Persistence of symptoms in long-COVID: follow-up trajectories of 30 symptoms in 755 patients from a national multicenter study from Italy

Aim of the study was to define the patterns and determinants of symptom persistence in Long-COVID. The study population was represented by a multicenter cohort of patients with persisting symptoms after SARS-CoV-2 infection. Data collection included demographics, comorbidities, characteristics of acute infection, vaccination, reinfection, plus 30 different symptoms. The associations between covariates and persistence were assessed in multivariable logistic regression models. The study evaluated, at a mean interval of 453 days from acute SARS-CoV-2 infection, symptom persistence in 755 patients who had Long-COVID symptoms at a mean interval of 223 days from COVID-19. At second evaluation, 423 (56.0%) patients still presented one or more symptoms and 332 (44.0%) were symptom free. In those who remained symptomatic, the mean number of symptoms significantly reduced between the two evaluations. Compared to the first evaluation, the overall mean symptom regression rate was 72%, with lower regression rates observed for dyspnea (53%), anxiety (54%) and sleep disturbances (55%). The risk of persistence was increased for female sex, higher BMI, hospitalization and stronger ventilatory support during acute disease, higher number of initial symptoms and particular comorbidities (anxiety, chronic pulmonary disease, asthma), and decreased with the increase of age and time from acute SARS-CoV-2 infection. Neither SARS-CoV-2 vaccination nor reinfection showed significant associations with persistence. In this case series, roughly half of the patients that were symptomatic 7 months after acute SARS-CoV-2 infection remained symptomatic after an additional 7 months. The pattern and predictors of persistence draw attention to certain particular risk factors and manifestations that tend to persist longer than others.