Risk factors related to the occurrence of post-COVID-19 Syndrome: a systematic review
DOI:
https://doi.org/10.34119/bjhrv8n5-028Keywords:
systematic review, Post-COVID-19 Syndrome, risk factorsAbstract
Background: Post-COVID-19 Syndrome is characterized by a set of signs and symptoms that appear after the acute phase, persist for more than 12 weeks, and cannot be explained by another diagnosis. This systematic review aimed to identify the main risk factors associated with Post-COVID-19 Syndrome and their relationship with disease severity regarding the persistence of signs and symptoms that, alone or combined, characterize the syndrome. Methods: Seventy-three articles published between 2021 and 2023 were selected based on Joanna Briggs Institute manuals and guidelines. Data collection occurred from March 2019 to April 2023 in the databases PubMed (MEDLINE), LILACS, Scopus, EMBASE, Web of Science, Google Scholar, LIVIVO, and ProQuest. Cross-sectional, case-control, and cohort studies in English, Portuguese, or Spanish were included. Results: Fatigue was the most reported symptom (39.42%), followed by a reduced or absent sense of smell (32.87%). Dyspnea (28.56%), persistent cough (28.56%), headache (24.65%), loss of taste (23.28%), sleep disturbances (20.54%), and depression (20.54%) were also frequent. The most associated comorbidities were diabetes mellitus (72.60%), systemic arterial hypertension (61.64%), cardiovascular disease (45.20%), and cancer (35.61%). Conclusion: Risk factors for Post-COVID-19 Syndrome are multifactorial and linked to pre-existing clinical conditions, with emphasis on diabetes, hypertension, and cardiovascular disease.
References
World Health Organization. WHO COVID-19 dashboard. 2024. Available from: https://data.who.int/dashboards/covid19/cases. Accessed May 22, 2024.
Ministério da Saúde. Nota Técnica N.º 57/2023 – DGIP/SE/MS. Atualizações acerca das “condições pós-COVID” no âmbito do Ministério da Saúde. 2023. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/nota_tecnica_n57_atualizacoes_condicoes_poscovid.pdf. Accessed May 28, 2024.
National Institute for Health and Care Excellence (NICE). COVID-19 rapid guideline: managing the longterm effects of COVID-19. Scottish Intercollegiate Guidelines Network (SIGN) and the Royal College of General Practitioners (RCGP). 2022. Available from: https://www.nice.org.uk/guidance/ng188/resources/covid19-rapid-guideline-managing-the-longterm-effects-of-covid19-pdf-51035515742. Accessed May 29, 2023.
Crimi C, Impellizzeri P, Campisi R, et al. COVID-19: A Risk Factor for Long-Term Residual Functional Deficits in Lung and Cardiac Functions. Front Immunol [Internet]. 2022 [cited 2023 Jun 30]; Available from: https://pubmed.ncbi.nlm.nih.gov/35937125/
Pereira SD. Conceitos e Definições da Saúde e Epidemiologia usados na Vigilância Sanitária. 2007. Available from: https://cvs.saude.sp.gov.br/pdf/epid_visa.pdf. Accessed May 30, 2024.
Murata N, et al. Cardiovascular manifestations identified by multi-modality imaging in patients with long COVID. Front Cardiovasc Med. 2022. Available from: https://www.scopus.com/record/display.uri?eid=2-s2.0-85140046919&doi=10.3389%2ffcvm.2022.968584&origin=inward&txGid=6290e968b20ba58221643b4c221b2825. Accessed Jun 25, 2023.
Organização Pan-Americana da Saúde (OPAS). Expandir nosso entendimento da Síndrome Pós-COVID-19. Relatório de um webinar da OMS. Brasília, D.F.: Organização Pan-Americana da Saúde; 2021. doi: 10.37774/9789275723999.
