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Gutzeit J, Weiß M, Nürnberger C, Lemhöfer C, Appel KS, Pracht E, Reese JP, Lehmann C, Polidori MC, Hein G, Deckert J. Definitions and symptoms of the post-COVID syndrome: an updated systematic umbrella review. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01868-y. [PMID: 39052056 DOI: 10.1007/s00406-024-01868-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
Post-COVID syndrome (PCS) describes a persistent complex of symptoms following a COVID-19 episode, lasting at least 4 to 12 weeks, depending on the specific criteria used for its definition. It is often associated with moderate to severe impairments of daily life and represents a major burden for many people worldwide. However, especially during the first two years of the COVID-19 pandemic, therapeutic and diagnostic uncertainties were prominent due to the novelty of the disease and non-specific definitions that overlooked functional deficits and lacked objective assessment. The present work comprehensively examines the status of PCS definitions as depicted in recent reviews and meta-analyses, alongside exploring associated symptoms and functional impairments. We searched the database Pubmed for reviews and meta-analysis evaluating PCS in the period between May 31, 2022, to December 31, 2023. Out of 95 studies, 33 were selected for inclusion in our analyses. Furthermore, we extended upon prior research by systematically recording the symptoms linked with PCS as identified in the studies. We found that fatigue, neurological complaints, and exercise intolerance were the most frequently reported symptoms. In conclusion, over the past eighteen months, there has been a notable increase in quantity and quality of research studies on PCS. However, there still remains a clear need for improvement, particularly with regard to the definition of the symptoms necessary for diagnosing this syndrome. Enhancing this aspect will render future research more comparable and precise, thereby advancing and understanding PCS.
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Affiliation(s)
- Julian Gutzeit
- Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany.
- Department of Psychology III - Psychological Methods, Cognition, and Applied Research, Julius-Maximilians-Universität Würzburg, Röntgenring 11, 97070, Würzburg, Germany.
| | - M Weiß
- Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
- Department of Psychology I - Biological Psychology, Clinical Psychology and Psychotherapy, Julius-Maximilians-Universität Würzburg, Marcusstraße 11, 97070, Würzburg, Germany
| | - C Nürnberger
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - C Lemhöfer
- Institute for Physical and Rehabilitative Medicine, University Hospital Jena, Jena, Germany
| | - K S Appel
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Frankfurt, Germany
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Cologne, Germany
| | - E Pracht
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Cologne, Germany
| | - J-P Reese
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - C Lehmann
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Cologne, Germany
- German Center for Infection Research, Partner site Bonn-Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - M C Polidori
- Aging Clinical Research, Department II of Internal Medicine, Center for Molecular Medicine Cologne, Faculty of Medicine, University Hospital Cologne, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress- Responses in Aging- Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - G Hein
- Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - J Deckert
- Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
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Appel KS, Nürnberger C, Bahmer T, Förster C, Polidori MC, Kohls M, Kraus T, Hettich-Damm N, Petersen J, Blaschke S, Bröhl I, Butzmann J, Dashti H, Deckert J, Dreher M, Fiedler K, Finke C, Geisler R, Hanses F, Hopff SM, Jensen BEO, Konik M, Lehnert K, de Miranda SMN, Mitrov L, Miljukov O, Reese JP, Rohde G, Scherer M, Tausche K, Tebbe JJ, Vehreschild JJ, Voit F, Wagner P, Weigl M, Lemhöfer C. Definition of the Post-COVID syndrome using a symptom-based Post-COVID score in a prospective, multi-center, cross-sectoral cohort of the German National Pandemic Cohort Network (NAPKON). Infection 2024:10.1007/s15010-024-02226-9. [PMID: 38587752 DOI: 10.1007/s15010-024-02226-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The objective examination of the Post-COVID syndrome (PCS) remains difficult due to heterogeneous definitions and clinical phenotypes. The aim of the study was to verify the functionality and correlates of a recently developed PCS score. METHODS The PCS score was applied to the prospective, multi-center cross-sectoral cohort (in- and outpatients with SARS-CoV-2 infection) of the "National Pandemic Cohort Network (NAPKON, Germany)". Symptom assessment and patient-reported outcome measure questionnaires were analyzed at 3 and 12 months (3/12MFU) after diagnosis. Scores indicative of PCS severity were compared and correlated to demographic and clinical characteristics as well as quality of life (QoL, EQ-5D-5L). RESULTS Six hundred three patients (mean 54.0 years, 60.6% male, 82.0% hospitalized) were included. Among those, 35.7% (215) had no and 64.3% (388) had mild, moderate, or severe PCS. PCS severity groups differed considering sex and pre-existing respiratory diseases. 3MFU PCS worsened with clinical severity of acute infection (p = .011), and number of comorbidities (p = .004). PCS severity was associated with poor QoL at the 3MFU and 12MFU (p < .001). CONCLUSION The PCS score correlated with patients' QoL and demonstrated to be instructive for clinical characterization and stratification across health care settings. Further studies should critically address the high prevalence, clinical relevance, and the role of comorbidities. TRAIL REGISTRATION NUMBER The cohort is registered at www. CLINICALTRIALS gov under NCT04768998.
