Here, we report the prevalence of post-COVID-19 conditions in a representative sample of previously hospitalized patients with COVID-19 living in Bolívar, Colombia. Our observations indicate that these conditions are frequent and disabling, with approximately 8 out of 10 patients with COVID-19 requiring hospitalization during the acute phase of the disease experiencing at least one condition after three months. Within this group, more than 70% showed deterioration in their health status (EQ5D-5L Scale) or new or worsened disability in at least one domain of the Washington Group. Additionally, a high proportion of patients (> 60%), continue to experience symptoms 12 months after discharge.
A median of six symptoms per patient was reported, with fatigue, joint pain, and dyspnea being the most common, and 40% experiencing impairment in their daily activities. These results are consistent with those observed in other countries for patients with an antecedent of hospitalization (18–20). In Colombia, there have been two published reports on the presentation of post-COVID-19 conditions. Compared to these data, the obtained prevalence rate of dyspnea was more similar to that reported by Serrano et al., in which 31% of patients experienced dyspnea one year after ICU discharge (21). Anaya et al. found a lower rate of this symptom in a sample of 100 patients with an antecedent of SARS-CoV-2 infection (22). The current study, which analyzes a population living in a region at sea level, and the previous reports on Bogotá (a high-altitude city) support that respiratory symptoms are common and persistent in a substantial proportion of Colombian patients who recovered from acute COVID-19.
In the current study, we observed that being a woman and requiring ICU admission were potential risk factors for experiencing at least one post-COVID-19 condition. Prior research has identified a heightened risk of developing post-COVID-19 symptoms in women, regardless of hospitalization status (23), and they were more prone to reporting lingering symptom (24). From a pathophysiological perspective, no studies have explained why women experience post-COVID-19 conditions more frequently than men. However, a study showed that the presence of autoantibodies is associated with the presence of post-COVID-19 symptoms (25), and considering that women have a greater propensity to develop a higher number of antibodies and autoantibodies (26), this could be one of the reasons why women more frequently manifest post-COVID-19 conditions. Similarly, in our analysis, we observed a significant increase in the presentation of respiratory difficulty, chest pain, and fatigue in women compared with men, which is consistent with previous studies (27). In addition, although the proportion of women in the 6 to 12 months post-discharge group was higher than that of men, there were no significant differences in the presentation of symptoms according to sex and time of hospital discharge (data not presented).
Similar to other studies, our findings showed a significant association between ICU admission and manifestation of post-COVID-19 conditions. Severe COVID-19 may be a risk factor for owing to its propensity to elicit an intensified immune response which may amplify the risk of organ impairment (28–30). Additionally, managing severe cases of COVID-19 often requires the use of corticosteroids and intubation, which can result in enduring adverse effects that may later manifest as post-COVID-19 conditions. Similarly, a cohort study observed that high level of RNA in the blood at the time of diagnosis, which may also be related to disease severity, are a risk factor for developing post-COVID-19 conditions (25).
In our study, comorbidities were not associated with the presentation of post-COVID conditions. These results are consistent with previous prospective and retrospective studies (31–33). However, other studies have found that type 2 diabetes is a risk factor for post-COVID conditions (34). Similarly, some post-COVID conditions, such as fatigue, dyspnea, and psychiatric disorders, are related to pre-existing conditions such as asthma, chronic pulmonary disease, and psychiatric disorders (31). In our study, we assessed the risk factors for each of the most frequent symptoms (fatigue, dyspnea, joint pain, and sleep disorders), but no association was found (data not presented). These results may be due to the sample of patients who had comorbidities.
We also quantified significant deterioration in disability, disability related to dyspnea, and overall health status. The severity of dyspnea may arise from direct lung injury; however, the causes of fatigue, pain, and cognitive issues remain unclear. Their resemblance to symptoms of other post-infectious and post-intensive care syndromes could provide insights into potential mechanisms such as autoimmunity triggered by infection (35–37). Furthermore, a significant percentage of participants reported worsening symptoms of anxiety and depression, as reported in previous studies (38, 39), highlighting the importance of psychological monitoring during the follow-up of post-COVID-19 patients.
Among the strengths of this study, we used a questionnaire that collected the most frequently reported symptoms in hospitalized patients with COVID-19, which was evaluated through a systematic review by our research group (unpublished data). Additionally, within the group of patients with persistent conditions, we applied a validated questionnaire and a current reference to evaluate disability and changes in health status in hospitalized COVID-19 patients (40, 41).
A limitation of our study is that data on post-COVID-19 conditions were not collected prospectively; thus, no temporal relationships (onset date) between the disease and the course of symptoms could be performed. Finally, our findings were limited by the absence of a control group and prehospitalization assessments for COVID-19.
In conclusion, our study demonstrates that post-COVID-19 conditions in previously hospitalized patients are highly prevalent, which can adversely affect patients' quality of life and lead to an increased demand for healthcare services.