Clinical Spectrum and Associated Risk Factors of Post-COVID-19 Complications Among Recovered Patients: A Cross-Sectional Observational Study

Abstract

Background: Coronavirus disease 2019 (COVID-19) may be followed by persistent or newly developing symptoms that continue beyond the acute phase of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This condition, commonly described as long COVID or post-COVID-19 condition, may involve multiple organ systems and significantly impair physical, psychological, social, and occupational functioning. Aim: To evaluate the clinical spectrum of post-COVID-19 complications and identify factors associated with persistent complications among recovered patients. Materials and Methods: A hospital-based cross-sectional observational study was conducted among 100 patients with a documented previous history of COVID-19. Demographic characteristics, associated comorbidities, severity of acute infection, hospitalization history, and persistent or newly developed symptoms were evaluated. Post-COVID manifestations were classified into systemic, respiratory, cardiovascular, neurological, musculoskeletal, psychological, and gastrointestinal categories. Categorical variables were expressed as frequencies and percentages. Associations were assessed using the Chi-square test or Fisher's exact test wherever appropriate. A p-value <0.05 was considered statistically significant. Results: Among the 100 participants, 55% experienced at least one persistent post-COVID complication. Fatigue was the most frequently reported symptom (46%), followed by breathlessness (34%), sleep disturbances (29%), myalgia (27%), persistent cough (23%), headache (21%), cognitive difficulty or brain fog (19%), anxiety/depressive symptoms (18%), palpitations (16%), and arthralgia (15%). Persistent complications were increasingly common with greater severity of acute COVID-19. Patients with moderate, severe, or critical disease demonstrated a significantly higher prevalence of persistent complications compared with those who experienced mild infection (p=0.007). Discussion: The findings demonstrate a substantial burden of persistent symptoms following recovery from acute COVID-19, with more than half of the study population reporting at least one post-COVID manifestation. The predominance of fatigue, dyspnoea, sleep disturbance, musculoskeletal complaints, and neurocognitive symptoms is broadly consistent with previous cohort studies and systematic reviews describing long COVID as a heterogeneous multisystem condition. The increasing frequency of persistent complications with greater severity of the initial infection also supports previous evidence showing a higher post-acute disease burden among patients with more severe COVID-19. Nevertheless, the occurrence of persistent manifestations following milder disease indicates that post-COVID morbidity is not confined to previously hospitalized or severely affected patients. The coexistence of respiratory, neurological, musculoskeletal, cardiovascular, and psychological manifestations further emphasizes the need for comprehensive rather than organ-specific assessment during follow-up. Conclusion: Post-COVID-19 complications represent an important multisystem health problem. Fatigue and respiratory, neurological, musculoskeletal, cardiovascular, and psychological manifestations contribute substantially to the post-acute disease burden. Greater severity of acute disease, hospitalization, increasing age, and comorbidities may increase the likelihood of persistent complications. Structured clinical follow-up and multidisciplinary rehabilitation should therefore be considered for symptomatic patients