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Affiliation(s)
- Katharina S Appel
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Carolin Nürnberger
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Christian Förster
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Maria Cristina Polidori
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Mirjam Kohls
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Tanja Kraus
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Nora Hettich-Damm
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Julia Petersen
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Sabine Blaschke
- Emergency Department, University Medical Center Göttingen, Göttingen, Germany
| | - Isabel Bröhl
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jana Butzmann
- Medical Faculty, Institute of Medical Microbiology and Hospital Hygiene, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Hiwa Dashti
- Practice for General Medicine Dashti, Eberswalde, Germany
| | - Jürgen Deckert
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Karin Fiedler
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Carsten Finke
- Department of Neurology, Charité Berlin, Berlin, Germany
| | - Ramsia Geisler
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Frank Hanses
- Emergency Department and Department for Infection Control an Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Sina M Hopff
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Björn-Erik O Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Margarethe Konik
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Kristin Lehnert
- DZHK (German Center for Cardiovascular Research), University Medicine Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Susana M Nunes de Miranda
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Lazar Mitrov
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Olga Miljukov
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Jens-Peter Reese
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine, Goethe University Frankfurt, University Hospital, Medical Clinic I, Frankfurt/Main, Germany
| | - Margarete Scherer
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Kristin Tausche
- Department of Internal Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Johannes J Tebbe
- Department of Gastroenterology and Infectious Diseases, Klinikum Lippe, Lippe, Germany
| | - Jörg Janne Vehreschild
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Florian Voit
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Patricia Wagner
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin Weigl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
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Skiba EM, Drewitz KP, Panchyrz I, Deckert S, Apfelbacher C, Piontek K. [Follow-up outpatient clinics for patients with post COVID: a survey to assess and characterize aspects of care]. Dtsch Med Wochenschr 2024; 149:e48-e57. [PMID: 38621680 PMCID: PMC11018383 DOI: 10.1055/a-2255-9252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
After acute infection with the SARS-CoV-2 virus, up to 10 % of affected individuals suffer from long-term health impairments, also referred to as "Post-COVID". In Germany, specialized outpatient clinics have been established to care for patients with Post-COVID. A structured survey of the care situation is not yet available, but essential for a demand-oriented care. The present study aimed to systematically assess and describe structural and process-related aspects of care, and to perform an inventory and needs analysis of Post-COVID outpatient clinics in Germany.An online survey was developed assessing the structure and organization of the outpatient clinics, service offerings and networking of care from the perspective of the outpatient clinic directors. A total of 95 outpatient clinics were identified, and an invitation to participate in the online survey was sent via e-mail to the directors of the outpatient clinics. Data were collected between February and May 2022. Descriptive data analysis was performed.A total of 28 outpatient clinic managers (29 %) took part in the survey. Participants were between 32 and 66 years old, and 61 % (n = 17) were male. The outpatient clinics were most frequently affiliated with the specialties of pneumology (n = 10; 36 %), internal medicine, psychiatric and psychosomatic medicine, and neurology (n = 8; 29 %, respectively). Among the outpatient clinic directors, 64 % (n = 18) stated that the time spent waiting for an appointment was more than one month. Utilization (n = 25; 89 %), appointment demand (n = 26; 93 %), and the need for more Post-COVID outpatient clinics (n = 20; 71 %) were rated as high by the outpatient clinic directors. Nearly all directors reported networking with in-clinic facilities (n = 27; 96 %), with primary care physicians and with specialists in private practice (n = 21; 75 %, respectively).The main focus of care is pneumology. Internal medicine, psychiatry/psychosomatics and neurology are also equally represented. Our data further suggest a high demand for Post-COVID outpatient clinics and the need to expand this care offer.
