Background: Long-term sequelae after SARS-CoV-2 infection may impact health-related quality-of-life (HRQoL), yet it is unknown how HRQoL changes during recovery. We compared patient-reported HRQoL among adults with COVID-19-like illness who tested SARS-CoV-2 positive (COVID+) with those who tested negative (COVID-).

Methods: Participants in this prospective, multicenter, longitudinal registry study were enrolled from December 2020 through August 2022 and completed 3-month follow-up assessments until 12 months after enrollment. Participants were adults (≥18 years) with acute symptoms suggestive of COVID-19 who received a Food and Drug Administration-approved SARS-CoV-2 test. Participants received questions from PROMIS-29 (subscales: physical function, anxiety, depression, fatigue, social participation, sleep disturbance, and pain interference) and PROMIS SF-8a (cognitive function). Latent transition analysis was used to identify meaningful patterns in HRQoL scores over time; 4 HRQoL categories were compared descriptively and using multivariable regression. Inverse probability weighting was used to adjust for covariate imbalance.

Results: There were 1096 (75%) COVID+ and 371 (25%) COVID-. Four distinct well-being classes emerged: optimal overall, poor mental, poor physical, and poor overall HRQoL. COVID+ participants were more likely to return to the optimal HRQoL class compared to COVID- participants. The most substantial transition from poor physical to optimal HRQoL occurred by 3 months, whereas movement from poor mental to optimal HRQoL occurred by 9 months.

Conclusions: In adults with COVID-19-like illness, COVID+ participants demonstrated meaningful recovery in their physical HRQoL by 3 months after infection, but mental HRQoL took longer to improve. Suboptimal HRQoL at 3 to 12 months after infection remained in approximately 20%.

Trial registration: NCT04610515.

Keywords: COVID-19; SARS-CoV-2; health-related quality of life; prospective cohort study.

© The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

背景： 长期的新冠病毒感染后遗症可能会影响与健康相关的生命质量（HRQoL），但人们尚不清楚在恢复过程中 HRQoL 如何变化。我们将比较 COVID-19 类似症状成人患者中，新冠病毒检测呈阳性（COVID+）和阴性（COVID-）患者的自我报告的 HRQoL。

方法： 本项前瞻性、多中心、纵向注册研究中的参与者于 2020 年 12 月至 2022 年 8 月期间被纳入，并在入组后完成为期 3 至 12 个月的随访评估。参与者为年龄≥18 岁且急性症状提示 COVID-19 的成人，他们接受了美国食品药品监督管理局批准的新冠病毒检测。参与者回答了 PROMIS-29（子量表：身体功能、焦虑、抑郁、疲劳、社会参与度、睡眠障碍和疼痛干扰）以及 PROMIS SF-8a（认知功能）。使用潜在转换分析识别 HRQoL 评分随时间变化中的有意义模式；通过描述性统计和多变量回归对四种不同的 HRQoL 类别进行了比较。利用逆概率加权法调整了协变量不平衡。

结果： 共有1096名（75%）为 COVID+，371 名（25%）为 COVID-。四种不同的福祉类别浮现出来：总体最佳、心理状态较差、身体状况较差和总体 HRQoL 较差。与 COVID- 参与者相比，COVID+ 参与者更有可能恢复到最佳 HRQoL 类别。从身体状况较差转至最佳 HRQoL 的最大转变发生在 3 个月时，而心理状态较差转至最佳 HRQoL 则在 9 个月时发生。

结论： 对于 COVID-19 类似症状的成人而言，COVID+ 参与者的身体状况相关 HRQoL 在感染后 3 个月内已显示出有意义的恢复进展；然而心理状态相关的 HRQoL 改善则需要更长时间。在感染后的 3 到 12 个月期间，大约有 20% 的人仍处于次优 HRQoL 状态。

临床试验注册： NCT04610515。

关键词： COVID-19；SARS-CoV-2；与健康相关的生命质量；前瞻性队列研究。

© The Author(s) 2025. Oxford University Press 代表 Infectious Diseases Society of America 发布。