ORIGINAL RESEARCH article
Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1581288
Pre-COVID Health-Related Quality of Life Predicts Symptoms and Outcomes for Patients with Long COVID
Provisionally accepted
- Cleveland Clinic, Cleveland, United States
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Background: Post-acute sequelae SARS-CoV-2 (PASC) is a prevalent condition with variable symptom presentation. PASC occurs more often with pre-existing medical conditions, however it is unknown whether pre-COVID health-related quality of life (HRQL) is associated with PASC. Similarly, the trajectory of HRQL following PASC is unknown.Objective: Our study sought to evaluate 1) whether pre-COVID HRQL is associated with PASC symptoms; 2) whether PASC patients have worse pre-COVID HRQL compared to matched controls; and 3) to compare HRQL trajectories from pre-COVID to 1-year follow-up between PASC patients and matched controls. Design: Retrospective cohort study with propensity-score matched control group. Participants: The cohort included 1,114 adult patients (mean age 53±14, 75% female) seen in a PASC clinic between 2/10/21-3/27/24 who completed HRQL surveys prior to their initial COVID-diagnosis in a large health system. A propensity-score matched control group included patients with COVID-19 without PASC. Main Measures: HRQL was measured with PROMIS Global Health (global mental health (GMH) and global physical health (GPH) summary scores).Key Results: PASC symptoms were significantly associated with pre-COVID HRQL. Symptoms most associated with PROMIS-GMH included diarrhea/nausea (odds ratio (OR)=1.27 (95% CI: 1.16-1.39) per 5-point worsening) and brain fog (OR=1.25 (95% CI: 1.14-1.37)), while fatigue (OR=1.39 (95% CI: 1.15-1.68)) had the highest association with PROMIS-GPH. Pre-COVID GMH and GPH were significantly worse for PASC patients compared to controls (-2.6 (SE 0.4) and -3.4 (0.3) T-score points, respectively). At 1-year following COVID, PASC patients worsened significantly in GMH and GPH (-2.0±8.2 and -1.2±7.5 T-score points, respectively), compared to controls who worsened significantly on GMH but not GPH (-0.8±7.7 and 0.2±7.4 T-score points, respectively). Conclusions: In patients with PASC, worse pre-COVID HRQL was associated with more PASC-related symptoms. PASC patients had worse pre-COVID HRQL compared to matched controls and experienced a greater decline in HRQL 1-year after COVID-diagnosis; however, this decline was below the threshold for clinical significance.
Keywords: Patient-reported outcome, health-related quality of life, PROMIS global health, Long-COVID symptoms, post-acute sequalae of COVID
Received: 21 Feb 2025; Accepted: 20 Jun 2025.
Copyright: © 2025 Lapin, Baker, Thompson, Li, Milinovich, Lago and Katzan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Brittany Lapin, Cleveland Clinic, Cleveland, United States
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