New research shows that COVID-19 survivors, especially older adults and non-hospitalized patients, are at an increased risk for chronic fatigue syndrome—underscoring the need for comprehensive care for vulnerable populations.
By Hugo Francisco de Souza
Extracts
In a recent study published in the Journal of Infection and Public Health, researchers carried out a retrospective cohort study comprising 3,227,281 pairs of patients with and without COVID-19 from a larger dataset of over 115 million patients to investigate the associations between severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infections and chronic fatigue syndrome (CFS) risk, particularly in the presence of comorbidities.
Background
Alarmingly, these conditions, collectively termed “long COVID,” are estimated to plague up to 78% of survivors, leaving them with chronic chest pain, lung diseases, muscle aches, and chronic fatigue syndrome (CFS). While studies aimed at establishing the association between SARS‑CoV‑2 infection and CFS risk have been carried out, none have evaluated the effects of covariates, particularly comorbidities and other preexisting medical conditions.
A growing body of evidence suggests the positive feedback loop between Long Covid and other chronic conditions, observing that the presence of one increases the risk and severity of the other. Furthermore, long COVID is a multi-organ condition, highlighting the need for comprehensive, extensive cohort investigations into the associations between CFS and long COVID risk factors.
About the study
The present study uses an extensive cohort (COVID-19 cases; n = 3,227,281 pairs) across a spectrum of infection severity, age, sex, race/ethnicity, vaccination status, and comorbidities to establish the risk associations between prior COVID-19 infections and CFS risk.
Relevant data included demographics, infection and comorbidity diagnoses, ongoing medications, procedures, and laboratory test results. Covariates under investigation included age, sex, COVID-19 vaccination status and disease severity, hypertensive diseases, race, ischemic heart diseases, hyperlipidemia, cerebrovascular diseases, chronic kidney disease, chronic obstructive pulmonary disease, and depression. Patients were further divided into subcohorts based on the wave (alpha, delta, or omicron) of initial SARS-CoV-2 infection. The outcome of interest was medically confirmed CFS diagnoses.
Findings
Of the 115,675,909 patients represented in the TriNetX database, 3,227,281 were confirmed to have experienced a prior COVID-19 infection and were included as cases. All cases were 1:1 PSM to COVID-free controls, doubling the size of the study dataset. Cases were predominantly female (54.4%), White (58.7%), and had a history of hypertensive disease (17%). Furthermore, obesity (8.1%), type 2 diabetes mellitus (7.8%), hyperlipidemia (14.2%), and depression (5.5%) were frequently observed as COVID-19-associated comorbidities.
Omicron and delta variant patients were found to be at slightly higher CFS risk (HR = 1.40, respectively) compared to alpha variant patients (HR = 1.33), with Omicron showing similar risk levels to Delta despite typically causing less severe acute illness. Infection severity outcomes on HR ranged from 1.22 (the most severe infection requiring immediate hospitalization) to 1.64 (no hospitalization required).
Conclusions
The present study uses a cohort of more than 6 million patients to elucidate the risk associations between COVID-19 and its comorbidities and subsequent CFS risk. Supporting previous research, the study established a higher CFS risk (HR = 1.59) in COVID-19 patients compared to their COVID-19-free counterparts.
Together, these findings provide a comprehensive evaluation of the landscape of CFS risk, helping clinicians better understand the needs of COVID-19 patients and potentially improving their quality of life.
MEA Comment
Further research evidence that Covid-19 infection can cause ME/CFS. Something that we have been pointing out to both health professionals and researchers for the past 4 years!
Dr Charles Shepherd,
Trustee and Hon. Medical Adviser to the ME Association,
Member of the 2018-2021 NICE Guideline Committee,
Member of the 2002 Independent Working Group on ME/CFS
