Fatigue and neuropsychiatric manifestations of post-acute sequelae of COVID-19 (PASC): examining the relationship with clinical and inflammatory markers

Abstract

ABSTRACT Background and aims Fatigue and neuropsychiatric (NP) symptoms are frequently observed in patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC). This study aims to explore the relationship between clinical characteristics, inflammatory markers, and severity of fatigue and NP manifestations in COVID-19 survivors following the acute phase. Methods This cross-sectional study included adult participants who experienced any post-COVID NP symptoms. Questionnaires for fatigue (CFQ-11), anxiety-depression (DASS-21), insomnia (PSQI), cognitive impairment (ACE-III), and delayed processing speed (TMT-B) were administered. Demographic data, clinical characteristics of COVID-19 infection, and laboratory tests for inflammatory markers (CRP, IL-6, albumin, hemoglobin, and NL-ratio) were collected. Results The most common symptoms reported by 82 participants were fatigue (85.4%), insomnia (84.2%), anxiety (62.2%), subjective brain fog (61%), and depression (50%). There was no observed association between the severity of any target symptoms and the inflammatory markers. In multivariable analysis, a strong positive correlation was found between the number of PASC symptoms and the severity of fatigue, depression, anxiety, and sleep problems (p < 0.01). Those who had been infected more than once experienced more fatigue (p = 0.03). Patients with respiratory tract diseases were more likely to experience depression (p = 0.01), and smoking was associated with more sleep disturbances (p = 0.02). Lack of exercise was associated with slower processing speed (p = 0.02). Conclusion The severity of fatigue and NP symptoms of PASC is not correlated with changes in the inflammatory markers. However, certain clinical factors can predict the severity, including the number of PASC symptoms, frequency of COVID-19 infections, respiratory tract diseases, smoking, and exercise.