Tag: long covid risk factors

Long COVID and its cardiovascular consequences: What is known?

Abstract:

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused high morbidity and mortality and has been a source of substantial challenges for healthcare systems globally. Despite a full recovery, a significant proportion of patients demonstrate a broad spectrum of cardiovascular, pulmonary and neurological symptoms that are believed to be caused by long-term tissue damage and pathological inflammation, which play a vital role in disease development. Microvascular dysfunction also causes significant health problems.

This review aimed to critically appraise the current data on the long-term cardiovascular sequelae of coronavirus disease 2019 (COVID-19), with a primary focus on cardiovascular symptoms such as chest pain, fatigue, palpitations, and breathlessness, and more significant disease entities including myocarditis, pericarditis and postural tachycardia syndrome. Potential risk factors identified in recent studies that contribute towards the development of long COVID are also included alongside a summary of recent advances in diagnostics and putative treatment options.

Source: Składanek JA, Leśkiewicz M, Gumiężna K, Baruś P, Piasecki A, Klimczak-Tomaniak D, Sygitowicz G, Kochman J, Grabowski M, Tomaniak M. Long COVID and its cardiovascular consequences: What is known? Adv Clin Exp Med. 2023 Jun 30. doi: 10.17219/acem/167482. Epub ahead of print. PMID: 37386857. https://advances.umw.edu.pl/en/ahead-of-print/167482/ (Full text)

Precision Medicine for More Oxygen (P4O2)—Study Design and First Results of the Long COVID-19 Extension

Abstract:

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has led to the death of almost 7 million people, however, with a cumulative incidence of 0.76 billion, most people survive COVID-19. Several studies indicate that the acute phase of COVID-19 may be followed by persistent symptoms including fatigue, dyspnea, headache, musculoskeletal symptoms, and pulmonary functional-and radiological abnormalities. However, the impact of COVID-19 on long-term health outcomes remains to be elucidated.
Aims: The Precision Medicine for more Oxygen (P4O2) consortium COVID-19 extension aims to identify long COVID patients that are at risk for developing chronic lung disease and furthermore, to identify treatable traits and innovative personalized therapeutic strategies for prevention and treatment. This study aims to describe the study design and first results of the P4O2 COVID-19 cohort.
Methods: The P4O2 COVID-19 study is a prospective multicenter cohort study that includes nested personalized counseling intervention trial. Patients, aged 40–65 years, were recruited from outpatient post-COVID clinics from five hospitals in The Netherlands. During study visits at 3–6 and 12–18 months post-COVID-19, data from medical records, pulmonary function tests, chest computed tomography scans and biological samples were collected and questionnaires were administered. Furthermore, exposome data was collected at the patient’s home and state-of-the-art imaging techniques as well as multi-omics analyses will be performed on collected data.
Results: 95 long COVID patients were enrolled between May 2021 and September 2022. The current study showed persistence of clinical symptoms and signs of pulmonary function test/radiological abnormalities in post-COVID patients at 3–6 months post-COVID. The most commonly reported symptoms included respiratory symptoms (78.9%), neurological symptoms (68.4%) and fatigue (67.4%). Female sex and infection with the Delta, compared with the Beta, SARS-CoV-2 variant were significantly associated with more persisting symptom categories.
Conclusions: The P4O2 COVID-19 study contributes to our understanding of the long-term health impacts of COVID-19. Furthermore, P4O2 COVID-19 can lead to the identification of different phenotypes of long COVID patients, for example those that are at risk for developing chronic lung disease. Understanding the mechanisms behind the different phenotypes and identifying these patients at an early stage can help to develop and optimize prevention and treatment strategies.
Source: Baalbaki N, Blankestijn JM, Abdel-Aziz MI, de Backer J, Bazdar S, Beekers I, Beijers RJHCG, van den Bergh JP, Bloemsma LD, Bogaard HJ, et al. Precision Medicine for More Oxygen (P4O2)—Study Design and First Results of the Long COVID-19 Extension. Journal of Personalized Medicine. 2023; 13(7):1060. https://doi.org/10.3390/jpm13071060 https://www.mdpi.com/2075-4426/13/7/1060 (Full text)

Trajectory of Post-COVID Self-Reported Fatigue and Dyspnoea in Individuals Who Had Been Hospitalized by COVID-19: The LONG-COVID-EXP Multicenter Study

Abstract:

