Post-COVID-19 fatigue: A cross-sectional study

Arailym Abilbayeva 1 * , Anel Tarabayeva 1, Elmira Bitanova 1, Akbope Myrkassymova 2, Amangul Duisenova 3, Moldir Sadykova 3, Uldana Sakhadin 3
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1 Department of General Immunology, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
2 Department of Biostatistics and Basics of Scientific Research, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
3 Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 3, pp. 63-68. https://doi.org/10.23950/jcmk/13323
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ABSTRACT

Aim: To evaluate the prevalence of post-infection fatigue (PVFS) over one year after COVID-19.
Material and methods: 165 people who had COVID-19 more than a year ago were interviewed. A Fatigue Assessment Scale was used to assess the degree of fatigue. Chemiluminescent analysis was carried out to detect antibodies to Epstein-Barr Virus (EBV) antigens. For statistical analysis Fisher's exact test and Spearman correlation were conducted.
Results: Among people with PVFS, there were 4.1 times more women than men (80.4% vs. 19.6%), people over 45 years old (76%), and people who needed hospitalization for COVID-19 (76%). The average fatigue duration was 573±18,3    days. Among individuals without PVFS, there were significantly more individuals under the age of 45 compared with the group of individuals with PVFS (40% and 24%, respectively, p=0.007) and there were significantly more individuals who did not need hospitalization compared with the group of individuals with PVFS (52% vs. 24%, p=0.005). EBV reactivation was determined in almost half of the individuals with PVFS (48%), while none of the individuals without PVFS had EBV reactivation. A statistically significant negative mean correlation was found between the duration of PVFS and the severity of PVFS (r=-0.357, p=0.007). A statistically significant negative correlation was found between the PVFS duration and the PVFS severity (r=-0.357, p=0.007).
Conclusion: PVFS is a prevalent symptom after COVID-19. The duration of PVFS can reach and not be limited to 1.5 years. PVFS is more typical of women, people over 45 years of age and people who have had moderate and severe COVID-19.  Over time, the severity of PVFS decreases.
Key words: COVID-19, post-infection fatigue, Epstein-Barr virus
Keywords: COVID-19, post-infection fatigue, Epstein-Barr virus

CITATION

Abilbayeva A, Tarabayeva A, Bitanova E, Myrkassymova A, Duisenova A, Sadykova M, et al. Post-COVID-19 fatigue: A cross-sectional study. J CLIN MED KAZ. 2023;20(3):63-8. https://doi.org/10.23950/jcmk/13323

