Tag: covid-19

Clinical characteristics with inflammation profiling of long-covid and association with one-year recovery following hospitalisation in the UK: a prospective observational study.

Summary:

Background: There are currently no effective pharmacological or non-pharmacological interventions for Long-COVID. To identify potential therapeutic targets, we focussed on previously described four recovery clusters five months after hospital discharge, their underlying inflammatory profiles and relationship with clinical outcomes at one year.

Methods: PHOSP-COVID is a prospective longitudinal cohort study, recruiting adults hospitalised with COVID-19 across the UK. Recovery was assessed using patient reported outcomes measures (PROMs), physical performance, and organ function at five-months and one-year after hospital discharge. Hierarchical logistic regression modelling was performed for patient-perceived recovery at one-year. Cluster analysis was performed using clustering large applications (CLARA) k-medoids approach using clinical outcomes at five-months. Inflammatory protein profiling from plasma at the five-month visit was performed.

Findings: 2320 participants have been assessed at five months after discharge and 807 participants have completed both five-month and one-year visits. Of these, 35·6% were female, mean age 58·7 (SD 12·5) years, and 27·8% received invasive mechanical ventilation (IMV). The proportion of patients reporting full recovery was unchanged between five months 501/1965 (25·5%) and one year 232/804 (28·9%). Factors associated with being less likely to report full recovery at one year were: female sex OR 0·68 (95% CI 0·46-0·99), obesity OR 0·50 (95%CI 0·34-0·74) and IMV OR 0·42 (95%CI 0·23-0·76).

Cluster analysis (n=1636) corroborated the previously reported four clusters: ‘very severe’, ‘severe’, ‘moderate/cognitive’, ‘mild’ relating to the severity of physical, mental health and cognitive impairments at five months in a larger sample. There was elevation of inflammatory mediators of tissue damage and repair in both the ‘very severe’ and the ‘moderate/cognitive’ clusters compared to the ‘mild’ cluster including interleukin-6 which was elevated in both comparisons. Overall, there was a substantial deficit in median (IQR) EQ5D-5L utility index from pre-COVID (retrospective assessment) 0·88 (0·74-1·00), five months 0·74 (0·60-0·88) to one year: 0·74 (0·59-0·88), with minimal improvements across all outcome measures at one-year after discharge in the whole cohort and within each of the four clusters.

Interpretation: The sequelae of a hospital admission with COVID-19 remain substantial one year after discharge across a range of health domains with the minority in our cohort feeling fully recovered. Patient perceived health-related quality of life remains reduced at one year compared to pre-hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

Source: Rachael A Evans, Olivia C Leavy, Matthew Richardson, Omer Elneima, Hamish J C McAuley, Aarti Shikotra, Amisha Singapuri, Marco Sereno et al. Clinical characteristics with inflammation profiling of long-covid and association with one-year recovery following hospitalisation in the UK: a prospective observational study. medRxiv 2021.12.13.21267471; doi: https://doi.org/10.1101/2021.12.13.21267471 https://www.medrxiv.org/content/10.1101/2021.12.13.21267471v1.full-text (Full Text)

Covid-19: Long covid symptoms among hospital inpatients show little improvement after a year, data suggest

People admitted to hospital with covid-19 who reported “long covid” symptoms five months after discharge had made only limited improvement after a full year, preliminary data from the PHOSP-COVID study show.

Researchers said that their results, released as a preprint on 16 December,1 showed that patients who experienced the most severe symptoms also had raised levels of substances associated with whole body inflammation and tissue damage and repair, suggesting autoimmune involvement.

The study, led by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, is following up 2230 adults admitted to hospital with covid-19. At five months after discharge only 2.5 in 10 people felt fully recovered.2 This was largely unchanged after 12 months, at less than 3 in 10 patients, in the 807 people assessed so far.

Chris Brightling, professor of respiratory medicine at the University of Leicester and chief investigator for the study, said, “People who were hospitalised and went on to develop long covid are not getting substantially better a year after they were discharged from hospital.

