of the participants exhibit various physical and mental impairments associated to self-rated health after COVID-19. We propose that defining specific cluster profiles is crucial for tailoring management of post-COVID sequelae. Further long-term studies are needed to understand recovery trajectories to optimise targeted interventions.

PLAIN LANGUAGE SUMMARY
This study examined symptom burden and physical and mental impairments in individuals with post–COVID-19 condition (PCC), comparing those who had been hospitalised with those who had not. Data from 931 participants (July 2020–December 2022) included medical history, physical tests, and questionnaires. Fatigue, breathlessness, joint pain, tingling, and chest pressure were common. Both groups showed reduced physical function, while depression and fatigue were more prevalent among non-hospitalised individuals. Four cluster profiles were identified, with most participants reporting moderate to severe impairments affecting self-rated health. These findings underscore the importance of comprehensive assessment and long-term follow-up to support recovery and guide rehabilitation strategies for people living with PCC.

Web | DOI | PDF | Nature Communications Medicine | Open Access

 

[Utsikt]

Fig. 2: All self-reported symptoms were presented by type of care.

All self-reported symptoms presented by type of care, Non-hospitalised (NH-group) (n = 449) and Hospitalised (H-group) (n = 482), with frequencies expressed as percentages.

Very low anxiety scores for once. It’s clear from the distributions that the H group to a larges degree struggled with the aftermath of a severe respiratory/cardiovascular disease, and that the NH are more PVF or ME/CFS-like.

There’s an obvious selection bias in the NH group - they’ve looked at those worse off, but not so bad that they can’t attend physically and go through all of the tests.

The NH-group demonstrated significantly lower values than the H-group in the following clinical outcome variables PCFS, EQ VAS, mMRC, Frändin-Grimby, 6 MWT, mental health and fatigue. While the H-group demonstrated significantly lower values than the NH-group in the following clinical outcomes variables: 1MSTS, lung function and cognitive function.

Lower 6MWT than the hospitalised group is saying something. And this correlation:

Hospitalisation was associated with 8.34 points higher EQ VAS scores (95% CI: 4.07 to 12.61)

Fig. 3: Patterns of the different cluster profiles.

Visualising the pattern in segmentation within and between the different clusters profiles regarding mental (GAD-7, PHQ-9) and physical impairments (1 MSTS ratio, MIP ratio 6 MWT ratio) (n = 770). GAD-7 General Anxiety Disorder −7, PHQ-9 Patient Health Questionnaire, 1MSTS One Minute Sit-To-Stand Test, MIP maximal inspiratory pressure, 6MWT Six Minute Walking Test, mMRC (modified Medical Research Council) dyspnoea scale, EQ VAS EuroQol Visual Analogue Scale.

Fig. 4: The 10 most commonly self-reported symptoms.

The 10 most commonly self-reported symptoms presented by each cluster (Cluster 1 (n = 111), Cluster 2 (n = 164), Cluster 3 (n = 236), and Cluster 4 (n = 259)), with frequencies expressed as percentages.

The contrasts between H and NH are striking:

Non-hospitalised and hospitalised individuals differed in demographic characteristics in agreement with previous findings5. The NH-group consisted of younger individuals of working age, predominantly women, who had been employed and physically active prior to initial COVID-19 illness and with few comorbidities. A majority in the NH-group were on sick leave at their first assessment, which had important implications for their own well-being and life economy7.

In line with other studies, the H-group was predominantly males with a mean age of 57 years, a higher BMI and a higher proportion of pre-existing comorbidities such as high blood pressure29,30. The H-group had relatively severe initial COVID-19 caused by the wild type, Alpha and Delta SARS-CoV-2 strains, with over 60% admitted to the ICU and of these 43% required invasive ventilation, which corresponds to similar proportions in other studies1,30.

An interesting finding, albeit not entirely surprising, is that patients who have been hospitalised report better perceived health than non-hospitalised patients. These findings indicate that PCC poses a significant burden for the individual7, which is comparable to other chronic conditions39. Non-hospitalised individuals comprise the majority of patients with PCC, which is a consequence that poses a significant burden also at a societal level7.

As might have been expected, there is no mention of how patients that clearly are severely ill will be falsely flagged as having poor mental health.

Luckily, there isn’t much BPS babble, but they were unable to stay away from calling for multidisciplinary rehabilitation services:

Tailored interventions for individuals with more severe PCC can be achieved through multidisciplinary and multiprofessional teams to identify underlying conditions, the need for specific medical treatment and individually adjusted rehabilitation.

I think the most useful info from this study is that a mild infection can have a much larger impact on your health than being hospitalised. That should make one think once or twice about preventative measures..

 

[rvallee]

Not bad. I still find most of the studies published so far inferior to the second Body Politic study on symptoms over time.

It contained most of this information and did a better job of it. 5.5 years and it barely just confirms things that were obvious well over 4 years ago.

What's absurd is that all the reflexive dismissal is still very much in effect, even as study after study confirms things are really bad for millions of people. Zero lessons learned, though. Who needs facts and evidence when we got ideology and politics?

 

[rvallee]

An interesting finding, albeit not entirely surprising, is that patients who have been hospitalised report better perceived health than non-hospitalised patients. These findings indicate that PCC poses a significant burden for the individual7, which is comparable to other chronic conditions39. Non-hospitalised individuals comprise the majority of patients with PCC, which is a consequence that poses a significant burden also at a societal level7.

Yes, health care and support are effective at helping sick people. Hence the whole obsession with denying health care based on delusional models is a seriously bad idea, but it's been known for decades so whatever.