Association between somatic symptom disorder and symptoms with daily life impairment after SARS-CoV-2 infection - results from a population-based cross-sectional study

BACKGROUND

Post-COVID syndrome (PCS) is defined by symptom persistence accompanied by daily life impairment (DLI). The association of somatic symptom disorder (SSD) and symptoms with DLI after SARS-CoV-2 infection in the general population is unclear to date. The main objective of the study was to investigate the association of possible SSD, depression, anxiety, and participant-reported symptoms with DLI in a local population sample.

METHODS

Anonymised cross-sectional study. A symptom questionnaire, including the scales Patient Health Questionnaire PHQ-15 (somatisation module), SSD-12 (psychological distress in SSD), PHQ-2 (depression), GAD-2 (anxiety), and FAS (fatigue assessment scale) was sent in 02/2022 to all adult residents of the district Bad Tölz-Wolfratshausen, Germany, who were registered for SARS-CoV-2-infection between 03/2020 and 11/2021 (8925 delivered). Associations between DLI, symptoms and scales were estimated using binary logistic regression models and network analysis.

RESULTS

2828 questionnaires (31.7%) were complete. 1486 (52.5%) reported persistent symptoms, and 509 (18.0%) perceived DLI. DLI was strongest associated with self-reported fatigue (OR 7.86; 95%CI 5.63-10.97), dyspnea (3.93; 2.73-5.67), impaired concentration (3.05; 2.17-4.30), SSD-12 (4.36; 2.57-7.41), and PHQ-2 (2.48; 1.57-3.92). Self-reported fatigue showed the strongest correlation (rp = 0.248) and closest proximity to DLI in network analysis.

CONCLUSION

PCS appears as a complex clinical picture in which SSD might play an important role when DLI is present. The pychological burden might partly be explained by the persistent symptoms, which are difficult to treat up to now. Screening for SSD could help in differential diagnostic decision-making to ensure that patients receive appropriate psychosocial interventions for disease coping.

Whole-body hyperthermia as part of a multimodal treatment for patients with post-covid syndrome - a case series

BACKGROUND

Post-Covid syndrome (PCS) has been an ongoing challenge since the COVID-19 pandemic. Relatively little is known about the effect of whole-body hyperthermia (WBH) in the treatment of PCS.

METHODS

We retrospectively analyzed the data of patients with PCS who were treated as inpatients with a multimodal integrative therapy approach including WBH. The primary outcome comprised changes in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) between T0 (at hospital admission) and T2 (four weeks after discharge), secondary outcomes were changes in Fatigue Impact Scale (FIS-D), Multidimensional Dyspnea Profile (MDP) and Covid-Associated Symptoms (CAS) between T0-T1 (at discharge) and T0-T2.

RESULTS

FACIT-F yielded a significant increase (p < 0.001) between T0 (19.1 ± 8.4) and T2 (29.9 ± 13.0) (primary outcome), indicating an improved health status. While FIS-D and CAS scores improved significantly between T0 and T2, dyspnea parameters improved only between T0 and T1. 63% of respondents identified WBH as an effective treatment.

CONCLUSIONS

Study results provide preliminary evidence for potentially positive effects of WBH in the setting of this study, in which it is embedded in a multimodal therapy approach. The results should be substantiated by future RCTs to identify specific effects of individual therapy components.

[Physiological assessment and management of post-COVID patients with normal cardiopulmonary imaging and functional tests]

OBJECTIVE

Contributing to elucidate the pathophysiology of dyspnoea and exertion intolerance in post-COVID syndrome patients with normal cardiopulmonary imaging and functional tests at rest, while determining their fitness and level of endurance in order to individualize working parameters for physical rehabilitation.

MATERIAL AND METHODS

After an anamnesis and clinical examination at rest, 27 subjects (50±11.9 years) (14 women) with post-COVID syndrome of more than 6 months of evolution performed a continuous maximal-incremental graded cardiopulmonary exercise test (CPET) with breath-by-breath gas-exchange monitoring and continuous ECG registration, on an electromagnetically braked cycle ergometer. The values obtained were compared with those of reference, gender or controls, using the Chi-square, t-Student or ANOVA test.

RESULTS

The clinical examination at rest and the CPET were clinically normal and without adverse events. Reasons for stopping exercise were leg discomfort. It is only worth noting a BMI=29.9±5.8kg/m2 and a basal lactate concentration of 2.1±0.7mmol/L. The physiological assessment of endurance showed the following results relative to predicted VO2máx: 1)peakVO2=80.5±18.6%; 2)VO2 at ventilatory threshold1 (VO2VT1): 46.0±12.9%; 3)VO2VT2: 57.2±16.4%; 4)working time in acidosis: 5.6±3,0minutes; and 5)maximum lactate concentration: 5.1±2.2mmol/L.

CONCLUSIONS

The CPET identified limited aerobic metabolism and early increase in glycolytic metabolism as causes of dyspnoea and exercise intolerance, determined fitness for physical rehabilitation, and individualized it based on the level of endurance.