Number of Symptoms During the Acute Phase of SARS-CoV-2 Infection in Athletes Is Associated With Multiorgan Involvement: AWARE III

OBJECTIVE: Acute respiratory infections (ARinf), including SARS-CoV-2 infection, can affect multiple organ systems that may influence return to sport (RTS) in athletes. Factors associated with multiorgan involvement in athletes with ARinf are lacking. The aim of this study was to explore whether factors such as demographics, sport participation, history of comorbidities/allergies, and number of acute symptoms are associated with multiorgan involvement in athletes with recent SARS-CoV-2 infection. DESIGN: Prospective cohort study with cross-sectional analysis. SETTING: Institutional clinical research facilities. PARTICIPANTS: Ninety-five athletes (18-60 years) underwent a comprehensive medical assessment 10 to 28 days after SARS-CoV-2 infection. INDEPENDENT FACTORS: Demographics, sport participation, history of comorbidities/allergies, and the number of acute symptoms (in 3 subgroups:1 = ≤5, 2 = 6-9, or 3 ≥ 10). MAIN OUTCOME MEASURES: Number of organs involved in athletes with recent SARS-CoV-2 infection. RESULTS: The number of organ systems involved was not associated with demographics (age, sex), sport participation (level and type), or history of comorbidities and allergies. However, the number of organ systems involved was significantly higher in athletes with 6 to 9 symptoms (subgroup 2) compared with those with ≤5 symptoms (subgroup 1) and this was more pronounced when comparing athletes with ≥10 symptoms (subgroup 3) with those with ≤5 symptoms (subgroup 1) ( P < 0.0001). CONCLUSIONS: Total number of acute symptoms of SARS-CoV-2 infection is related to number of organ systems involved, which is a measure of disease severity, and could therefore influence RTS decision making. Future studies should explore whether this observation holds for athletes with ARinf caused by other pathogens.