Longo Covid-19: avaliação e comparação da qualidade de vida, sarcopenia e proteinúria em pacientes que tiveram apresentação clínica leve e moderada

Abstract

The pandemic caused by the coronavirus (SARS-CoV-2) called COVID-19, was responsible for high hospitalization and mortality rates. Patients recovered from COVID-19 (long COVID-19), especially those who were admitted to the ICU, report tiredness, dyspnea, muscle pain; which are associated with worse quality of life. However, there are few reports evaluating long COVID-19 in its sequelae regarding quality of life, sarcopenia and proteinuria in individuals with mild and moderate clinical presentation. Objective: To evaluate and compare quality of life, sarcopenia and proteinuria in patients with long COVID-19 according to mild and moderate clinical presentation. Methods: Quantitative and longitudinal study. We evaluated 253 individuals with mild (n=119) and moderate (n=134) clinical presentation for COVID-19 (positive RT-PCR) after 6 (T6) and 12 (T12) months from the date of acute infection. Quality of life was assessed using the Short Form 36 (SF – 36) questionnaire, pain using the visual analogue scale (VAS), risk of sarcopenia using the Simple Questionnaire to Rapidly Diagnose Sarcopenia (SARC-F), functionality using the Dominant Palm Grip Strength (HGS), Sit – Up (sit and stand), and with the aid of the Duke Activity Status Index Questionnaire (DASI) and proteinuria using a urinalysis strip. Results: The average age was 44±10 and 43±12 years; female 68% and 59% for the mild and moderate groups, respectively. 75% or more of patients were vaccinated with at least 2 doses before acquiring COVID-19 infection. Individuals with a moderate clinical presentation in relation to mild cases were: hypertensive (23% and 6%, p < 0.001) and with diabetes mellitus (9% and 2%; p = 0.01) at the time of COVID-19 infection. The moderate group showed a statistically significant difference at T6: lower functional capacity (SF36: 46±20 vs. 61±24); more pain (SF36: 45±29 vs. 67±32 and VAS: 55% vs. 32%); greater dysfunctionality for daily activities (DASI: 40±11 vs. 45±10); lower number of repetitions for lower limb muscle strength (Sit-up: 9±2 vs. 11±2); higher sarcopenia score (SARC-F: 6±4 vs. 4±3) and higher proteinuria ≥1”+”: 59% vs. 42%) compared to the mild group. After 12 months, the moderate group remained with greater pain (SF36+VAS) and more dysfunctionality in daily activities (DASI) compared to the mild group. Comparing T12 to T6, we observed that the mild group had worse functional capacity; more pain (SF36+VAS); lower FPP and higher proteinuria ≥1”+”: 63% vs. 42%). The moderate group had lower HGS; greater 10 number of repetitions for the Sit-up at T12 compared to T6. We observed that individuals who had a higher SARC-F score showed a negative correlation with upper limb strength (Handgrip/FPP); lower limbs (Sit-up); functional capacity (SF36); dysfunction for daily activities (DASI). Conclusion: our results show that individuals who had mild and moderate presentation at the time of COVID-19 infection had long-term COVID-19 sequelae. However, the moderate group had greater pain sequelae at T6 and T12 and a greater risk of sarcopenia after 6 months, reduced muscle strength, which may contribute to a worse quality of life for these individuals. Furthermore, the presence of proteinuria for both groups is a warning to evaluate renal function; through other biomarkers to determine whether this proteinuria is transient or whether the infection caused by SARS-CoV-2 may be a risk factor for loss of kidney function and progression of kidney disease. Therefore, it is necessary to develop strategies for physical rehabilitation and follow-up assessment of renal filtration function in this population.