“Many patients in our study had not fully recovered at five months, and most of these reported little positive change in their health condition at one year.”

Rachael Evans, associate professor at the University of Leicester and respiratory consultant at Leicester’s Hospitals, who is the paper’s lead author, said, “Healthcare professionals will need to proactively continue assessing their patients for some time to come in order to identify their ongoing healthcare needs and provide support.

“We urgently need healthcare packages and medicines that target the potentially treatable traits of long covid to help people feel better and get back to their normal lives. Without these, long covid has the potential to become highly prevalent as a new long term condition.”

Ongoing inflammatory process

The most common long covid symptoms reported by patients were fatigue, muscle pain, physically slowing down, poor sleep, and breathlessness, and patients said that their health related quality of life remained substantially worse one year after hospital discharge than before they had the SARS-CoV-2 infection.

A cluster analysis on the five month data revealed four distinct groups of patients based on the severity of symptoms they experienced: in 39% symptoms were considered mild, in 30% severe, in 20% very severe, and in 11% they were moderate or primarily affected cognition.

Blood samples taken at five months were analysed for around 300 substances linked to inflammation and immunity. These showed that patients in the “very severe” group had higher levels of substances associated with whole body inflammation, tissue damage, and tissue repair, while those reporting poor cognition appeared to have higher levels of substances linked to “brain fog,” suggesting possible neuro-inflammation.

Brightling said that the results suggested “an ongoing inflammatory process” and that other studies had indicated an increase in autoimmunity in some cases against specific organs such as heart or skeletal muscle. “We’re working very closely with immunologists to try to unpick that and see whether autoimmunity may be one of the key drivers [of long covid],” he said.

Source: Ingrid Torjesen. Covid-19: Long covid symptoms among hospital inpatients show little improvement after a year, data suggest. BMJ 2021;375:n3092. Published 15 December 2021. https://www.bmj.com/content/375/bmj.n3092 (Full text)

Characterizing the COVID-19 Illness Experience to Inform the Study of Post-acute Sequelae and Recovery

Abstract:

Background: There is an urgent need to fully understand the impact of variable COVID-19 experiences and the optimal management of post-acute sequelae of SARS-CoV-2 infection. We characterized the variability in the acute illness experience and ongoing recovery process from participants in a COVID-19 recovery cohort study in Northern California in 2020.

Method: We completed 24 semi-structured in-depth interviews with adults with confirmed positive SARV-CoV-2 nucleic acid amplification test result, had recovered or were recovering from acute infection, and underwent serial evaluations. We purposefully sampled English- and Spanish-speaking adults with asymptomatic, mild, and severe symptomatic infection, including those who were hospitalized and those with HIV co-infection. We used a thematic analysis to analyze interviews and identify salient themes.

Results: After integrating the thematic analysis with clinical data, we identified key themes: (1) across symptom profiles and severity, experiencing COVID-19 was associated with psychological distress; (2) symptomatic infection carried uncertainty in symptom presentation and ongoing recovery (e.g., long COVID); and (3) health information-seeking behavior was facilitated by access to medical care and uncertainty with the recovery process.

Conclusion: Our data informs the emerging field of “long COVID” research and shows a need to provide information and continuous support to persons with post-acute sequelae to ensure they feel secure along the path to recovery.

Source: Santiago-Rodriguez EI, Maiorana A, Peluso MJ, Hoh R, Tai V, Fehrman EA, Hernandez Y, Torres L, Spinelli MA, Gandhi M, Kelly JD, Martin JN, Henrich TJ, Deeks SG, Sauceda JA. Characterizing the COVID-19 Illness Experience to Inform the Study of Post-acute Sequelae and Recovery. Int J Behav Med. 2021 Dec 16:1–14. doi: 10.1007/s12529-021-10045-7. Epub ahead of print. PMID: 34918211; PMCID: PMC8675303. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8675303/ (Full text)

Cognitive sequelae of long COVID may not be permanent. A prospective study

Abstract:

Background and purpose: Cognitive decline is a recognized manifestation of long COVID, even among patients who experience mild disease. However, there is no evidence regarding the length of cognitive decline in these patients. This study aimed to assess whether COVID-19-related cognitive decline is a permanent deficit or if it improves over time.