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Affiliation(s)
- Eva-Maria Skiba
- Institut für Sozialmedizin und Gesundheitssystemforschung, Universitätsmedizin Magdeburg
| | - Karl Philipp Drewitz
- Institut für Sozialmedizin und Gesundheitssystemforschung, Universitätsmedizin Magdeburg
| | - Ivonne Panchyrz
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Stefanie Deckert
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Christian Apfelbacher
- Institut für Sozialmedizin und Gesundheitssystemforschung, Universitätsmedizin Magdeburg
| | - Katharina Piontek
- Institut für Sozialmedizin und Gesundheitssystemforschung, Universitätsmedizin Magdeburg
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Lemhöfer C, Bahmer T, Baumbach P, Besteher B, Boekel A, Finke K, Katzer K, Lehmann-Pohl K, Lewejohann JC, Loudovici-Krug D, Nowka M, Puta C, Quickert S, Reuken PA, Walter M, Stallmach A. Variations and Predictors of Post-COVID Syndrome Severity in Patients Attending a Post-COVID Outpatient Clinic. J Clin Med 2023; 12:4013. [PMID: 37373706 DOI: 10.3390/jcm12124013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
A relevant proportion of patients suffer from long-lasting impairments following an acute SARS-CoV-2 infection. The proposed post-COVID syndrome (PCS) score may improve comparison in the course and classification of affected patients. A prospective cohort of 952 patients presenting to the post-COVID outpatient clinic at Jena University Hospital, Germany, was enrolled. Patients received a structured examination. PCS score was calculated per visit. A total of 378 (39.7%) and 129 (13.6%) patients of the entire population visited the outpatient clinic two or three times, respectively (female: 66.4%; age: 49.5 (SD = 13) years). The initial presentation took place, on average, 290 (SD = 138) days after acute infection. The most frequently reported symptoms were fatigue (80.4%) and neurological impairments (76.1%). The mean PCS scores of patients with three visits were 24.6 points (SD = 10.9), 23.0 points (SD = 10.9) and 23.5 points (SD = 11.5) (p = 0.407), indicating moderate PCS. Female sex (p < 0.001), preexisting coagulation disorder (p = 0.021) and coronary artery disease (p = 0.032) were associated with higher PCS scores. PCS is associated with a multitude of long-lasting problems. The PCS score has proven its capability to objectify and quantify PCS symptoms in an outpatient setting. The influence of therapeutic measures on various PCS aspects should be the subject of further analyses.
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Affiliation(s)
- Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), 35392 Grosshansdorf, Germany
| | - Philipp Baumbach
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, 07747 Jena, Germany
| | - Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Andrea Boekel
- Department of Rehabilitation and Sports Medicine, Hanover Medical School, 30625 Hanover, Germany
| | - Kathrin Finke
- Department of Neurology, Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Katrin Katzer
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Katja Lehmann-Pohl
- Center for Sepsis Control & Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Jan-Christoph Lewejohann
- Department of Emergency Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Dana Loudovici-Krug
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Matthias Nowka
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Christian Puta
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Stefanie Quickert
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Philipp Alexander Reuken
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
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