High proportions of post-exertional malaise and orthostatic intolerance in people living with post-COVID-19 condition: the PRIME post-COVID study

Demi M E Pagen; Maarten Van Herck; Céline J A van Bilsen; Stephanie Brinkhues; Kevin Konings; Casper D J den Heijer; Martijn A Spruit; Christian J P A Hoebe; Nicole H T M Dukers-Muijrers

doi:10.3389/fmed.2023.1292446

High proportions of post-exertional malaise and orthostatic intolerance in people living with post-COVID-19 condition: the PRIME post-COVID study

Front Med (Lausanne). 2023 Dec 15:10:1292446. doi: 10.3389/fmed.2023.1292446. eCollection 2023.

Authors

Demi M E Pagen^{1

2}, Maarten Van Herck^{3

4

5}, Céline J A van Bilsen^{1

2}, Stephanie Brinkhues⁶, Kevin Konings⁷, Casper D J den Heijer^{1

2}, Martijn A Spruit^{3

4}, Christian J P A Hoebe^{1

2

8}, Nicole H T M Dukers-Muijrers^{1

9}

Affiliations

¹ Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Netherlands.
² Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.
³ Department of Research and Education, Ciro, Horn, Netherlands.
⁴ Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands.
⁵ Faculty of Rehabilitation Sciences, The Rehabilitation Research Center (REVAL), BIOMED-Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.
⁶ Department of Knowledge and Innovation, South Limburg Public Health Service, Heerlen, Netherlands.
⁷ Department of Process and Information Management, Communication and Automation, South Limburg Public Health Service, Heerlen, Netherlands.
⁸ Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands.
⁹ Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.

Abstract

Background: Exercise-based treatments can worsen/exacerbate symptoms in people who were SARS-CoV-2 positive and living with post-COVID-19 condition (PL-PCC) and who have post-exertional malaise (PEM) or orthostatic intolerance (OI). Nevertheless, PEM and OI are not routinely assessed by clinicians. We estimated PEM and OI proportions in PL-PCC, as well as in people not living with PCC (PnL-PCC) and negatives (i.e., never reported a SARS-CoV-2 positive test), and identified associated factors.

Methods: Participants from the Prevalence, Risk factors, and Impact Evaluation (PRIME) post-COVID-19 condition study were included. PEM and OI were assessed using validated questionnaires. PCC was defined as feeling unrecovered after SARS-CoV-2 infection. Multivariable regression analyses to study PEM and OI were stratified for sex.

Results: Data from 3,783 participants were analyzed. In PL-PCC, the proportion of PEM was 48.1% and 41.2%, and the proportion of OI was 29.3% and 27.9% in women and men, respectively. Proportions were higher in PL-PCC than negatives, for PEM in women OR=4.38 [95%CI:3.01-6.38]; in men OR = 4.78 [95%CI:3.13-7.29]; for OI in women 3.06 [95%CI:1.97-4.76]; in men 2.71 [95%CI:1.75-4.21]. Associated factors were age ≤ 60 years, ≥1 comorbidities, and living alone.

Conclusion: High proportions of PEM and OI are observed in PL-PCC. Standard screening for PEM and OI is recommended in PL-PCC to promote appropriate therapies.

Keywords: COVID-19; long COVID; orthostatic intolerance; post-COVID-19 condition; post-exertional malaise.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by the Dutch National Institute for Health and Environment, Ministry of Health, Welfare and Sport (Grant numbers: 3910090442/3910105642/3910121041). The funders had no role in the design, collection, analysis, interpretation of data, and in writing the manuscript.