Bellan M, Baricich A, Patrucco F, Zeppegno P, Gramaglia C, Balbo PE, et al. Determinants of long COVID among adults hospitalized for SARS-CoV-2 infection: a prospective cohort study. Front Immunol [Internet]. 2022 [cited 2023 Jun 13]; Available from: https://pubmed.ncbi.nlm.nih.gov/36601115/
Joanna Briggs Institute. University of Adelaide. 2023. Available from: https://jbi.global/. Accessed Jun 9, 2023.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. doi: 10.1186/2046-4053-4-1.
PRISMA. Transparent Reporting of Systematic Reviews and Meta-Analyses [Internet]. 2021 [cited Jun 15, 2022]. Available from: https://www.prisma-statement.org/
Mourad O, Hossam H, Fedorowicz Z, Elmagarmid A. Rayyan — a web and mobile app for systematic reviews. Syst Rev. 2016. doi: 10.1186/s13643-016-0384-4.
Aranda J, Segurola V, Rivero V, García-Carrión A, Fernández-Méndez F, Romero-Gómez MP, et al. Persistent COVID-19 symptoms 1 year after hospital discharge: a prospective multicenter study. PLoS One [Internet]. 2022 [cited 2023 Jun 3]; Available from: https://pubmed.ncbi.nlm.nih.gov/36215250/
Abdelrahman MM, Abd‐Elrahman NM, Bakheet TM. Persistence of symptoms after improvement of acute COVID-19 infection, a longitudinal study. J Med Virol. 2021;5942-5946.
del Rio C, Collins LF, Malani P. Long-term health consequences of COVID-19. JAMA [Internet]. 2020 [cited 2023 Jul 16]; Available from: https://jamanetwork.com/journals/jama/fullarticle/2768351
Daugherty SE, Guo Y, Heath K, et al. Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study. BMJ [Internet]. 2021 [cited 2023 Jul 12]; Available from: https://www.bmj.com/content/373/bmj.n1098
de Melo BS, de Carvalho MP, Luz LCT, et al. Prevalence and severity of persistent symptoms in post-acute COVID-19 syndrome: a cross-sectional study in Northeast Brazil. PLoS One [Internet]. 2022 [cited 2023 Jul 14]; Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269318
di Toro A, Bozzani A, Tavazzi G, et al. Systematic characterization of risk factors for long COVID: a meta-analysis of observational studies. Int J Infect Dis [Internet]. 2022 [cited 2023 Jul 22]; Available from: https://www.ijidonline.com/article/S1201-9712(22)00154-6/fulltext
Martin-Loeches I, et al. ICU-acquired pneumonia is associated with poor health post-COVID-19 syndrome. J Clin Med. 2021. Available from: https://doi.org/10.3390/jcm11010224. Accessed Jun 10, 2023.
Peghin M, et al. Post-COVID-19 symptoms 6 months after acute infection among hospitalized and non-hospitalized patients. Clin Microbiol Infect. 2021. Available from: https://pubmed.ncbi.nlm.nih.gov/34111579/. Accessed Jun 21, 2023.
Huang C, et al. RETRACTED: 6-month consequences of covid-19 in patients discharged from hospital. Lancet. 2021. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736[20]32656-8/fulltext. Accessed Jun 19, 2023.
Huang L, et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet. 2021. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85113690711&doi=10.1016%2fS0140-6736%2821%2901755-4&partnerID=40&md5=34d5913b57a2d670552f10d7670b4944. Accessed Jun 14, 2023.
Larijani MS, et al. Characterization of long COVID-19 manifestations and its associated factors: a prospective cohort study from Iran. Microb Pathog. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/35690233/. Accessed Jun 11, 2023.
Li D, et al. Clinical status of patients 1 year after hospital discharge following recovery from COVID-19: a prospective cohort study. Ann Intensive Care. 2022. Available from: https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-022-01034-4. Accessed Jun 19, 2023.
