key: cord-0739504-u5ytba2r authors: Fernández-de-las-Peñas, Dr. César title: Long-Term Post-COVID Symptoms and Associated Risk Factors in Previously Hospitalized Patients: A Multicenter Study date: 2021-05-11 journal: J Infect DOI: 10.1016/j.jinf.2021.04.036 sha: 0486e4b9a327012b5f11bf4fb147f724271e501a doc_id: 739504 cord_uid: u5ytba2r nan The word is in front of a second pandemic associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), i.e., post-COVID sequelae and "long-haulers". A preprint meta-analysis has found that 80% of COVID-19 survivors exhibit at least one post-COVID symptom after infection [1] . However, most of the studies included in this meta-analysis had follow-up periods <3 months, sample sizes <300 participants, and were conducted at a single center [1] . In a letter to the editor in Journal of Infection, Garrigues et al found that fatigue, dyspnoea, and loss of memory were the most prevalent post-COVID symptoms 3 months after hospital discharge [2] . More recently, Moreno-Perez et al observed that 59% of hospitalized and 37% of nonhospitalized patients exhibited post-COVID symptoms 3 months after the infection [3] . Here we report a multicenter study assessing post-COVID symptoms and associated risk factors seven months after hospital discharge. This multicenter study found that 80% of hospitalized COVID-19 survivors exhibited at least one post-COVID symptom seven months after hospital discharge. Fatigue, hair loss, and dyspnea were the most prevalent symptoms. Female gender, number of days at hospital, previous comorbidities, and number of symptoms at hospital admission were associated with a higher number of long-term post-COVID symptoms. Our prevalence rates of fatigue (60.8%), hair loss (26.3%), and dyspnea (23.5%). as post-COVID sequelae agree with pooled prevalence data reported by Lopez-Leon et al [1] . Although most studies investigating post-COVID symptoms have included follow-up periods <3 months [1] , a small number of single-center studies have included follow-ups >6 months [4] [5] [6] [7] . Our study increases evidence to the current literature with a large, multicenter design evaluating long-term post-COVID symptoms. Based on the available evidence, the term persistent post-COVID is supported, since symptoms are present more than six months after infection [8] . It seems that the post-COVID-19 symptom burden will be comparable to the long-term burden of severe acute respiratory syndrome (SARS), where subjects present with symptoms one year after infection [9] . In fact, unlike other acute respiratory syndromes, COVID-19 survivors also exhibit multiple non-respiratory symptoms, e.g., tachycardia, ageusia, anosmia, brain fog, memory loss and gastrointestinal problems, several months after infection. Biological (e.g., cytokine storm) and emotional (e.g., posttraumatic stress, uncertainty on prognosis, social alarm) factors surrounding COVID-19 are suggested to be responsible of this plethora of post-COVID symptoms. This heterogeneity in post-COVID symptoms supports that they will certainly need a multidisciplinary treatment. Identification of risk factors associated with persistent COVID-19 sequelae will facilitate diagnosis and counselling strategies for these patients. We identified that female gender, longer stay at hospital, higher number of comorbidities, and higher number of symptoms at hospital admission were risk factors associated with a higher number of post-COVID symptoms seven months after discharge. These results agree with potential risk factors previously identified in other single-center studies [1] . Our study has some weaknesses. First, only hospitalized patients were included. Second, the number of patients requiring ICU admission was small. Third, we did not collect objective measures of COVID-19 disease, e.g., inflammatory biomarkers, blood oxygen saturation. All authors contributed to the study concept and design. CFdlP, DMP, VGM, and VHB No conflict of interest is declared by any of the authors No funds were received for this study Legend of Figure Figure : Distribution of the most prevalent post-COVID symptoms (fatigue, hair loss, dyspnea, memory loss, skin rashes, and brain fog) in male and female patients. More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis. medRxiv Postdischarge persistent symptoms and health-related quality of life after hospitalization for COVID-19 Post-acute COVID-19 syndrome. Incidence and risk factors: a Mediterranean cohort study 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study Risk factors for long-term consequences of COVID-19 in hospitalised adults in Moscow using the ISARIC Global follow-up protocol: StopCOVID cohort study Persistence of symptoms up to 10 months following acute COVID-19 illness. medRxiv Rapid implementation of a cohort for the study of post-acute sequelae of SARS-CoV-2 infection/COVID-19. medRxiv Defining Post-COVID Symptoms (Post-Acute COVID, Long COVID, Persistent Post-COVID): An Integrative Classification Long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome coronavirus (MERS) outbreaks after hospitalisation or ICU admission: a systematic review and meta-analysis days 14 (12) Intensive Care Unit (ICU) admission Yes/No, n (%) Stay at ICU, mean (SD), days 80 (7%) / 1062 (93%) 15 (13) Number of persistent post-COVID symptoms