Severity, predictors and clinical correlates of Post-COVID syndrome (PCS) in Germany: A prospective, multi-centre, population-based cohort study

Background
Post-COVID syndrome (PCS) is a frequent consequence of SARS-CoV-2 infection, defined by persistent or newly emerging symptoms lasting more than three months. Its causes and public health impact remain poorly understood, partly due to the lack of standardized tools to assess PCS presence and severity.

Methods
COVIDOM is a population-based cohort study of PCR-confirmed SARS-CoV-2 cases recruited via public health authorities in Kiel, Berlin, and Würzburg (November 2020–September 2021). Adults (≥18 years) were examined at least six months after infection using standardized interviews, clinical assessments, and biomaterial collection. In the Kiel-I sub-cohort, a PCS severity score based on 12 long-term symptom complexes was developed and validated in two independent sub-cohorts (Würzburg/Berlin and Kiel-II). Predictors of PCS severity were also identified. The study is registered at ClinicalTrials.gov (NCT04679584).

Findings
The Kiel-I sub-cohort included 667 participants (57% women), 90% of whom had outpatient treatment during acute infection. At 6–12 months post-infection, the most frequent persistent symptoms were neurological complaints (61.5%), fatigue (57.1%), and sleep disturbances (57.0%). Across validation cohorts (Würzburg/Berlin, n=316; Kiel-II, n=459), higher PCS scores were strongly associated with lower health-related quality of life (EQ-5D-5L). Severe, moderate, and mild/no PCS were observed in 18.8%, 48.2%, and 32.9% of participants, respectively. PCS severity was predicted by acute symptom burden and individual resilience.

Interpretation
PCS severity can be quantified using a simple symptom-based score reflecting disease burden and psychological predisposition, supporting its use in clinical practice, research, and therapeutic development.

Rights

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