Fatigue and dyspnoea are common post-COVID symptoms. The aim of this study was to apply Sankey plots and exponential bar plots for visualizing the evolution and trajectory of post-COVID fatigue and dyspnoea symptoms in a cohort of previously hospitalized COVID-19 survivors. A total of 1266 previously hospitalized patients due to COVID-19 participated in this multicentre study. They were assessed at hospital admission (T0), 8.4 months (T1), 13.2 months (T2) and 18.3 months (T3) after hospital discharge and were asked about the presence of self-reported fatigue or dyspnoea symptoms.
Fatigue was defined as a self-perceived feeling of constant tiredness and/or weakness whereas dyspnoea was defined as a self-perceived feeling of shortness of breath at rest. We specifically asked for fatigue and dyspnoea that participants attributed to the infection. Clinical/hospitalization data were collected from hospital medical records.
The prevalence of post-COVID fatigue was 56.94% (n = 721) at T1, 52.31% (n = 662) at T2 and 42.66% (n = 540) at T3. The prevalence of dyspnoea at rest decreased from 28.71% (n = 363) at hospital admission (T0), to 21.29% (n = 270) at T1, to 13.96% (n = 177) at T2 and 12.04% (n = 153) at T3. The Sankey plots revealed that 469 (37.08%) and 153 (12.04%) patients exhibited fatigue and dyspnoea at all follow-up periods.
The recovery exponential curves show a decreased prevalence trend, showing that fatigue and dyspnoea recover the following three years after hospitalization. The regression models revealed that the female sex and experiencing the symptoms (e.g., fatigue, dyspnoea) at T1 were factors associated with the presence of post-COVID fatigue or dyspnoea at T2 and T3.
The use of Sankey plots shows a fluctuating evolution of post-COVID fatigue and dyspnoea during the first two years after infection. In addition, exponential bar plots revealed a decreased prevalence of these symptoms during the first years after. The female sex is a risk factor for the development of post-COVID fatigue and dyspnoea.
Source:Fernández-de-las-Peñas C, Cancela-Cilleruelo I, Rodríguez-Jiménez J, Fuensalida-Novo S, Martín-Guerrero JD, Pellicer-Valero OJ, de-la-Llave-Rincón AI. Trajectory of Post-COVID Self-Reported Fatigue and Dyspnoea in Individuals Who Had Been Hospitalized by COVID-19: The LONG-COVID-EXP Multicenter Study. Biomedicines. 2023; 11(7):1863. https://doi.org/10.3390/biomedicines11071863 https://www.mdpi.com/2227-9059/11/7/1863 (Full text)

Long COVID and possible preventive options

Abstract:

Most of the people who suffered from COVID-19 fully recovered, but approximately 10–20% of them developed a wide variety of symptoms after they recover from their initial illness. Long COVID can develop at any patient; however, several studies suggest that the development of Long Covid syndrome may be linked to severity of acute illness.

Some of the risk factors are hospitalization (with mechanical ventilation), Intensive Care Unit admission, age (over 50 years), gender (female) and comorbidities. Since the precise mechanism of Long COVID has not been clarified, neither the management of Long COVID-19 syndrome has been solved yet.

Promising results have been published with vaccines as they effectively reduced the risk of Long COVID; however, other data suggest that vaccination results only partial protection in the post-acute phase of the disease. Recently, the orally effective antiviral agents (Paxlovid, molnupiravir) are preferred for outpatient management, and they highly reduce the progression of mild-to-moderate COVID-19 to severe one, and consequently, might reduce the development of Long COVID. Finally, recently, several clinical trials are in progress with either dietary supplements or drugs with different mechanisms of action.

Additional information on the precise mechanisms, risk factors of Long COVID may result in successful preventive and therapeutic management of Long Covid 19 syndrome.

Source: Sebők S, Gyires K. Long COVID and possible preventive options. Inflammopharmacology. 2023 Jun 21. doi: 10.1007/s10787-023-01204-1. Epub ahead of print. PMID: 37344737. https://link.springer.com/article/10.1007/s10787-023-01204-1 (Full text)

Mild COVID-19 infection associated with post-COVID-19 condition after 3 months – a questionnaire survey

Abstract:

Introduction: The coronavirus disease 2019 (COVID-19), caused by infection with SARS-CoV-2, can lead to post-COVID-19 condition, a secondary syndrome of persistent and new post-acute symptoms, but evidence on this syndrome is still scarce.

Methods: In a questionnaire survey, residents of the city of Bremen (Germany) with verified SARS-CoV-2 infection were invited to answer questions (online questionnaire or interview) concerning symptoms experienced at the time of infection and at the time of questionnaire completion at least three months later. Main outcome of the analysis was the presence of a post-COVID-19 condition at the time of the interview, defined as the presence of at least two of three leading symptoms: fatigue, breathing difficulties, or cognitive problems.

Results: A post-COVID-19 condition was more likely to be reported if respondents had, at the time of infection, suffered from fatigue (OR 1.75; 95% CI: 1.00, 3.06), breathing difficulties (OR 4.02; 95% CI: 2.80, 5.77), cognitive symptoms (OR 2.98; 95% CI: 1.48, 6.02), or head- & bone aches (OR 2.06; 95% CI: 1.25, 3.42). The odds of developing a post-COVID-19 condition increased with the number of symptoms at infection. Females were more likely to report a post-COVID-19 condition (OR 1.54; 95% CI: 1.05, 2.24). Analyzing only non-hospitalized respondents changed results only slightly.