Methods: Cognitive performance was evaluated by means of the Montreal Cognitive Assessment (MoCA) in COVID-19 survivors and noninfected individuals. All study participants had four cognitive evaluations, two of them before the pandemic and the other two, 6 and 18 months after the initial SARS-CoV-2 outbreak infection in the village. Linear mixed effects models for longitudinal data were fitted to assess differences in cognitive performance across COVID-19 survivors and noninfected individuals.

Results: The study included 78 participants, 50 with history of mild COVID-19 and 28 without. There was a significant-likely age-related-decline in MoCA scores between the two prepandemic tests (β = -1.53, 95% confidence interval [CI] = -2.14 to -0.92, p < 0.001), which did not differ across individuals who later developed COVID-19 when compared to noninfected individuals. Six months after infection, only COVID-19 survivors had a significant decline in MoCA scores (β = -1.37, 95% CI = -2.14 to -0.61, p < 0.001), which reversed after 1 additional year of follow-up (β = 0.66, 95% CI = -0.11 to 1.42, p = 0.092). No differences were noticed among noninfected individuals when both postpandemic MoCA scores were compared.

Conclusions: Study results suggest that long COVID-related cognitive decline may spontaneously improve over time.

Source: Del Brutto OH, Rumbea DA, Recalde BY, Mera RM. Cognitive sequelae of long COVID may not be permanent: A prospective study. Eur J Neurol. 2021 Dec 16. doi: 10.1111/ene.15215. Epub ahead of print. PMID: 34918425. https://pubmed.ncbi.nlm.nih.gov/34918425/

Symptoms and management of long COVID: A scoping review

Abstract:

Aim: This scoping review aims to describe published work on the symptoms and management of long COVID conditions.

Background: Symptoms and management of COVID-19 have focused on the acute stage. However, long-term consequences have also been observed.

Methods: A scoping review was performed based on the framework suggested by Arksey and O’Malley. We conducted a literature search to retrieve articles published from May 2020 to March 2021 in CINHAL, Cochrane library, Embase, PubMed and Web of science, including backward and forward citation tracking from the included articles. Among the 1880 articles retrieved, 34 articles met our criteria for review: 21 were related to symptom presentation and 13 to the management of long COVID.

Results: Long COVID symptoms were described in 21 articles. Following COVID-19 treatment, hospitalised patients most frequently reported dyspnoea, followed by anosmia/ageusia, fatigue and cough, while non-hospitalised patients commonly reported cough, followed by fever and myalgia/arthralgia. Thirteen studies described management for long COVID: Focused on a multidisciplinary approach in seven articles, pulmonary rehabilitation in three articles, fatigue management in two articles and psychological therapy in one study.

Conclusion: People experience varied COVID-19 symptoms after treatment. However, guidelines on evidence-based, multidisciplinary management for long COVID conditions are limited in the literature. The COVID-19 pandemic may extend due to virus mutations; therefore, it is crucial to develop and disseminate evidence-based, multidisciplinary management guidelines.

Relevance to clinical practice: A rehabilitation care plan and community healthcare plans are necessary for COVID-19 patients before discharge. Remote programmes could facilitate the monitoring and screening of people with long COVID.

Source: Chiyoung Cha PhD, RN,Gumhee Baek Master Candidate, RN. Symptoms and management of long COVID: A scoping review. First published: 15 December 2021. https://doi.org/10.1111/jocn.16150

Long covid: research must guide future management

Back in February 2021, the UK government announced that £18.5m is being invested into clinical research into long covid by UK Research and Innovation (UKRI).1 In light of public and medical concern about the long term effects of covid-19 infection, this is welcome.