Subramanian A, et al. Symptoms and risk factors for long COVID in non-hospitalized adults. Nat Med. 2022. Available from: https://www.nature.com/articles/s41591-022-01909-w. Accessed Jun 13, 2023
Wong MC-S, et al. Epidemiology, symptomatology, and risk factors for long COVID symptoms: population-based, multicenter study. JMIR Public Health Surveill. 2023. Available from: https://pubmed.ncbi.nlm.nih.gov/36645453/. Accessed Jun 20, 2023.
Yang X, et al. Two-year health outcomes in hospitalized COVID-19 survivors in China. JAMA Netw Open. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/36107425/. Accessed Jun 24, 2023.
Kingery JR, et al. Health status, persistent symptoms, and effort intolerance one year after acute COVID-19 infection. J Gen Intern Med. 2022;10.1007/s11606-021-07379-z. Available from: https://doi.org/10.1007/s11606-021-07379-z. Accessed Jun 17, 2023.
Spinicci M, et al. Infection with SARS-CoV-2 variants is associated with different Long COVID phenotypes. Viruses. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/36366465/. Accessed Jun 8, 2023.
Tleyjeh IM, et al. Long term predictors of breathlessness, exercise intolerance, chronic fatigue and well-being in hospitalized patients with COVID-19: a cohort study with 4 months median follow-up. J Infect Public Health. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/34861604/. Accessed Jun 2, 2023.
Whitaker M, et al. Persistent COVID-19 symptoms in a community study of 606,434 people in England. Nat Commun. 2022. Available from: https://www.nature.com/articles/s41467-022-29521-z. Accessed Jun 20, 2023.
Xie Y, et al. Nirmatrelvir and the risk of post-acute sequelae of COVID-19. MedRxiv. 2022. Available from: https://www.medrxiv.org/content/10.1101/2022.11.03.22281783v1. Accessed Jun 22, 2023.
Zhang H, et al. Data-driven identification of post-acute SARS-CoV-2 infection subphenotypes. Nat Med. 2022. Available from: https://www.nature.com/articles/s41591-022-02116-3. Accessed Jun 22, 2023.
Mazzitelli M, et al. Factors associated with severe COVID-19 and post-acute COVID-19 syndrome in a cohort of people living with HIV on antiretroviral treatment and with undetectable HIV RNA. Viruses. 2022. Available from: https://www.mdpi.com/1999-4915/14/3/493. Accessed Jun 7, 2023.
Pywaczewska-Jakubowska M, et al. Lifestyle, course of COVID-19, and risk of Long-COVID in non-hospitalized patients. Front Med. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/36353225/. Accessed Jun 10, 2023.
Schulze H, et al. Cross-sectional analysis of clinical aspects in patients with long-COVID and post-COVID syndrome. Front Neurol. 2022. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9614029/. Accessed Jun 15, 2023.
Amorim CEN, Ribeiro DF, Rocha FHS, Fernandes PA, Simões E, Pinto JT, et al. High Prevalence of Long-COVID Among Kidney Transplant Recipients: a longitudinal cohort study. Transplantation [Internet]. 2022 [cited 2023 May 9]; Available from: https://pubmed.ncbi.nlm.nih.gov/36228200/
Cazé AB, Oliveira VM, Goulart BD, Lima AM. Prevalence and risk factors for long COVID after mild disease: a longitudinal study with a symptomatic control group. J Glob Health [Internet]. 2022 [cited 2023 Jun 2]; Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L2020587415&from=export
Dennis A, Wamil M, Alberts J, et al. Multiorgan impairment in low-risk individuals with long COVID. BMJ Open [Internet]. 2021 [cited 2023 Jul 18]; Available from: https://bmjopen.bmj.com/content/11/3/e048391
Lapa J, et al. Prevalence and associated factors of post-COVID-19 syndrome in a Brazilian cohort after 3 and 6 months of hospital discharge. Int J Environ Res Public Health. 2023. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9820092/. Accessed Jun 10, 2023.
