Definition of the Post-COVID syndrome using a symptom-based Post-COVID score in a prospective, multi-center, cross-sectoral cohort of the German National Pandemic Cohort Network (NAPKON)

Katharina S. Appel, Carolin Nürnberger, Thomas Bahmer, Christian Förster, Maria Cristina Polidori, Mirjam Kohls, Tanja Kraus, Nora Hettich-Damm, Julia Petersen, Sabine Blaschke, Isabel Bröhl, Jana Butzmann, Hiwa Dashti, Jürgen Deckert, Michael Dreher, Karin Fiedler, Carsten Finke, Ramsia Geisler, Frank Hanses, Sina M. Hopff, Björn-Erik O. Jensen, Margarethe Konik, Kristin Lehnert, Susana M. Nunes de Miranda, Lazar Mitrov, Olga Miljukov, Jens-Peter Reese, Gernot Rohde, Margarete Scherer, Kristin Tausche, Johannes J. Tebbe, Jörg Janne Vehreschild, Florian Voit, Patricia Wagner, Martin Weigl, Christina Lemhöfer on behalf of the NAPKON Study Group


The objective examination of the Post-COVID syndrome (PCS) remains difficult due to heterogeneous definitions and clinical phenotypes. The aim of the study was to verify the functionality and correlates of a recently developed PCS score.


The PCS score was applied to the prospective, multi-center cross-sectoral cohort (in- and outpatients with SARS-CoV-2 infection) of the „National Pandemic Cohort Network (NAPKON, Germany)“. Symptom assessment and patient-reported outcome measure questionnaires were analyzed at 3 and 12 months (3/12MFU) after diagnosis. Scores indicative of PCS severity were compared and correlated to demographic and clinical characteristics as well as quality of life (QoL, EQ-5D-5L).


Six hundred three patients (mean 54.0 years, 60.6% male, 82.0% hospitalized) were included. Among those, 35.7% (215) had no and 64.3% (388) had mild, moderate, or severe PCS. PCS severity groups differed considering sex and pre-existing respiratory diseases. 3MFU PCS worsened with clinical severity of acute infection (p = .011), and number of comorbidities (p = .004). PCS severity was associated with poor QoL at the 3MFU and 12MFU (p < .001).


The PCS score correlated with patients’ QoL and demonstrated to be instructive for clinical characterization and stratification across health care settings. Further studies should critically address the high prevalence, clinical relevance, and the role of comorbidities.

Infection (2024)


definitionlong-COVIDmulti-center prospective cohort studypatient reported outcome measurespost-COVIDquality of lifescore
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