Fatigue in long-COVID; frequency, severity and impact on quality of life

Öz

Objective: The aim of our study was to investigate the frequency, severity, and impact on quality of life related to fatigue during the prolonged period of COVID-19. Methods: The cross-sectional study consists of data of 266 participants aged 18 and above, all with confirmed diagnoses of COVID-19. Participants' fatigue severity was assessed using the Modified Fa-tigue Impact Scale (mFIS) and their quality of life using the Nothingham Health Profile (NHP). Results: Of the 266 participants, 60 reported no fatigue complaints, 132 experienced fatigue during the acute illness that subsequently resolved and 74 (33.6%) noted persistent fatigue beyond the acute ill-ness period. Participants with fatigue exhibited significantly lower quality of life scores compared to those without, particularly affecting the NHP Pain, Physical Activity, and Energy subscales. The NHP scores positively correlate with mFIS scores. Conclusion: This study revealed that fatigue, which continues during the long-COVID period, impairs the quality of life in relation to its severity. Fatigue was notably associated with a reduced quality of life, particularly evident in the energy sub-dimension. These findings underscore the importance of add-ressing and managing post-COVID fatigue for improved overall well-being.

Anahtar Kelimeler

• quality of life
• COVID-19
• Post-Acute COVID-19 Syndrome
• fatigue

Uzamış-COVID'de yorgunluk; sıklığı, şiddeti ve yaşam kalitesi üzerine etkisi

Öz

Amaç: Çalışmada, uzamış COVID-19 döneminde yorgunluk sıklığını, şiddetini ve yaşam kalitesi üze-rindeki etkilerini araştırmak amaçlanmıştır. Yöntem: Kesitsel desendeki bu çalışma, 18 yaş ve üzeri, tamamı kesin COVID-19 teşhisi konmuş 266 katılımcının verilerini içermektedir. Katılımcıların yorgunluk şiddeti, Modifiye Yorgunluk Etki Ölçeği (mFIS) kullanılarak değerlendirilmiş ve yaşam kaliteleri Nothingham Sağlık Profili (NHP) ile ölçülmüş-tür. Bulgular: 266 katılımcıdan 60'ı herhangi bir yorgunluk şikayeti bildirmezken, 132'si akut hastalık sırasında yorgunluk yaşamış ve bu daha sonra çözülmüştür; 74'ü (%33.6) ise akut hastalık döneminin ötesinde süregelen bir yorgunluk belirtmiştir. Yorgunluğu olan katılımcılar, özellikle NHP Ağrı, Fizik-sel Aktivite ve Enerji alt ölçeklerini etkileyerek, yorgunluk yaşamayanlara göre anlamlı düşük yaşam kalitesi skorları sergilemiştir. NHP skorları, mFIS skorları ile pozitif korelasyon göstermiştir. Sonuç: Bu çalışma, uzamış COVID döneminde devam eden yorgunluğun, şiddetiyle orantılı olarak, özellikle enerji alt boyutunda azalmış yaşam kalitesi ile ilişkilendirildiğini ortaya koymuştur. Bu bul-gular, post-COVID yorgunluğunun ele alınması ve yönetilmesinin genel yaşam kalitesini iyileştirmek açısından önemini vurgular.

Anahtar Kelimeler

• COVID-19
• yorgunluk
• yaşam kalitesi
• Post-Akut COVID-19 Sendromu

Kaynakça

1. 1. Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV WHO Clinical Case Definition Working Group on Post-COVID-19 Condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis 2022;22:e102–7. doi: 10.1016/S1473-3099(21)00703-9
2. 2. Hartvig Honoré P. Fatigue. Eur J Hosp Pharm 2013;20:147-8. doi: 10.1136/ejhpharm-2013-000309.
3. 3. Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect 2020;81(6):e4-6. doi: 10.1016/j.jinf.2020.08.029.
4. 4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5.
5. 5. Carlile O, Briggs A, Henderson AD, Butler-Cole BFC, Tazare J, Tomlinson LA, et al. Impact of long COVID on health-related quality-of-life: an OpenSAFELY popula-tion cohort study using patient-reported outcome measures (OpenPROMPT). Lancet Reg Health Eur. 2024;40:100908. doi: 10.1016/j.lanepe.2024.100908.
6. 6. Gaber T. Assessment and management of post-COVID fatigue. Prog Neurol Psychiatry 2021; 25: 36-9. doi: 10.1002/pnp.698.
7. 7. Rudroff T, Fietsam AC, Deters JR, Bryant AD, Kam-holz J. Post-COVID-19 fatigue: potential contributing factors. Brain Sci 2020;10(12):1012. doi: 10.3390/brainsci10121012.
8. 8. Jin M, Tong Q. Rhabdomyolysis as potential late com-plication associated with COVID-19. Emerg Infect Dis 2020; 26: 1618–20. doi: 10.3201/eid2607.200445.