Elkan M, Avrahami M, Bernstein N, et al. Long COVID in hospitalized and non-hospitalized patients in Israel: findings and risk factors. Clin Microbiol Infect [Internet]. 2023 [cited 2023 Jul 24]; Available from: https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(22)00333-4/fulltext
Peters C, et al. Long-term effects of COVID-19 on workers in health and social services in Germany. Int J Environ Res Public Health. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/35742231/. Accessed Jun 20, 2023.
Steinbeis F, et al. Functional limitations 12 months after SARS-CoV-2 infection correlate with initial disease severity: an observational study of cardiopulmonary exercise capacity testing in COVID-19 convalescents. Respir Med. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/36081267/. Accessed Jun 9, 2023.
Choutka J, Jansari V, Hornig M, Iwasaki A. Unexplained post-acute infection syndromes. Nat Med [Internet]. 2022 [cited 2023 Jun 22]; Available from: https://www.nature.com/articles/s41591-021-01429-9
Pujari S, et al. Long-coronavirus disease among people living with HIV in western India: an observational study. Immun Inflamm Dis. 2021. Available from: https://pubmed.ncbi.nlm.nih.gov/34078004/. Accessed Jun 19, 2023.
Rocha RPS, et al. Post-COVID-19 syndrome among hospitalized COVID-19 patients: a cohort study assessing patients 6 and 12 months after hospital discharge. CSP. 2024. Available from: https://www.scielo.br/j/csp/a/zhmLzYby56mjgxdnXYbC7dc/?format=pdf&lang=pt. Accessed May 23, 2024.
Alghamdi S, Al Ghamdi F, Abuzinadah S, Daghistani MH. Post-COVID-19 Syndrome: incidence, risk factor, and the most common persisting symptoms. Cureus [Internet]. 2022 [cited 2023 May 8]; Available from: https://pubmed.ncbi.nlm.nih.gov/36600841/
Asadi-Pooya AA, Akbarpour S, Emami A, Lotfi-Pourkazemi P, Nemati H, Maghooli R, et al. Risk Factors Associated with Long COVID Syndrome: a retrospective study. Iran J Med Sci [Internet]. 2021 [cited 2023 Jun 27]; Available from: https://pubmed.ncbi.nlm.nih.gov/34840383/
Cervia C, Zurbuchen Y, Valaperti A, et al. Immunoglobulin signature predicts risk of post-acute COVID-19 syndrome. Nat Commun [Internet]. 2022 [cited 2023 Jun 3]; Available from: https://www.nature.com/articles/s41467-021-27797-1
Charalampous O, Efthimiou N, Stafylidis K, et al. Prevalence and determinants of long COVID syndrome in post-COVID patients: a prospective study. Eur J Clin Invest [Internet]. 2022 [cited 2023 Jun 15]; Available from: https://pubmed.ncbi.nlm.nih.gov/35721193/
Díaz O, Jaramillo CL, León C, et al. Long COVID symptoms in a cohort of Chilean adults: frequency, risk factors, and impacts on quality of life. Int J Environ Res Public Health [Internet]. 2022 [cited 2023 Jul 21]; Available from: https://pubmed.ncbi.nlm.nih.gov/35447637/
Fernández-de-Las-Peñas C, Torres-Macho J, Velasco-Arribas M, et al. Long-term post-COVID symptoms in primary care. J Clin Med [Internet]. 2022 [cited 2023 Jul 26]; Available from: https://pubmed.ncbi.nlm.nih.gov/35565355/
Jassat W, et al. A cohort study of post-COVID-19 condition across the Beta, Delta, and Omicron waves in South Africa: 6-month follow-up of hospitalized and nonhospitalized participants. Int J Infect Dis. 2023. Available from: https://pubmed.ncbi.nlm.nih.gov/36587841/. Accessed Jun 9, 2023.
Pérez-González A, et al. Long COVID in hospitalized and non-hospitalized patients in a large cohort in Northwest Spain, a prospective cohort study. Sci Rep. 2022. Available from: https://www.nature.com/articles/s41598-022-07414-x. Accessed Jun 10, 2023.