In 1988, colleagues and I published an article in The BMJ called “Post viral fatigue: time for a new approach.”2 This was an attempt by young researchers to make the case that viewing the syndrome through a more unified mental-physical health lens and epidemiological orientation might counteract the increasingly polarised debate between patients with post-viral fatigue or myalgic encephalomyelitis (ME) and their doctors. We called for a clearer operational case definition, a biopsychosocial approach, and an end to emotive language all round. A generation later and our calls remain current.

Bodies including the National Institute for Health and Clinical Excellence (NICE), the Scottish Intercollegiate guidelines network (SIGN), the Royal College of General Practitioners (RCGP) and the Centres for Disease Control and Prevention (CDC) in the US have all attempted to operationally define persistent symptoms and disability after acute covid-19 illness.3 I think the term used by NICE—post-covid-19 syndrome—is a reasonable starting point. NICE’s definition includes the phrase “not attributable to alternative diagnoses.” This seems obvious, and yet is critical, as this should not be a catch-all category where any disorder with unexplained symptoms can be attached. For example, if a patient recovers from the acute respiratory illness, but remains short of breath and is found to have pulmonary fibrosis or pericarditis by accepted criteria, or, experiences brain fog and mental slowing, later linked to microvascular infarcts on MRI—can they be removed from the post-covid-19 cohort? I would say yes. Their condition may be unusual, and it may be serious, but it is not mysterious. These conditions add to the tally of morbidity caused by covid-19, but not to post-covid-19 syndrome. This, however, depends on patients getting access to the right assessments and investigations and there have been many calls from long covid patients to ensure that they have proper medical assessment of their symptoms.

We must not fall into the trap set by all “unexplained” symptoms: endless investigation by clinicians who then impart the “good news” that the test was normal. Because there is no accompanying positive explanation for the symptoms, this is perceived as implying, “it’s not real” or somehow worse, that “it’s all in your mind.” A devastating and embittering experience for many patients whose symptoms persist, and ultimately unhelpful in reaching a solution.

Read the rest of this article here: https://www.bmj.com/content/375/bmj.n3109

Source: Anthony S David. Long covid: research must guide future management. BMJ 2021;375:n3109. https://www.bmj.com/content/375/bmj.n3109

Symptoms and quality of life at 1-year follow up of patients discharged after an acute COVID-19 episode

Summary:

AIM OF THE STUDY: Patients surviving COVID-19 have been described as being at risk of developing sequelae. We aimed to investigate and elicit persistent symptoms, emotional status and quality-of-life in patients discharged after an acute COVID-19 episode.

METHODS: Patient-reported outcome measures were collected during a telephone interview 30 days and 1 year after discharge. Patients’ general health status was evaluated using questions based on their symptoms, emotional status was assessed using the items 9 to 12 of the HeartQoL questionnaire and quality of life was assessed at 1 year through the EQ-5D-5L. In patients with a history of cardiovascular disease, all 14 items of the HeartQoL questionnaire were completed to derive the HeartQoL global score.

RESULTS: Among 687 patients who survived after being hospitalised for COVID-19 at the University Hospitals of Geneva between 26 February and 26 April 2020, 184 (27%) and 165 (24%), respectively, participated in the follow-up at 30 days and 1 year. Of these 184 participants, 62% were male, median age was 58 years and 21% had a past medical history of cardiovascular disease. At one month after discharge, 61% (113/184) of patients presented fatigue and 28% (52/184) dyspnoea. One year after discharge, the main complaints were persistent fatigue in 27% (45/165) of patients, neurological problems in 17% (28/165) and dyspnoea in 14% (23/165). Eight percent (14/184) of patients declared being significantly worried 1 month after discharge and 5% (9/184) feeling depressed. The number of patients reporting being significantly worried or depressed at 1 year was lower. Regarding the quality of life at 1 year, the median EQ-5D-5L visual analogue scale score was 80 (interquartile range 70–90).

