Post COVID syndrome among symptomatic COVID-19 patients: a prospective study in a tertiary care center in Bangladesh

Background: Post-coronavirus disease (COVID-19) syndrome includes
persistence of symptoms beyond viral clearance and fresh development of
symptoms or exaggeration of chronic diseases within a month after initial
clinical and virological cure of the disease with a viral etiology. We
aimed to determine the incidence, association, and risk factors associated
with development of the post-COVID-19 syndrome. Methods: We conducted a
prospective cohort study at Dhaka Medical College Hospital between June
01, 2020 and August 10, 2020. All the enrolled patients were followed up
for a month after clinical improvement, which was defined according the
World Health Organization and Bangladesh guidelines as normal body
temperature for successive 3 days, significant improvement in respiratory
symptoms (respiratory rate <25/breath/minute with no dyspnea), and
oxygen saturation >93% without assisted oxygen inhalation.
Findings: Among the 400 recruited patients, 355 patients were analyzed. In
total, 46% patients developed post-COVID-19 symptoms, with post-viral
fatigue being the most prevalent symptom in 70% cases. The post-COVID-19
syndrome was associated with female gender (relative risk [RR]: 1.2, 95%
confidence interval [CI]: 1.02–1.48, p=0.03), those who required a
prolonged time for clinical improvement (p<0.001), and those
showing COVID-19 positivity after 14 days (RR: 1.09, 95% CI: 1.00–1.19,
p<0.001) of initial positivity. Patients with severe COVID-19 at
presentation developed post-COVID-19 syndrome (p=0.02). Patients with
fever (RR: 1.5, 95% CI: 1.05–2.27, p=0.03), cough (RR: 1.36, 95% CI:
1.02–1.81, p=0.04), respiratory distress (RR: 1.3, 95% CI: 1.4–1.56,
p=0.001), and lethargy (RR: 1.2, 95% CI: 1.06–1.35, p=0.003) as the
presenting features were associated with the development of the more
susceptible to develop post COVID-19 syndrome than the others. Logistic
regression analysis revealed female sex, respiratory distress, lethargy,
and long duration of the disease as risk factors. Conclusion: Female sex,
respiratory distress, lethargy, and long disease duration are critical
risk factors for the development of post-COVID-19
syndrome.