Severe Fatigue in the First Year Following SARS-CoV-2 Infection: A Prospective Cohort Study: A Prospective Cohort Study

RECoVERED Study Group; A. Verveen; E. Wynberg; H.D.G. van Willigen; A. Boyd; M.D. de Jong; G. de Bree; U. Davidovich; A. Lok; E.P. Moll van Charante; H. Knoop; M. Prins; P. Nieuwkerk; Ivette Agard; Jane Ayal; Floor Cavdar; Marianne Craanen; Annemarieke Deuring; Annelies van Dijk; Ertan Ersan; Laura del Grande; Joost Hartman; Nelleke Koedoot; Tjalling Leenstra; Romy Lebbink; Dominique Loomans; Agata Makowska; Tom du Maine; Ilja de Man; Amy Matser; Lizenka van der Meij; Marleen van Polanen; Maria Oud; Clark Reid; Leeann Storey; Marc van Wijk; Joost van den Aardweg; Joyce van Assem; Marijne van Beek; Thyra Blankert; Maartje Dijkstra; Orlane Figaroa; Leah Frenkel; Marit van Gils; Jelle van Haga; Xiaochuan Han; Agnes Harskamp-Holwerda; Mette Hazenberg; Soemeja Hidad; Nina de Jong; Neeltje Kootstra; Lara Kuijt; Colin Russell; Karlijn van der Straten; Annelou van der Veen; Bas Verkaik; Gerben-Rienk Visser

doi:https://doi.org/10.1093/ofid/ofac127

Severe Fatigue in the First Year Following SARS-CoV-2 Infection: A Prospective Cohort Study: A Prospective Cohort Study

RECoVERED Study Group, A. Verveen, E. Wynberg, H.D.G. van Willigen, A. Boyd, M.D. de Jong, G. de Bree, U. Davidovich, A. Lok, E.P. Moll van Charante, H. Knoop, M. Prins, P. Nieuwkerk, Ivette Agard, Jane Ayal, Floor Cavdar, Marianne Craanen, Annemarieke Deuring, Annelies van Dijk, Ertan ErsanLaura del Grande, Joost Hartman, Nelleke Koedoot, Tjalling Leenstra, Romy Lebbink, Dominique Loomans, Agata Makowska, Tom du Maine, Ilja de Man, Amy Matser, Lizenka van der Meij, Marleen van Polanen, Maria Oud, Clark Reid, Leeann Storey, Marc van Wijk, Joost van den Aardweg, Joyce van Assem, Marijne van Beek, Thyra Blankert, Maartje Dijkstra, Orlane Figaroa, Leah Frenkel, Marit van Gils, Jelle van Haga, Xiaochuan Han, Agnes Harskamp-Holwerda, Mette Hazenberg, Soemeja Hidad, Nina de Jong, Neeltje Kootstra, Lara Kuijt, Colin Russell, Karlijn van der Straten, Annelou van der Veen, Bas Verkaik, Gerben-Rienk Visser

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Severe fatigue can persist for months after coronavirus disease 2019 (COVID-19) onset. This longitudinal study describes fatigue severity and its determinants up to 12 months after illness onset across the full spectrum of COVID-19 severity.

Methods: RECoVERED, a prospective cohort study in Amsterdam, the Netherlands, enrolled participants aged ≥16 years after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis. Fatigue was measured using the validated Short Fatigue Questionnaire (SFQ; range 4-28) at months 1, 3, 6, 9, and 12 of follow-up. Fatigue severity was modeled over time using mixed-effects linear regression. Determinants of severe fatigue (SFQ ≥18) at 6 months since illness onset (ie, persistent fatigue) were identified using logistic regression.

Results: Between May 2020 and July 2021, 303 participants completed at least 1 fatigue questionnaire. Twelve months after illness onset, 17.4% (95% CI, 6.7% to 38.3%), 21.6% (95% CI, 11.2% to 37.7%), and 44.8% (95% CI, 28.0% to 62.9%) of participants with mild, moderate, and severe/critical COVID-19 (World Health Organization definition), respectively, experienced severe fatigue. When adjusting for age and sex, having ≥3 comorbidities (P = .007), severe/critical COVID-19 (P = .002), low mood (P < .001), and dyspnea in the first 2 weeks of illness (P = .001) were associated with more severe fatigue over time. Severe/critical COVID-19 (adjusted odds ratio [aOR], 3.37; 95% CI, 1.28 to 8.93) and low mood at enrollment (aOR, 2.43; 95% CI, 1.11 to 5.29) were associated with persistent fatigue. Recovery rarely occurred beyond 6 months after illness onset, regardless of COVID-19 severity.