Sun L-L, et al. 15-month health outcomes and the related risk factors of hospitalized COVID-19 patients from onset: a cohort study. Front Med. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/35646985/. Accessed Jun 21, 2023.
Xu E, et al. Risks and burdens of incident dyslipidaemia in long COVID: a cohort study. Lancet Diabetes Endocrinol. 2023. Available from: https://pubmed.ncbi.nlm.nih.gov/36623520/. Accessed Jun 24, 2023.
Barış SA, Çörtük E, Kılıç P, Selçuk ZT, Öcal MA, Çetinkaya E, et al. The predictors of long–COVID in the cohort of Turkish Thoracic Society– TURCOVID multicenter registry: one year follow-up results. Asian Pac J Trop Med [Internet]. 2022 [cited 2023 Jun 9]; Available from: https://pesquisa.bvsalud.org/global-literature-on-novel-coronavirus-2019-ncov/resource/pt/covidwho-2080621
da Silva JC, Goulart BG, Orellana JD, et al. Post-acute sequelae of SARS-CoV-2 infection in the Brazilian Amazon: prevalence and associated risk factors. BMC Infect Dis [Internet]. 2022 [cited 2023 Jul 8]; Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07008-w
Senjam SS, et al. A Comprehensive Assessment of Self-Reported Post COVID-19 Symptoms Among Beneficiaries of Hospital Employee Scheme at a Tertiary Healthcare Institution in Northern India. Int J Gen Med. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/36164285/. Accessed Jun 11, 2023.
Strahm C, et al. Symptoms compatible with long coronavirus disease [COVID] in healthcare workers with and without severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection—results of a prospective multicenter cohort. Clin Infect Dis. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/35090015/. Accessed Jun 16, 2023.
Moreno-Pérez O, et al. Post-acute COVID-19 syndrome. Incidence and risk factors: a Mediterranean cohort study. J Infect. 2021. Available from: https://doi.org/10.1016/j.jinf.2021.01.004. Accessed Jun 22, 2023.
Ko ACS, et al. Number of initial symptoms is more related to long COVID-19 than acute severity of infection: a prospective cohort of hospitalized patients. Int J Infect Dis. 2022. Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L2017454270&from=export. Accessed Jun 6, 2023.
Righi E, et al. Determinants of persistence of symptoms and impact on physical and mental wellbeing in Long COVID: a prospective cohort study. J Infect. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/35150765/. Accessed Jun 3, 2023.
Ahmad I, Avula A, Ahmad SM, Khalid M, Thomas B, Khan S, et al. High prevalence of persistent symptoms and reduced health-related quality of life 6 months after COVID-19. Front Public Health [Internet]. 2023 [cited 2023 May 3]; Available from: https://www.frontiersin.org/articles/10.3389/fpubh.2023.1104267/full
Banić M, Mrsić V, Mraković Špoljar N, Mičetić Turk D. Risk factors and severity of functional impairment in long COVID: a single-center experience in Croatia. Croat Med J [Internet]. 2022 [cited 2023 Jun 18]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8895334/
Bliddal S, Kristiansen TB, Kirchner S, Sonne MP, Skov J. Acute and persistent symptoms in non-hospitalized PCR-confirmed COVID-19 patients. Sci Rep [Internet]. 2021 [cited 2023 Jun 16]; Available from: https://www.nature.com/articles/s41598-021-92045-x
Chen Z, Meng Y, Feng Y, et al. Risk factors for persistent post-acute sequelae of SARS-CoV-2 infection in a Chinese cohort. J Infect Dis [Internet]. 2022 [cited 2023 Jun 20]; Available from: https://academic.oup.com/jid/article/226/7/1157/6651817
Dhesi PK, Dhaliwal M, Agarwal V, et al. Long-term respiratory and general health outcomes after COVID-19: a systematic review. Clin Infect Dis [Internet]. 2022 [cited 2023 Jul 19]; Available from: https://academic.oup.com/cid/article/75/4/e730/6594637
Seery V, et al. Persistent symptoms after COVID-19 in children and adolescents from Argentina. Int J Infect Dis. 2023. Available from: https://pubmed.ncbi.nlm.nih.gov/36736574/. Accessed Jun 11, 2023.