9. 9. Poenaru S, Abdallah SJ, Corrales-Medina V, Cowan J. COVID-19 and post-infectious myalgic encephalomyeli-tis/chronic fatigue syndrome: a narrative review. Ther Adv Infect Dis. 2021; 8: 20499361211009385. doi: 10.1177/20499361211009385.
10. 10. Morgul E, Bener A, Atak M, Akyel S, Aktas S, Bhugra D, Ventriglio A, Jordan TR. COVID-19 pandemic and psychological fatigue in Turkey. Int J Soc Psychiatry 2021; 67(2): 128-35. doi: 10.1177/0020764020941889.
11. 11. Giszas B, Trommer S, Schüßler N, Rodewald A, Besteher B, Bleidorn J, et al. Post-COVID-19 condition is not only a question of persistent symptoms: Struc-tured screening including health-related quality of life reveals two separate clusters of post-COVID. Infection 2022; 22: 1–13. doi: 10.1007/s15010-022-01886-9.
12. 12. Ceban F, Ling S, Lui LMW, Lee Y, Gill H, Teopiz KM, et el. Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis. Brain Behav Immun 2022;101:93-135. doi: 10.1016/j.bbi.2021.12.020.
13. 13. Kos D, Kerckhofs E, Carrea I, Verza R, Ramos M, Jansa J. Evaluation of the Modified Fatigue Impact Scale in four different European countries. Mult Scler J 2005; 11: 76–80. doi: 10.1191/1352458505ms1117oa.
14. 14. Armutlu K, Keser İ, Korkmaz N, Akbıyık Dİ, et al. Psychometric study of Turkish version of fatique impact scale in multiple sclerosis patients. J NeurolSci 2007; 255:64-8. doi: 10.1016/j.jns.2007.01.073.
15. 15. Kücükdeveci AA, McKenna SP, Kutlay S, Gürsel Y, Whalley D, Arasil T. The development and psychometric assessment of the Turkish version of the Nottingham Health Profile. Int J Rehabil Res 2000;23(1):31-8. doi:10.1097/00004356-200023010-00004.
16. 16. Broch L, Simonsen CS, Flemmen HØ, Berg-Hansen P, Skardhamar Å, Ormstad H, Celius EG. High prevalence of fatique in contemporary patients with multiple sclerosis. Mult Scler J ExpTransl Clin 2021;7(1):2055217321999826. doi: 10.1177/2055217321999826.
17. 17. Lee KA, Hicks G, Nino-Murcia G. Validity and relia-bility of a scale to assess fatique. Psychiatry Research 1990; 36(3): 291-8. doi: 10.1016/0165-1781(91)90027-m.
18. 18. Wessely S. Chronic fatique symptom and syndrome. Ann Intern Med 2001; 134: 838–43. doi: 10.7326/0003-4819-134-9_part_2-200105011-00007.
19. 19. Xu X-W, Wu X-X, Jiang X-G, Xu K-J, Ying L-J, Ma C-L, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ 2020; 368: m606. doi: 10.1136/bmj.m606.
20. 20. del Rio C, Malani PN. New insights on a rapidly changing epidemic. J Amer Med Assoc 2020;323(24):1339–40. doi:10.1001/jama.2020.3072.
21. 21. Han Q, Zheng B, Daines L, Sheikh A. Long-term se-quelae of COVID-19: a systematic review and meta-analysis of one-year follow up studies on post-COVID symptoms. Pathogens 2022; 11(2): 269. doi: 10.3390/pathogens11020269.
22. 22. David AS, Wessely S, Pelosi AJ. Post viral fatique syndrome: time for a new approach. Br Med J (Clin Res Ed) 1988;296(6623):696–9. doi: 10.1136/bmj.296.6623.696
23. 23. Burke RM, Killerby ME, Newton S, Ashworth CE, Berns AL, Brennan S, et al. Symptom profiles of a con-venience sample of patients with COVID-19—United States, January–April 2020. MMWR Morb Mortal Wkly Rep 2020;69:904–8. doi: 10.15585/mmwr.mm6928a2.
24. 24. Katz BZ, Collin SM, Murphy G, Moss-Morris R, Wyller VB, Wensaas KA, et al. The international collabo-rative on fatique following infection (COFFI). Fatique 2018;6(2):106–21. doi: 10.1080/21641846.2018.1426086.
25. 25. Figueiredo EAB, Silva WT, Tsopanoglou SP, Vitorino DFM, Oliveira LFL, Silva KLS, et al. The health-related quality of life in patients with post-COVID-19 after hospitalization: A systematic review. Rev Soc Bras Med Trop 2022; 55: e0741. doi: 10.1590/0037-8682-0741-2021.
26. 26. Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F, et al. Persistent fatique following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoSOne 2020;15(11):e0240784. doi: 10.1371/journal.pone.0240784.
27. 27. Nandasena HMRKG, Pathirathna ML, Atapattu AMMP, Prasanga PTS. Quality of life of COVID 19 pa-tients after discharge: Systematic review. PLoSOne 2022; 17: e0263941. doi: 10.1371/journal.pone.0263941.
28. 28. Mitrović-Ajtić O, Stanisavljević D, Miljatović S, Dragojević T, Živković E, Šabanović M, Čokić VP. Quali-ty of life in post-COVID-19 patients after hospitaliza-tion. Healthcare (Basel) 2022;10(9):1666. doi: 10.3390/healthcare10091666.