Al-Hadrawi, Dhurgham Shihab, Al-Rubaye, Haneen Tahseen, Almulla, Abbas F et al. · Acta neuropsychiatrica · 2023 · DOI
This study examined whether low oxygen levels and high fever during acute COVID-19 could predict who develops Long COVID symptoms like fatigue, depression, and anxiety. Researchers found that these two early warning signs, combined with being female, could explain about 61% of why some people develop these lingering symptoms. They also identified a subgroup (about 27% of Long COVID patients) with particularly severe oxygen drops and fever who experienced the worst combination of fatigue, mood problems, and digestive symptoms.
This study provides evidence that specific measurable markers during acute COVID-19 infection—low oxygen and high fever—may predict who will develop severe Long COVID and ME/CFS-like symptoms. Identifying these early biomarkers could help clinicians stratify risk and potentially intervene earlier in high-risk patients. The discovery of distinct endophenotypes supports the biological basis of Long COVID and suggests different mechanistic pathways may underlie symptom clusters.
This study does not prove causation—it shows correlation between acute-phase SpO2/temperature and later symptoms, but cannot establish that hypoxemia directly causes Long COVID. The cross-sectional design (measuring outcomes 3-4 months post-infection) cannot establish temporal dynamics or whether other acute-phase factors (viral load, immune response) are the true drivers. The study focuses on Long COVID broadly and may not directly apply to ME/CFS as a distinct disease entity.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Al-Hadrawi, Dhurgham Shihab, Al-Rubaye, Haneen Tahseen, Almulla, Abbas F, Al-Hakeim, Hussein Kadhem, & Maes, Michael (2023). Lowered oxygen saturation and increased body temperature in acute COVID-19 largely predict chronic fatigue syndrome and affective symptoms due to Long COVID: A precision nomothetic approach.. Acta neuropsychiatrica. https://doi.org/10.1017/neu.2022.21
BibTeX
@article{mecfsatlas-al-hadrawi-2023-lowered-oxygen,
author = {Al-Hadrawi, Dhurgham Shihab and Al-Rubaye, Haneen Tahseen and Almulla, Abbas F and Al-Hakeim, Hussein Kadhem and Maes, Michael},
title = {Lowered oxygen saturation and increased body temperature in acute COVID-19 largely predict chronic fatigue syndrome and affective symptoms due to Long COVID: A precision nomothetic approach.},
journal = {Acta neuropsychiatrica},
year = {2023},
doi = {10.1017/neu.2022.21},
note = {PubMed: 36134517},
url = {https://www.mecfsatlas.com/evidence/al-hadrawi-2023-lowered-oxygen},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/al-hadrawi-2023-lowered-oxygen
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