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Margalit I, Yelin D, Sagi M, Rahat MM, Sheena L, Mizrahi N, Gordin Y, Agmon H, Epstein NK, Atamna A, Tishler O, Daitch V, Babich T, Abecasis D, Yarom Y, Kazum S, Shitenberg D, Baltaxe E, Elkana O, Shapira-Lichter I, Leibovici L, Yahav D. Risk factors and multidimensional assessment of long COVID fatigue: a nested case-control study. Clin Infect Dis 2022; 75:1688-1697. [PMID: 35403679 PMCID: PMC9383780 DOI: 10.1093/cid/ciac283] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Fatigue is the most prevalent and debilitating long COVID symptom, however risk factors and pathophysiology of this condition remain unknown.We assessed risk factors for long COVID fatigue and explored its possible pathophysiology. METHODS Nested case-control study in a COVID recovery clinic. Individuals with (cases) and without (controls) significant fatigue were included. We performed a multidimensional assessment evaluating various parameters, including pulmonary function tests and cardiopulmonary exercise testing, and implemented multivariable logistic regression to assess risk factors for significant long COVID fatigue. RESULTS Total of 141 individuals were included. Mean age was 47 (SD 13) years; 115 (82%) were recovering from mild COVID-19. Mean time for evaluation was 8 months following COVID-19. Sixty-six (47%) individuals were classified with significant long COVID fatigue. They had significantly higher number of children, lower proportion of hypothyroidism, higher proportion of sore throat during acute illness and long COVID symptoms, and of physical limitation in daily activities.Individuals with fatigue had poorer sleep quality and higher degree of depression. They had significantly lower heart rate [153.52 (22.64) vs 163.52 (18.53), p=0.038] and oxygen consumption per Kg [27.69 (7.52) vs 30.71 (7.52), p=0.036] at peak exercise.The two independent risk factors for fatigue identified in multivariable analysis were peak exercise heart rate (odds ratio [OR] 0.79 per 10 beats/minute, 95% confidence interval [CI] 0.65-0.96, p=0.019); and long COVID memory impairment (OR 3.76, 95% CI 1.57-9.01, p=0.003). CONCLUSIONS Long COVID fatigue may be related to autonomic dysfunction, impaired cognition and decreased mood. This may suggest a limbic-vagal pathophysiology. Clinical Trial registration: NCT04851561.
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Affiliation(s)
- Ili Margalit
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Dana Yelin
- COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Moshe Sagi
- Department of Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Maya Merav Rahat
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Liron Sheena
- Department of Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Nadav Mizrahi
- Department of Internal Medicine B, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Yael Gordin
- The Hebrew University-Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Hadar Agmon
- Department of Internal Medicine B, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Nitzan Karny Epstein
- Department of Internal Medicine B, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Alaa Atamna
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Ori Tishler
- COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Department of Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Vered Daitch
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Tanya Babich
- Research Authority, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Donna Abecasis
- Functional MRI Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Yoni Yarom
- Medix Sport Medicine Center, Tel Aviv, Israel
| | - Shirit Kazum
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Dorit Shitenberg
- Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Erik Baltaxe
- Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Odelia Elkana
- Behavioral Sciences, Academic College of Tel Aviv-Yafo, Tel Aviv-Jaffa, Israel
| | - Irit Shapira-Lichter
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.,Functional MRI Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sagol School of Neuroscience, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Leonard Leibovici
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.,Research Authority, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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