Development of a symptom-based severity score anchored to health-related quality of life post-COVID-19 within the population-based EPILOC cohorts

Purpose Because simple symptom counts treat all symptoms as equally important and may not adequately capture the HRQoL impact of heterogeneous post-COVID-19 symptoms, we aimed to develop an HRQoL-anchored symptom severity score providing an interpretable measure of post-COVID-19 disease burden. Methods Baseline data from the population-based EPILOC and EPILOC Omicron surveys (adults aged 18-65 years) were used to develop a symptom-based severity score anchored to physical and mental HRQoL assessed with the SF-12. A two-stage modelling approach was applied to identify HRQoL-relevant symptoms and to derive symptom-specific weights for physical and mental component scores, incorporating 30 ordinal symptom severity variables. Symptom-specific weights were extracted to compute physical, mental, and composite severity scores. Score interpretation was examined using external reference measures, including EPILOC case status, self-reported health recovery, and functional consequences. Results A total of 19,004 participants (mean age 44.3 years, 59.6% female) were included. Sixteen symptoms contributed to the physical and eleven to the mental HRQoL score, with a limited subset accounting for most of the HRQoL loss. Severity scores were heavily right-skewed, with 50.6% of participants showing no measurable HRQoL impairment. Higher scores correlated with lower self-reported recovery, and increased probability of rehabilitation use and health-related changes in working time, supporting convergent and criterion-related validity. Conclusions This study introduces a transparent, HRQoL-anchored symptom severity score that measures graded post-COVID-19 burden beyond simple symptom counts. The score may be particularly suited for longitudinal assessment of recovery trajectories.