REFERENCES

  • Weekly epidemiological update on COVID-19 - 11 January 2023. URL: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---11-january-2023 (date of the application: 16.01.2023).
  • Long COVID or Post-COVID Conditions. URL: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html (date of the application: 16.01.2023).
  • Higgins V., Sohaei D., Diamandis E.P. et al. COVID-19: from an acute to chronic disease? Potential long-term health consequences. Crit Rev Clin Lab Sci. 2021;58(5):1473–310. https://doi.org/10.1080/10408363.2020.1860895
  • Sudre C.H., Murray B., Varsavsky T. et al. Attributes and predictors of long COVID. Nat Med. 2021;27(4):626–631. https://doi.org/10.1038/s41591-021-01292-y
  • Rudroff T., Fietsam A.C., Deters J.R., Bryant A.D., Kamholz J. Post-COVID-19 fatigue: potential contributing factors. Brain Sci.2020;10:1012. https://doi.org/10.3390/brainsci10121012
  • Graham E.L., Clark J.R., Orban Z.S., Lim P.H., Szymanski A.L., Taylor C. et al. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 “long haulers”. Ann Clin Transl Neurol. 2021;8:1073–85. https://doi.org/10.1002/acn3.5135
  • Samir E.S., Shokry D., Gomaa S.H. Post-COVID-19 fatigue and anhedonia: a cross-sectional study and their correlation to post-recovery period. Neuropsychopharmacol Rep. 2021;41:50–5. https://doi.org/10.1002/npr2.12154
  • Malik P., Patel K., Pinto C., Jaiswal R., Tirupathi R., Pillai S. et al. Post-acute COVID-19 syndrome (PCS) and healthrelated quality of life (HRQoL)-a systematic review and metaanalysis. J Med Virol. 2022;94:253–62. https://doi.org/10.1002/jmv.27309
  • Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome; Board on the Health of Select Populations; Institute of Medicine. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington (DC): National Academies Press (US). 2015. PMID: 25695122.
  • Son C.G. Differential diagnosis between "chronic fatigue" and "chronic fatigue syndrome". Integr Med Res.2019;8(2):89-91. https://doi.org/10.1016/j.imr.2019.04.005
  • Elanwar R., Hussein M., Magdy R., Eid R.A. et al. Physical and mental fatigue in subjects recovered from COVID-19 infection: a case-control study. Neuropsychiatr dis treat. 2021;17:2063–71. https://doi.org/10.2147/NDT.S317027
  • Ganesh R., Ghosh A.K., Nyman M.A., Croghan I.T. et al. PROMIS scales for assessment of persistent post-COVID symptoms: a cross sectional study. J Prim Care Community Health. 2021;12:21501327211030413. https://doi.org/10.1177/21501327211030413
  • Graham E.L., Clark J.R., Orban Z.S., Lim P.H. et al. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 “long haulers”. Ann Clin Transl Neurol. 2021;8:1073–85. https://doi.org/10.1002/acn3.51350
  • Townsend L., Dyer A.H., McCluskey P., O’Brien P.K. et al. Investigating the relationship between vitamin D and persistent symptoms following SARS-CoV-2 infection. Nutrients. 2021;13:2430. https://doi.org/10.3390/nu13072430
  • Townsend L., Dyer A.H., Jones K., Dunne J., Mooney A., Gaffney F. et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS ONE. 2020;15:e0240784. https://doi.org/10.1371/journal.pone.0240784
  • Townsend L., Moloney D., Finucane C., McCarthy K., Bergin C., Bannan C. et al. Fatigue following COVID-19 infection is not associated with autonomic dysfunction. PLoS ONE.2021;16:e0247280. https://doi.org/10.1371/journal.pone.0247280
  • Augustin M., Schommers P., Stecher M., Dewald .F, Gieselmann L., Gruell H. et al. Post-COVID syndrome in non-hospitalised patients with COVID19: a longitudinal prospective cohort study. Lancet Reg Health Eur. 2021; 6:100122. https://doi.org/10.1016/j.lanepe.2021.100122
  • Lopez-Leon S., Wegman-Ostrosky T., Perelman C. et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep. 2021; 11:16144. https://doi.org/10.1038/s41598-021-95565-8
  • Michielsen H.J., De Vries J., Van Heck G.L. Psychometric qualities of a brief self-rated fatigue measure the fatigue assessment scale. J sychosom Res. 2003;54(4):345–52. https://doi.org/10.1016/s0022-3999(02)00392-6
  • De Vries J., Michielsen H.J., Van Heck G.L. Assessment of fatigue among working people: a comparison of six questionnaires. Occupational and Environmental Medicine. 2003;60:i10-i15. https://doi.org/10.1136/oem.60.suppl_1.i10
  • Drent M., Lower E.E., De Vries J. Sarcoidosis-associated fatigue. Eur Respir J. 2012; 40: 255–263. https://doi.org/10.1183/09031936.00002512
  • Hendriks C., Drent M., Elfferich M., De Vries J. The Fatigue Assessment Scale: quality and availability in sarcoidosis and other diseases. Current Opinion in Pulmonary Medicine. 2018;24(5):495–503. https://doi.org/10.1097/MCP.0000000000000496
