Prevalence and predictors of Post-Acute COVID-19 Syndrome (PACS) after hospital discharge: A cohort study with 4 months median follow-up

PLoS One. 2021 Dec 7;16(12):e0260568. doi: 10.1371/journal.pone.0260568. eCollection 2021.


Background: Post-acute COVID-19 syndrome (PACS) is an emerging healthcare burden. The risk factors associated with PACS remain largely unclear. The aim of this study was to evaluate the frequency of new or persistent symptoms in COVID-19 patients post hospital discharge and identify associated risk factors.

Methods: Our prospective cohort comprised of PCR-confirmed COVID-19 patients admitted to King Fahad Medical City, Riyadh, Saudi Arabia between May and July 2020. The patients were interviewed through phone calls by trained physicians from 6 weeks up to 6 months post hospital discharge. Multivariate Cox proportional hazards and logistic regression models were used to examine for predictors associated with persistence of symptoms and non-return to baseline health.

Results: 222 COVID-19 patients responded to follow-up phone interviews after a median of 122 days post discharge. The majority of patients were men (77%) with mean age of 52.47 (± 13.95) years. 56.3% of patients complained of persistent symptoms; 66 (29.7%) experiencing them for >21 days and 64 (28.8%) reporting not having returned to their baseline health. Furthermore, 39 patients (17.6%) reported visiting an emergency room post discharge for COVID-19-related symptoms while 16 (7.2%) had required re-hospitalization. Shortness of breath (40.1%), cough (27.5%) and fatigue (29.7%) were the most frequently reported symptoms at follow-up. After multivariable adjustments, female gender, pre-existing hypertension and length of hospital stay were associated with an increased risk of new or persistent symptoms. Age, pre-existing lung disease and emergency room visits increased the likelihood of not fully recovering from acute COVID-19. Patients who were treated with interferon β-1b based triple antiviral therapy during hospital stay were less likely to experience new or persistent symptoms and more likely to return to their baseline health.

Conclusions: COVID-19 survivors continued to suffer from dyspnea, cough and fatigue at 4 months post hospital discharge. Several risk factors could predict which patients are more likely to experience PACS and may benefit from individualized follow-up and rehabilitation programs.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • COVID-19 / complications*
  • COVID-19 / epidemiology
  • COVID-19 / pathology
  • COVID-19 / psychology
  • COVID-19 / virology
  • Cohort Studies
  • Cough / etiology
  • Fatigue / etiology
  • Female
  • Follow-Up Studies
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Patient Discharge
  • Post-Acute COVID-19 Syndrome
  • Prevalence
  • SARS-CoV-2 / isolation & purification
  • Saudi Arabia
  • Surveys and Questionnaires
  • Young Adult

Grants and funding

The author(s) received no specific funding for this work.