Adler L, Efrati O, Neuberger A, Levit I, Shoenfeld Y, Elkan M, et al. Long COVID symptoms in Israeli children with and without a history of SARS-CoV-2 infection: a cross-sectional study. BMJ Open [Internet]. 2023 [cited 2023 Apr 3];13(2):e064155. Available from: https://bmjopen.bmj.com/content/13/2/e064155
Bergia M, Lara-Reyes A, Cantarero-Villegas E, Torres-López E. Comparative study shows that 1 in 7 Spanish children with COVID‐19 symptoms were still experiencing issues after 12 weeks. Acta Paediatr [Internet]. 2022 [cited 2023 Jun 11]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9111513/
Crook H, Raza S, Nowell J, Young M, Edison P. Long covid—mechanisms, risk factors, and management. BMJ [Internet]. 2021 [cited 2023 Jul 2]; Available from: https://www.bmj.com/content/374/bmj.n1648
Lima JBd, Salazar L, Fernandes A, Teixeira C, Marques L, Afonso C. Long COVID in children and adolescents: a retrospective study in a pediatric cohort. Pediatr Infect Dis J. 2023. Available from: https://pubmed.ncbi.nlm.nih.gov/36728643/. Accessed Jun 10, 2023.
Rezel-Potts E, et al. Cardiometabolic outcomes up to 12 months after COVID-19 infection. A matched cohort study in the UK. PLoS Med. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/35853019/. Accessed Jun 3, 2023.
Sugiyama A, et al. Long COVID occurrence in COVID-19 survivors. Sci Rep. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/35411017/. Accessed Jun 7, 2023.
Björsell T, Olsson A, Strömberg A. Risk factors for impaired respiratory function post COVID‐19: a prospective cohort study of nonhospitalized and hospitalized patients. J Intern Med [Internet]. 2023 [cited 2023 Jun 27]; Available from: https://onlinelibrary.wiley.com/doi/10.1111/joim.13614
Li D, et al. Healthy outcomes of patients with COVID-19 two years after the infection: a prospective cohort study. Emerg Microbes Infect. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/36215047/. Accessed Jun 2, 2023.
Stromberg S, et al. Relationships between plasma fatty acids in adults with mild, moderate, or severe COVID-19 and the development of post-acute sequelae. Front Nutr. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/36185653/. Accessed Jun 11, 2023.
Kim Y, et al. Post-acute COVID-19 syndrome in patients after 12 months from COVID-19 infection in Korea. BMC Infect Dis. 2022. Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07062-6. Accessed Jun 13, 2023.
Mazibas H, et al. Long COVID in the Belgian Defence forces: prevalence, risk factors and impact on quality of daily functioning. BMJ Mil Health. 2023. Available from: https://pubmed.ncbi.nlm.nih.gov/36828639/. Accessed Jun 28, 2023.
Oliveira JF, et al. Persistent symptoms, quality of life, and risk factors in long COVID: a cross-sectional study of hospitalized patients in Brazil. Int J Infect Dis. 2022. Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L2019810331&from=export. Accessed Jun 18, 2023.
Kurki SN, et al. APOE ε4 associates with increased risk of severe COVID-19, cerebral microhaemorrhages, and post-COVID mental fatigue: a Finnish biobank, autopsy, and clinical study. Acta Neuropathol Commun. 2021. Available from: https://pubmed.ncbi.nlm.nih.gov/34949230/. Accessed Jun 6, 2023.
Yelin D, et al. Patterns of long COVID symptoms: a multi-center cross-sectional study. J Clin Med. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/35207171/. Accessed Jun 23, 2023.
Kahlert CR, et al. Post-acute sequelae after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by viral variant and vaccination status: a multicenter cross-sectional study. Clin Infect Dis. 2023. Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07062-6. Accessed Jun 10, 2023.