Conclusions: The occurrence of severe fatigue in our cohort was high, especially among those with initially severe/critical COVID-19, with little recovery beyond 6 months after illness onset. Our findings highlight an urgent need for improved understanding of persistent severe fatigue following COVID-19 to help inform prevention and intervention.

Original language	English
Article number	ofac127
Number of pages	11
Journal	Open forum infectious diseases
Volume	9
Issue number	5
Early online date	10 Apr 2022
DOIs	https://doi.org/10.1093/ofid/ofac127
Publication status	Published - 1 May 2022

Keywords

COVID-19
fatigue
infection
persistence
predictors

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https://doi.org/10.1093/ofid/ofac127Licence: CC BY-NC-ND

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RECoVERED Study Group, Verveen, A., Wynberg, E., van Willigen, H. D. G., Boyd, A., de Jong, M. D., de Bree, G., Davidovich, U., Lok, A., Moll van Charante, E. P., Knoop, H., Prins, M., Nieuwkerk, P., Agard, I., Ayal, J., Cavdar, F., Craanen, M., Deuring, A., van Dijk, A., ... Visser, G.-R. (2022). Severe Fatigue in the First Year Following SARS-CoV-2 Infection: A Prospective Cohort Study: A Prospective Cohort Study. Open forum infectious diseases, 9(5), Article ofac127. https://doi.org/10.1093/ofid/ofac127

@article{98369aeba91b4eeeaa9f281c2f46022f,

title = "Severe Fatigue in the First Year Following SARS-CoV-2 Infection: A Prospective Cohort Study: A Prospective Cohort Study",

abstract = "Background: Severe fatigue can persist for months after coronavirus disease 2019 (COVID-19) onset. This longitudinal study describes fatigue severity and its determinants up to 12 months after illness onset across the full spectrum of COVID-19 severity.Methods: RECoVERED, a prospective cohort study in Amsterdam, the Netherlands, enrolled participants aged ≥16 years after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis. Fatigue was measured using the validated Short Fatigue Questionnaire (SFQ; range 4-28) at months 1, 3, 6, 9, and 12 of follow-up. Fatigue severity was modeled over time using mixed-effects linear regression. Determinants of severe fatigue (SFQ ≥18) at 6 months since illness onset (ie, persistent fatigue) were identified using logistic regression.Results: Between May 2020 and July 2021, 303 participants completed at least 1 fatigue questionnaire. Twelve months after illness onset, 17.4% (95% CI, 6.7% to 38.3%), 21.6% (95% CI, 11.2% to 37.7%), and 44.8% (95% CI, 28.0% to 62.9%) of participants with mild, moderate, and severe/critical COVID-19 (World Health Organization definition), respectively, experienced severe fatigue. When adjusting for age and sex, having ≥3 comorbidities (P = .007), severe/critical COVID-19 (P = .002), low mood (P < .001), and dyspnea in the first 2 weeks of illness (P = .001) were associated with more severe fatigue over time. Severe/critical COVID-19 (adjusted odds ratio [aOR], 3.37; 95% CI, 1.28 to 8.93) and low mood at enrollment (aOR, 2.43; 95% CI, 1.11 to 5.29) were associated with persistent fatigue. Recovery rarely occurred beyond 6 months after illness onset, regardless of COVID-19 severity.Conclusions: The occurrence of severe fatigue in our cohort was high, especially among those with initially severe/critical COVID-19, with little recovery beyond 6 months after illness onset. Our findings highlight an urgent need for improved understanding of persistent severe fatigue following COVID-19 to help inform prevention and intervention.",

keywords = "COVID-19, fatigue, infection, persistence, predictors",

author = "{RECoVERED Study Group} and A. Verveen and E. Wynberg and {van Willigen}, H.D.G. and A. Boyd and {de Jong}, M.D. and {de Bree}, G. and U. Davidovich and A. Lok and {Moll van Charante}, E.P. and H. Knoop and M. Prins and P. Nieuwkerk and Ivette Agard and Jane Ayal and Floor Cavdar and Marianne Craanen and Annemarieke Deuring and {van Dijk}, Annelies and Ertan Ersan and {del Grande}, Laura and Joost Hartman and Nelleke Koedoot and Tjalling Leenstra and Romy Lebbink and Dominique Loomans and Agata Makowska and {du Maine}, Tom and {de Man}, Ilja and Amy Matser and {van der Meij}, Lizenka and {van Polanen}, Marleen and Maria Oud and Clark Reid and Leeann Storey and {van Wijk}, Marc and {van den Aardweg}, Joost and {van Assem}, Joyce and {van Beek}, Marijne and Thyra Blankert and Maartje Dijkstra and Orlane Figaroa and Leah Frenkel and {van Gils}, Marit and {van Haga}, Jelle and Xiaochuan Han and Agnes Harskamp-Holwerda and Mette Hazenberg and Soemeja Hidad and {de Jong}, Nina and Neeltje Kootstra and Lara Kuijt and Colin Russell and {van der Straten}, Karlijn and {van der Veen}, Annelou and Bas Verkaik and Gerben-Rienk Visser",

