Review Prognostic Factors for Post-COVID-19 Syndrome: A Systematic Review and Meta-Analysis, 2022, Maglietta et al

Prognostic Factors for Post-COVID-19 Syndrome: A Systematic Review and Meta-Analysis

Clinical and Epidemiological Research Unit, University Hospital of Parma, University of Parma, 43126 Parma, Italy

Abstract
Evidence shows that a substantial proportion of patients with COVID-19 experiences long-term consequences of the disease, but the predisposing factors are poorly understood. We conducted a systematic review and meta-analysis to identify factors present during COVID-19 hospitalization associated with an increased risk of exhibiting new or persisting symptoms (Post-COVID-19 Syndrome, PCS). MedLine and WebOfScience were last searched on 30 September 2021. We included English language clinical trials and observational studies investigating prognostic factors for PCS in adults previously hospitalized for COVID-19, reporting at least one individual prospective follow-up of minimum 12 weeks. Two authors independently assessed risk of bias, which was judged generally moderate. Risk factors were included in the analysis if their association with PCS was investigated by at least two studies. To summarize the prognostic effect of each factor (or group of factors), odds ratios were estimated using raw data.

Overall, 20 articles met the inclusion criteria, involving 13,340 patients. Associations were statistically significant for two factors: female sex with any symptoms (OR 1.52; 95% CI 1.27-1.82), with mental health symptoms (OR 1.67, 95% CI 1.21-2.29) and with fatigue (OR 1.54, 95% CI 1.32-1.79); acute disease severity with respiratory symptoms (OR 1.66, 95% CI 1.03-2.68). The I² statistics tests were calculated to quantify the degree of study heterogeneity.

This is the first meta-analysis measuring the association between factors present during COVID-19 hospitalization and long-term sequelae. The role of female sex and acute disease severity as independent prognostic factors must be confirmed in robust longitudinal studies with longer follow-up. Identifying populations at greatest risk for PCS can enable the development of targeted prevention and management strategies. Systematic review registration: PROSPERO CRD42021253467.

https://pmc.ncbi.nlm.nih.gov/articles/pmid/35329867/
open access

 

So, hospitalised patients only, symptoms persistence at least 12 weeks. The hospitalisation means that it is particularly likely to be all sorts of pathology jumbled up and labelled Long Covid.

They found a fairly modest association between having any symptom of Long Covid and being female (for every male case, there was about 1.5 female cases). The mention of mental health symptoms is a bit confusing - what they are saying there is that there was a similar signifiant association between being female and having a mental health symptom after hospitalisation with a Covid-19 infection. There was also a similar significant association between being female and having fatigue after hospitalisation with a Covid-19 infection. I expect that there was a bit of a crossover there - if you have a persistent symptom, such as debilitating fatigue, you are likely to be rather concerned and anxious about it.

They also found a significant association between acute disease severity and (only) persisting respiratory symptoms. Which is hardly surprising.

Pre-infection psychological factors were not found to have prognostic value.

Risk of bias of included studies was assessed as moderate.