Symptom Burden and Post-COVID-19 Syndrome 24 Months Following SARS-CoV-2 Infection: Longitudinal Population-Based Study, 2025, Peter et al

[forestglip]

Symptom Burden and Post-COVID-19 Syndrome 24 Months Following SARS-CoV-2 Infection: Longitudinal Population-Based Study

Raphael S. Peter, Lisamaria Eble, Alexandra Nieters, Stefan O. Brockmann, Siri Göpel, Uta Merle, Jürgen M. Steinacker, Hans-Georg Kräusslich, Dietrich Rothenbacher, Winfried V. Kern for the EPILOC Phase 3a Study Group

[Line breaks added]

Highlights
• Post-COVID symptoms remain frequent two years after infection.
• Symptom trajectories show both significant recovery and new emergence.
• Fatigue and cognitive impairment dominate long-term post-COVID outcomes
• Persistent symptom clusters strongly influence health-related quality of life.
• Few emerging symptoms are clearly attributable to SARS-CoV-2 reinfection.

Objectives
To describe the symptom burden and associated impairment two years after SARS-CoV-2 index infection.

Methods
Participants of an earlier large population-based survey in Southwestern Germany (August - September 2021) were contacted again in November 2023. We calculated the prevalences of suspected PCS and specific symptom clusters at both time points and investigated factors for their resolution or emergence.

Results
A total of 6635 subjects (mean age 46.6 years, 60.9% females) participated at follow-up. Between baseline and follow-up (median 8.7 and 23.9 months after infection) there were only small changes in the point prevalence of post-COVID-19 syndrome (PCS) (29.9% versus 31.2%) or defined symptom clusters such as fatigue (23.8% versus 22.0%), neurocognitive impairment (15.8% versus 17.3%), or chest symptoms (14.4% versus 13.7%).

Probabilities of resolution were often similar to probabilities of emergence, e.g. fatigue symptoms resolved in 9.8% of participants but emerged in 8.0%. Consistent predictors for emerging symptom clusters were female sex, obesity and medical treatment of the acute infection. The six main symptom clusters together explained 45% (physical domain) and 29% (mental domain) of the variance in health-related quality of life (hrQoL).

Conclusions
We found a remaining high symptom prevalence two years after SARS-CoV-2 infection, but symptoms present nine months after index infection often resolved, which was associated with increasing hrQoL. Remarkably, a considerable portion of symptoms newly emerged, of which only few could be attributed to reported SARS-CoV-2 reinfection.

Link | PDF (Infectious Disease Practice) [Open Access]

 

[Utsikt]

A German translation of the DSQ-PEM questionnaire was used to assess post-exertional-malaise, and to screen for possible ME/CFS.12

PEM and complaints compatible with ME/CSF affected circa 20.5% and 5.5% of the study participants about two years after the index infection. PEM was prevalent in over 50% of PCS cases, with symptom clusters of fatigue, neurocognitive impairment or chest symptoms. The prevalence is comparable to other studies in subjects with PCS, with a PEM-prevalence of 48.1% in women and 41.2% in men.27

I think this highlights the issues with DSQ.

Overall prevalences of post-exertional malaise (PEM) or positive screening for ME/CFS at two years were 20.5% and 5.5% (supplemental Table S1) and it was 60.8% and 15.3% in participants with persistent PCS at follow-up, respectively. Prevalence of PEM at follow-up was higher than 50% in those participants reporting symptoms of the fatigue, chest symptoms, or neurocognitive impairment clusters (59.6, 59.6, 57.9, or 52.3%, respectively). Screening for ME/CFS was positive, most often in participants reporting symptoms of neurocognitive impairment (15.9%), followed by chest symptoms (14.9%), musculoskeletal pain (14.9%), and fatigue (13.7%), respectively.

It might be my brainfog, but I really struggle with their writing here. It’s hard to follow what they are actually saying.

The table is a bit clearer:
Supplementary Table S1. Prevalence of PEM and suspected ME/CFS in participants, overall, by post-covid syndrom status and by presence of the main symptom clusters.