note = "With supplementary files",

year = "2022",

month = may,

day = "1",

doi = "https://doi.org/10.1093/ofid/ofac127",

language = "English",

volume = "9",

journal = "Open forum infectious diseases",

issn = "2328-8957",

publisher = "Oxford University Press",

number = "5",

}

RECoVERED Study Group, Verveen, A, Wynberg, E, van Willigen, HDG, Boyd, A, de Jong, MD, de Bree, G, Davidovich, U, Lok, A , Moll van Charante, EP , Knoop, H , Prins, M, Nieuwkerk, P, Agard, I, Ayal, J, Cavdar, F, Craanen, M, Deuring, A, van Dijk, A, Ersan, E, del Grande, L, Hartman, J, Koedoot, N, Leenstra, T, Lebbink, R, Loomans, D, Makowska, A, du Maine, T, de Man, I, Matser, A, van der Meij, L, van Polanen, M, Oud, M, Reid, C, Storey, L, van Wijk, M, van den Aardweg, J, van Assem, J, van Beek, M, Blankert, T, Dijkstra, M, Figaroa, O, Frenkel, L, van Gils, M, van Haga, J, Han, X, Harskamp-Holwerda, A, Hazenberg, M, Hidad, S, de Jong, N, Kootstra, N, Kuijt, L, Russell, C, van der Straten, K, van der Veen, A, Verkaik, B & Visser, G-R 2022, 'Severe Fatigue in the First Year Following SARS-CoV-2 Infection: A Prospective Cohort Study: A Prospective Cohort Study', Open forum infectious diseases, vol. 9, no. 5, ofac127. https://doi.org/10.1093/ofid/ofac127

TY - JOUR

T1 - Severe Fatigue in the First Year Following SARS-CoV-2 Infection: A Prospective Cohort Study

T2 - A Prospective Cohort Study

AU - RECoVERED Study Group

AU - Verveen, A.

AU - Wynberg, E.

AU - van Willigen, H.D.G.

AU - Boyd, A.

AU - de Jong, M.D.

AU - de Bree, G.

AU - Davidovich, U.

AU - Lok, A.

AU - Moll van Charante, E.P.

AU - Knoop, H.

AU - Prins, M.

AU - Nieuwkerk, P.

