RISK FACTORS FOR DEVELOPING POST COVID-19 CONDITION OF FATIGUE AND DYSPNOEA IN ADULTS: A SYSTEMATIC REVIEW

S.N. Sim^1,2, E. O'Shea², S. Timmons², S. Fox²

¹National University Hospital, Department of Rehabilitation, Singapore, Singapore, ²University College Cork, Centre for Gerontology and Rehabilitation, School of Medicine, UCC, Cork, Ireland

Background: With each wave of COVID-19 infection, the risk of post COVID-19 condition developing among COVID-19 survivors exists. However, the factors that place individuals at increased risk of specific symptoms of post COVID-19 condition are unclear. Compiled evidence is required to predict this manifestation and guide the development of management guidelines to address this debilitating condition.

Purpose: This systematic review aims to identify baseline risk factors associated with an increased risk of developing fatigue and dyspnoea as symptoms of post COVID-19 condition. A secondary objective of this review is to explore the role of the COVID-19 vaccination on the development of post COVID-19 condition after a breakthrough infection.

Methods: A search was conducted in Scopus, ScienceDirect, PubMed, OVID/EMBASE, SpringerLink, SAGE Journals, PLOS, Journal of Infectious Disease, Taylor and Francis Online from March 1st, 2020, to March 11th, 2022. Observational studies that assessed for characteristics within adult COVID-19 survivors who developed fatigue and dyspnoea, were included. Two independent reviewers appraised and extracted the summary data. Results were compiled through narrative synthesis. This review adopts the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline and is registered on PROSPERO, CRD42022318597.

Results: Overall, 25 studies were included from 13 countries. By narrative synthesis, the factors associated with fatigue and dyspnoea as symptoms of post COVID-19 condition were categorised into two main categories: baseline factors and acute factors during COVID-19 infection. Fatigue and dyspnoea manifestation were associated with female sex, presence of more than one co-morbidity, and the severity of initial COVID-19 infection. Additionally, the symptom burden of initial COVID-19 infection also had a role in fatigue manifestation. The association of age with symptoms manifestation was non-significant. Most factors were noted in hospitalised and non-hospitalised COVID-19 survivors. All the reviewed studies recruited individuals before the production and roll-out of the COVID-19 vaccination globally (December 2020).

Conclusions: Female sex, multiple co-morbidities and the severity of initial COVID-19 infection were factors associated with fatigue and dyspnoea. Individuals with these risk factors would be an important target group for post-acute recovery interventions (e.g., rehabilitation).

Implications: Healthcare institutions should provide appropriate follow-ups to both hospitalised and non-hospitalised COVID-19 survivors. Further research with an integrative approach on the mechanism supporting these risk factors is needed. Another key area for future research should be on the predisposing factors in developing post COVID-19 condition after a breakthrough infection among vaccinated COVID-19 survivors.

Funding acknowledgements: None

Keywords:
Post COVID-19 condition
Risk factors
Fatigue, Dyspnoea

Topics:
COVID-19
Non-communicable diseases (NCDs) & risk factors
Service delivery/emerging roles

Did this work require ethics approval? No

Reason: Paper was a systematic review