CONCLUSIONS: Approximately half of patients reported some symptoms 1 year after discharge following an acute episode of COVID-19. The predominant symptom was persistent fatigue both at 1-month and at 1-year follow-up. Emotional status and quality of life appeared satisfactory.

ClinicalTrials.gov number: NCT04384029

Source: Elena Tessitorea, Sandra Handgraafa, Antoine Poncetb, Maëlle Achardac, Stefan Höferd, Sebastian Carballoe, Christophe Martie, Cédric Follonierac, François Girardinfg, François Macha, David Carballoa. Symptoms and quality of life at 1-year follow up of patients discharged after an acute COVID-19 episode. Swiss Med Wkly. 2021;151:w30093. Publication Date: 13.12.2021. https://smw.ch/article/doi/smw.2021.w30093 (Full text)

Recovery From COVID-19 in Multiple Sclerosis: A Prospective and Longitudinal Cohort Study of the United Kingdom Multiple Sclerosis Register

Abstract:

Background and objectives: To understand the course of recovery from coronavirus disease 2019 (COVID-19) among patients with multiple sclerosis (MS) and to determine its predictors, including patients’ pre-COVID-19 physical and mental health status.

Methods: This prospective and longitudinal cohort study recruited patients with MS who reported COVID-19 from March 17, 2020, to March 19, 2021, as part of the United Kingdom MS Register (UKMSR) COVID-19 study. Participants used online questionnaires to regularly update their COVID-19 symptoms, recovery status, and duration of symptoms for those who fully recovered. Questionnaires were date stamped for estimation of COVID-19 symptom duration for those who had not recovered at their last follow-up. The UKMSR holds demographic and up-to-date clinical data on participants as well as their web-based Expanded Disability Status Scale (web-EDSS) and Hospital Anxiety and Depression Scale (HADS) scores. The association between these factors and recovery from COVID-19 was assessed using multivariable Cox regression analysis.

Results: Of the 7,977 patients with MS who participated in the UKMSR COVID-19 study, 599 reported COVID-19 and prospectively updated their recovery status. Twenty-eight hospitalized participants were excluded. At least 165 participants (29.7%) had long-standing COVID-19 symptoms for ≥4 weeks and 69 (12.4%) for ≥12 weeks. Participants with pre-COVID-19 web-EDSS scores ≥7, participants with probable anxiety and/or depression (HADS scores ≥11) before COVID-19 onset, and women were less likely to report recovery from COVID-19.

Discussion: Patients with MS are affected by postacute sequelae of COVID-19. Preexisting severe neurologic impairment or mental health problems appear to increase this risk. These findings can have implications in tailoring their post-COVID-19 rehabilitation.

Source: Garjani A, Middleton RM, Nicholas R, Evangelou N. Recovery From COVID-19 in Multiple Sclerosis: A Prospective and Longitudinal Cohort Study of the United Kingdom Multiple Sclerosis Register. Neurol Neuroimmunol Neuroinflamm. 2021 Nov 30;9(1):e1118. doi: 10.1212/NXI.0000000000001118. PMID: 34848503; PMCID: PMC8631790. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8631790/ (Full text)

Brain structure and function in people recovering from COVID-19 after hospital discharge or self-isolation: a longitudinal observational study protocol

Abstract:

Background: The detailed extent of neuroinvasion or deleterious brain changes resulting from COVID-19 and their time courses remain to be determined in relation to “long-haul” COVID-19 symptoms. Our objective is to determine whether there are alterations in functional brain imaging measures among people with COVID-19 after hospital discharge or self-isolation.