AU - Agard, Ivette

AU - Ayal, Jane

AU - Cavdar, Floor

AU - Craanen, Marianne

AU - Deuring, Annemarieke

AU - van Dijk, Annelies

AU - Ersan, Ertan

AU - del Grande, Laura

AU - Hartman, Joost

AU - Koedoot, Nelleke

AU - Leenstra, Tjalling

AU - Lebbink, Romy

AU - Loomans, Dominique

AU - Makowska, Agata

AU - du Maine, Tom

AU - de Man, Ilja

AU - Matser, Amy

AU - van der Meij, Lizenka

AU - van Polanen, Marleen

AU - Oud, Maria

AU - Reid, Clark

AU - Storey, Leeann

AU - van Wijk, Marc

AU - van den Aardweg, Joost

AU - van Assem, Joyce

AU - van Beek, Marijne

AU - Blankert, Thyra

AU - Dijkstra, Maartje

AU - Figaroa, Orlane

AU - Frenkel, Leah

AU - van Gils, Marit

AU - van Haga, Jelle

AU - Han, Xiaochuan

AU - Harskamp-Holwerda, Agnes

AU - Hazenberg, Mette

AU - Hidad, Soemeja

AU - de Jong, Nina

AU - Kootstra, Neeltje

AU - Kuijt, Lara

AU - Russell, Colin

AU - van der Straten, Karlijn

AU - van der Veen, Annelou

AU - Verkaik, Bas

AU - Visser, Gerben-Rienk

N1 - With supplementary files

PY - 2022/5/1

Y1 - 2022/5/1

N2 - Background: Severe fatigue can persist for months after coronavirus disease 2019 (COVID-19) onset. This longitudinal study describes fatigue severity and its determinants up to 12 months after illness onset across the full spectrum of COVID-19 severity.Methods: RECoVERED, a prospective cohort study in Amsterdam, the Netherlands, enrolled participants aged ≥16 years after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis. Fatigue was measured using the validated Short Fatigue Questionnaire (SFQ; range 4-28) at months 1, 3, 6, 9, and 12 of follow-up. Fatigue severity was modeled over time using mixed-effects linear regression. Determinants of severe fatigue (SFQ ≥18) at 6 months since illness onset (ie, persistent fatigue) were identified using logistic regression.Results: Between May 2020 and July 2021, 303 participants completed at least 1 fatigue questionnaire. Twelve months after illness onset, 17.4% (95% CI, 6.7% to 38.3%), 21.6% (95% CI, 11.2% to 37.7%), and 44.8% (95% CI, 28.0% to 62.9%) of participants with mild, moderate, and severe/critical COVID-19 (World Health Organization definition), respectively, experienced severe fatigue. When adjusting for age and sex, having ≥3 comorbidities (P = .007), severe/critical COVID-19 (P = .002), low mood (P < .001), and dyspnea in the first 2 weeks of illness (P = .001) were associated with more severe fatigue over time. Severe/critical COVID-19 (adjusted odds ratio [aOR], 3.37; 95% CI, 1.28 to 8.93) and low mood at enrollment (aOR, 2.43; 95% CI, 1.11 to 5.29) were associated with persistent fatigue. Recovery rarely occurred beyond 6 months after illness onset, regardless of COVID-19 severity.Conclusions: The occurrence of severe fatigue in our cohort was high, especially among those with initially severe/critical COVID-19, with little recovery beyond 6 months after illness onset. Our findings highlight an urgent need for improved understanding of persistent severe fatigue following COVID-19 to help inform prevention and intervention.

AB - Background: Severe fatigue can persist for months after coronavirus disease 2019 (COVID-19) onset. This longitudinal study describes fatigue severity and its determinants up to 12 months after illness onset across the full spectrum of COVID-19 severity.Methods: RECoVERED, a prospective cohort study in Amsterdam, the Netherlands, enrolled participants aged ≥16 years after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis. Fatigue was measured using the validated Short Fatigue Questionnaire (SFQ; range 4-28) at months 1, 3, 6, 9, and 12 of follow-up. Fatigue severity was modeled over time using mixed-effects linear regression. Determinants of severe fatigue (SFQ ≥18) at 6 months since illness onset (ie, persistent fatigue) were identified using logistic regression.Results: Between May 2020 and July 2021, 303 participants completed at least 1 fatigue questionnaire. Twelve months after illness onset, 17.4% (95% CI, 6.7% to 38.3%), 21.6% (95% CI, 11.2% to 37.7%), and 44.8% (95% CI, 28.0% to 62.9%) of participants with mild, moderate, and severe/critical COVID-19 (World Health Organization definition), respectively, experienced severe fatigue. When adjusting for age and sex, having ≥3 comorbidities (P = .007), severe/critical COVID-19 (P = .002), low mood (P < .001), and dyspnea in the first 2 weeks of illness (P = .001) were associated with more severe fatigue over time. Severe/critical COVID-19 (adjusted odds ratio [aOR], 3.37; 95% CI, 1.28 to 8.93) and low mood at enrollment (aOR, 2.43; 95% CI, 1.11 to 5.29) were associated with persistent fatigue. Recovery rarely occurred beyond 6 months after illness onset, regardless of COVID-19 severity.Conclusions: The occurrence of severe fatigue in our cohort was high, especially among those with initially severe/critical COVID-19, with little recovery beyond 6 months after illness onset. Our findings highlight an urgent need for improved understanding of persistent severe fatigue following COVID-19 to help inform prevention and intervention.

KW - COVID-19

KW - fatigue

KW - infection

KW - persistence

KW - predictors

UR - https://pure.uva.nl/ws/files/87619948/ofac127_suppl_supplementary_figures.docx

UR - https://pure.uva.nl/ws/files/87619950/ofac127_suppl_supplementary_tables.docx

UR - http://www.scopus.com/inward/record.url?scp=85128738504&partnerID=8YFLogxK

U2 - https://doi.org/10.1093/ofid/ofac127

DO - https://doi.org/10.1093/ofid/ofac127

M3 - Article

C2 - 35415196

SN - 2328-8957

VL - 9

JO - Open forum infectious diseases

JF - Open forum infectious diseases

IS - 5

M1 - ofac127

ER -

Severe Fatigue in the First Year Following SARS-CoV-2 Infection: A Prospective Cohort Study: A Prospective Cohort Study

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