Relationships between Inflammatory Biomarkers and Fatigue among Patients with Moderate and Severe COVID-19

Background Patients with moderate or severe COVID-19 infection suffer from varying levels of fatigue; however, there is a lack of understanding regarding the effect of inflammation on fatigue; and whether these relationships differ according to the severity of the infection. Aim To assess the relationships between selected inflammatory biomarkers and fatigue levels among hospitalized Jordanian patients with moderate or severe COVID-19 infection. Methods A quantitative cross-sectional design was used. A total of 352 participants were recruited for the study. Data regarding fatigue type and level were collected using the Chalder fatigue scale. Laboratory test results regarding several selected inflammatory biomarkers (e.g., ESR, CRP, IL-6, D-dimer, and others) were collected from patient records. The severity of the COVID-19 infection was determined using the criteria of the Ministry of Health in Jordan based on the results of O2% (oxygen saturation). Results The mean scores of the total fatigue level significantly differed between the two levels of the severity of COVID-19 infection (moderate and severe levels) (t = −3.0, p < 0.05). Similar findings were observed with physiological fatigue (t = −3.50, p < 0.05), and no significant difference was observed in psychological fatigue. Out of the selected inflammatory markers, only neutrophil and lymphocyte count had a significant influence on total fatigue level. Conclusion The level and type of fatigue was affected by the severity of the disease. However, the disease process itself represented by the levels of the inflammatory markers showed little influence on fatigue. The implications such as continuous screening of fatigue, and monitoring of the levels of the inflammatory markers are important to assist in diagnosing and managing COVID-19 patients. Furthermore, the relationship between the inflammatory process and fatigue is complex and requires further exploration.

[1]  F. Benedetti,et al.  Post-COVID-19 Depressive Symptoms: Epidemiology, Pathophysiology, and Pharmacological Treatment , 2022, CNS Drugs.

[2]  D. Azzolino,et al.  Fatigue in the COVID-19 pandemic , 2022, The Lancet Healthy Longevity.

[3]  A. Mackay.  A Paradigm for Post-Covid-19 Fatigue Syndrome Analogous to ME/CFS , 2021, Frontiers in Neurology.

[4]  S. Balter,et al.  Diagnostic Performance of an Antigen Test with RT-PCR for the Detection of SARS-CoV-2 in a Hospital Setting — Los Angeles County, California, June–August 2020 , 2021, MMWR. Morbidity and mortality weekly report.

[5]  B. Allen,et al.  Analysis of absolute lymphocyte count in patients with COVID-19 , 2021, The American Journal of Emergency Medicine.

[6]  Sara J. Abdallah,et al.  COVID-19 and post-infectious myalgic encephalomyelitis/chronic fatigue syndrome: a narrative review , 2021, Therapeutic advances in infectious disease.

[7]  T. Rudroff,et al.  Post-COVID-19 Fatigue: Potential Contributing Factors , 2020, Brain sciences.

[8]  N. Harvey.  Behavioral Fatigue: Real Phenomenon, Naïve Construct, or Policy Contrivance? , 2020, Frontiers in Psychology.

[9]  H. Mansouritorghabeh,et al.  D-dimer level in COVID-19 infection: a systematic review , 2020, Expert review of hematology.

[10]  A. Robert,et al.  A meta-analysis of potential biomarkers associated with severity of coronavirus disease 2019 (COVID-19) , 2020, Biomarker research.

[11]  Rakesh Lodha,et al.  Pathophysiology of COVID-19: Why Children Fare Better than Adults? , 2020, The Indian Journal of Pediatrics.

[12]  Ying Guo,et al.  Association of inflammatory markers with the severity of COVID-19 , 2020, medRxiv.

[13]  L. Jason,et al.  Post-viral fatigue and COVID-19: lessons from past epidemics , 2020 .

[14]  Valmi D Sousa,et al.  Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. , 2011, Journal of evaluation in clinical practice.