Methods: This paper describes a protocol for NeuroCOVID-19, a longitudinal observational study of adults aged 20-75 years at Sunnybrook Health Sciences Centre in Toronto, Ontario, that began in April 2020. We aim to recruit 240 adults, 60 per group: people who contracted COVID-19 and were admitted to hospital (group 1), people who contracted COVID-19 and self-isolated (group 2), people who experienced influenza-like symptoms at acute presentation but tested negative for COVID-19 and self-isolated (group 3, control) and healthy people (group 4, control). Participants are excluded based on premorbid neurologic or severe psychiatric illness, unstable cardiovascular disease, and magnetic resonance imaging (MRI) contraindications. Initial and 3-month follow-up assessments include multiparametric brain MRI and electroencephalography. Sensation and cognition are assessed alongside neuropsychiatric assessments and symptom self-reports. We will test the data from the initial and follow-up assessments for group differences based on 3 outcome measures: MRI cerebral blood flow, MRI resting state fractional amplitude of low-frequency fluctuation and electroencephalography spectral power.

Interpretation: If neurophysiologic alterations are detected in the COVID-19 groups in our NeuroCOVID-19 study, this information could inform future research regarding interventions for long-haul COVID-19. The study results will be disseminated to scientists, clinicians and COVID-19 survivors, as well as the public and private sectors to provide context on how brain measures relate to lingering symptoms.

Source: MacIntosh BJ, Ji X, Chen JJ, Gilboa A, Roudaia E, Sekuler AB, Gao F, Chad JA, Jegatheesan A, Masellis M, Goubran M, Rabin J, Lam B, Cheng I, Fowler R, Heyn C, Black SE, Graham SJ. Brain structure and function in people recovering from COVID-19 after hospital discharge or self-isolation: a longitudinal observational study protocol. CMAJ Open. 2021 Nov 30;9(4):E1114-E1119. doi: 10.9778/cmajo.20210023. PMID: 34848552; PMCID: PMC8648350. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8648350/ (Full text)

Post-COVID-19 syndrome: Something to think about

The disease caused by the new coronavirus detected in 2019 (COVID-19), which arose in the Asian continent and later spread worldwide, has generated more than 3.5 million deaths, in America, 1.6 million have been registered, and in Mexico, around 223,000 , in the latter, it is equivalent to 10% of the population that suffered from COVID-19.

With the above, we must take the next step and ask ourselves: do we have to worry about the 90% who survived the acute infection? The answer is yes. The symptoms caused by COVID-19 can continue more than 4 weeks after the onset of the disease and are known as a post-COVID-19 syndrome.

The syndrome has a persistent cough, dyspnea, chest pain, and fatigue, and it may be present in one-third of survivors regardless of the severity of the initial infection 1 . The cause has not yet been founded; however, we know that the transforming growth factor-beta is involved. This cytokine promotes cell repair through fibrosis, which may explain the persistence of the symptoms 2 . It can also present with neurological disorders characterized by post-traumatic stress syndrome, neuropathy, and critically ill myopathy, especially in patients who required invasive mechanical ventilation support in intensive care units and general care wards 3 .

Regarding treatment, there is nothing specific but general recommendations such as identifying the syndrome and documentation of the present symptoms, leaving as a cornerstone the follow-up of patients after hospital discharge without forgetting those who kept at home.

Who can follow up? It can be done by family or general practitioner, with interventions of a pulmonary rehabilitator, and last the pulmonologist and cardiologist if there is an exacerbation of the symptoms 4 . It should be noted that people who have post-COVID-19 syndrome are predisposed to develop depression, anxiety, and obsessive-compulsive disorder 5 . Therefore, the purposeful search and evaluation by psychology and psychiatry are essential.

Finally, the post-COVID-19 syndrome can be considered as a chronic disease, which generates the need to implement strategies that include continuing education for health personnel and, above all, the dissemination of information to the general public. It is probably not enough in the months to follow, but no strategy has better results than the one that does not start with a vision for the future since this will be a large percentage of the consultation in general for a long time.

Source: Moral OR. Post-COVID-19 syndrome: Something to think about. Cir Cir. 2021;89(6):848-849. English. doi: 10.24875/CIRU.21000510. PMID: 34851597. https://www.cirugiaycirujanos.com/frame_esp.php?id=593