  • Fatigue Assessment Scale (FAS). URL: https://novopsych.com.au/assessments/health/fatigue-assessment-scale-fas/. (date of the application: 16.01.2023).
  • Obel N., Høier-Madsen M., Kangro H. Serological and clinical findings in patients with serological evidence of reactivated Epstein-Barr virus infection. APMIS. 1996;104(6):424-8. https://doi.org/10.1111/j.1699-0463.1996.tb00737.x
  • Han Q., Zheng B., Daines L., Sheikh A. Long-term sequelae of COVID-19: A systematic review and meta-analysis of one-year follow-up studies on post-COVID symptoms. Pathogens. 2022;11(2):269. https://doi.org/10.3390/pathogens11020269
  • Seeßle J., Waterboer T., Hippchen T., Simon J. et al. Persistent Symptoms in Adult Patients 1 Year After Coronavirus Disease 2019 (COVID-19): A Prospective Cohort Study. Clinical Infectious Diseases. 2022;74(7):1191–1198. https://doi.org/10.1093/cid/ciab611
  • Tran V., Porcher R., Pane I., Ravaud P. Course of post COVID-19 disease symptoms over time in the ComPaRe long COVID prospective e-cohort. Nature Communications. 2022;13:1812. https://doi.org/10.1038/s41467-022-29513-z
  • Buonsenso D., Gualano M.R., Rossi M.F., Gris A.V. et al. Post-acute COVID-19 sequelae in a working population at one-year follow-up: A wide range of impacts from an Italian sample. Int. J. Environ. Res. Public Health. 2022;19(17):11093; https://doi.org/10.3390/ijerph191711093
  • Ceban F., Ling S., Lui L.M.W., Lee Y., Gill H. et al. Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis. Brain, Behavior, and Immunity. 2022;101: 93-135. https://doi.org/10.1016/j.bbi.2021.12.020
  • Sharma P., Bharti S., Garg I. Post COVID fatigue: Can we really ignore it? Indian Journal of Tuberculosis.2022;69(2): 238-241. https://doi.org/10.1016/j.ijtb.2021.06.012
  • Son Chang-Gue Review of the Prevalence of Chronic Fatigue Worldwide. The Journal of Korean Medicine. 2012; 33(2):25-33.
  • Estévez-López F., Mudie K., Wang-Steverding X., Bakken I.J. et al. Systematic Review of the Epidemiological Burden of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Across Europe: Current Evidence and EUROMENE Research Recommendations for Epidemiology. J. Clin. Med. 2020; 9(5):1557. https://doi.org/10.3390/jcm9051557
  • Son Chang-Gue Differential diagnosis between “chronic fatigue” and “chronic fatigue syndrome”. Integr Med Res. 2019; 8(2): 89–91. https://doi.org/10.1016/j.imr.2019.04.005
  • Joli J., Buck P., Zipfel S., Stengel A. Post-COVID-19 fatigue: A systematic review. Front Psychiatry. 2022;13: 947973. https://doi.org/10.3389/fpsyt.2022.947973
  • Janiri D., Tosato M., Simonetti A., Montanari S. et al. Post-COVID-19 Psychiatric Symptoms in the Elderly: The Role of Gender and Resilience. J. Pers. Med. 2022;12(12):2016; https://doi.org/10.3390/jpm12122016
  • Townsend L., Dyer A.H., Jones K., Dunne J. et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One. 2020; 15(11): e0240784. https://doi.org/10.1371/journal.pone.0240784
  • Hartung T.J., Neumann C., Bahmer T., Chaplinskaya-Sobol I., Endres M. et al. Fatigue and cognitive impairment after COVID-19: A prospective multicentre study. eClinical Medicine Part of the Lancet Discovery science. 2022; 53:101651. https://doi.org/10.1016/j.eclinm.2022.101651
  • Naendrup J.H., Borrega J.G., Böll B. et al. Reactivation of EBV and CMV in Severe COVID-19—Epiphenomena or Trigger of Hyperinflammation in Need of Treatment? A Large Case Series of Critically ill Patients. Journal of Intensive Care Medicine.2021; 37(9). https://doi.org/10.1177/08850666211053990
  • Paolucci S., Cassaniti I., Novazzi F., Fiorina L. et al. EBV DNA increase in COVID-19 patients with impaired lymphocyte subpopulation count. IJID. 2021;104:315-319. https://doi.org/10.1016/j.ijid.2020.12.051
  • Simonnet A., Engelmann I., Moreau A.-S., Garcia B. High incidence of Epstein–Barr virus, cytomegalovirus, and human-herpes virus-6 reactivations in critically ill patients with COVID-19. Infectious Diseases Now. 2021; 51(3):296-299. https://doi.org/10.1016/j.idnow.2021.01.005
  • Rohrhofer J., Graninger M., Lettenmaier L., Schweighardt J. et al. Association between Epstein‐Barr‐Virus reactivation and development of Long‐COVID fatigue. Allergy. 2022: 10.1111/all.15471. https://doi.org/10.1111/all.15471
  • Haeri S., Baker A.M., Boggess K.A. Prevalence of Epstein-Barr Virus Reactivation in Pregnancy. Am J Perinatol. 2010; 27(9): 715-720. https://doi.org/10.1055/s-0030-1253098
  • Peric Z., Cahu X., Chevallier P., Brissot E., Malard F. et al. Features of Epstein-Barr Virus (EBV) reactivation after reduced intensity conditioning allogeneic hematopoietic stem cell transplantation. Leukemia. 2011;25:932–938. https://doi.org/10.1038/leu.2011.26