Conclusion: Our study adds to growing evidence that even a mild course of COVID-19 poses a risk for developing a post-COVID-19 condition. Females and those with initial symptoms including fatigue, breathing difficulties, and cognitive symptoms seem more likely to also experience post COVID-19 symptoms several months after infection.

KEY MESSAGES

Even a mild course of COVID-19 poses a risk for developing a post-COVID-19 condition.

Females seem more likely to develop a post-COVID-19 condition.

Those with initial symptoms including fatigue, breathing difficulties, and cognitive symptoms seem more likely to develop a post-COVID-19 condition.

Source: Rach S, Kühne L, Zeeb H, Ahrens W, Haug U, Pohlabeln H. Mild COVID-19 infection associated with post-COVID-19 condition after 3 months – a questionnaire survey. Ann Med. 2023 Dec;55(1):2226907. doi: 10.1080/07853890.2023.2226907. PMID: 37337723; PMCID: PMC10283437. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10283437/ (Full text)

Acute and post-acute sequelae of SARS-CoV-2 infection: a review of risk factors and social determinants

Abstract:

SARS-CoV-2 infection leading to Coronavirus Disease 2019 (COVID-19) has caused more than 762 million infections worldwide, with 10-30% of patients suffering from post-acute sequelae of SARS-CoV-2 infections (PASC). Initially thought to primarily affect the respiratory system, it is now known that SARS-CoV-2 infection and PASC can cause dysfunction in multiple organs, both during the acute and chronic stages of infection.

There are also multiple risk factors that may predispose patients to worse outcomes from acute SARS-CoV-2 infection and contribute to PASC, including genetics, sex differences, age, reactivation of chronic viruses such as Epstein Barr Virus (EBV), gut microbiome dysbiosis, and behavioral and lifestyle factors, including patients’ diet, alcohol use, smoking, exercise, and sleep patterns.

In addition, there are important social determinants of health, such as race and ethnicity, barriers to health equity, differential cultural perspectives and biases that influence patients’ access to health services and disease outcomes from acute COVID-19 and PASC.

Here, we review risk factors in acute SARS-CoV-2 infection and PASC and highlight social determinants of health and their impact on patients affected with acute and chronic sequelae of COVID-19.

Source: Wang C, Ramasamy A, Verduzco-Gutierrez M, Brode WM, Melamed E. Acute and post-acute sequelae of SARS-CoV-2 infection: a review of risk factors and social determinants. Virol J. 2023 Jun 16;20(1):124. doi: 10.1186/s12985-023-02061-8. PMID: 37328773; PMCID: PMC10276420. https://virologyj.biomedcentral.com/articles/10.1186/s12985-023-02061-8 (Full text)

Pre-existing allergic diseases as risk factors for long-term Long-COVID symptoms: a systematic review of prospective cohort studies

Abstract:

Background: The role of allergy as risk factor for Long-COVID (LC) is unclear. We aimed to systematically review and appraise the epidemiological evidence on allergic diseases as risk factors for LC (PROSPERO: CRD42023391245).
Methods: We examined literature for prospective cohort studies with a follow-up duration of 12 months for LC symptoms, published within the timeframe from January 2020 and January 2023 that recruited individuals with confirmed SARS-CoV-2 infection and information on pre-existing allergic diseases. Risk of bias and certainty of evidence were assessed (GRADE). Random effects meta-analyses were used to pool unadjusted ORs within homogeneous data subsets.
Results: We identified 13 studies (participants range = 39 – 1,950), all of which were associated with high risk of bias. Four of these studies did not provide data to calculate ORs. Significant associations were observed between increased LC incidences and pre-existing asthma measured in hospital-based populations ( n = 6) and pre-existing rhinitis ( n = 3) ( OR = 1.94; 95% CI [1.08, 3.50]; OR = 1.96; 95% CI [1.61, 2.39]), respectively. However, the level of certainty regarding these exposure outcome associations was very low.
Conclusion: Findings show that allergies may increase the risk of LC, although the reliability of this evidence is tenuous.
Source: Doreen Wolff, Karl Philipp Drewitz, Angela Ulrich, et al. Pre-existing allergic diseases as risk factors for long-term Long-COVID symptoms: a systematic review of prospective cohort studies. Authorea. June 14, 2023. DOI: 10.22541/au.168670123.38714309/v1 https://d197for5662m48.cloudfront.net/documents/publicationstatus/141144/preprint_pdf/5f547b44a0ff27aa14957c16c0561b73.pdf (Full text)

Long COVID in the Long Run-23-Month Follow-up Study of Persistent Symptoms

Abstract:

Symptoms of long coronavirus disease (COVID) were found in 38% of 170 patients followed for a median of 22.6 months. The most prevalent symptoms were fatigue, affected taste and smell, and difficulties remembering and concentrating. Predictors for long COVID were older age and number of symptoms in the acute phase. Long COVID may take many months, maybe years, to resolve.

Source: Helmsdal G, Hanusson KD, Kristiansen MF, Foldbo BM, Danielsen ME, Steig BÁ, Gaini S, Strøm M, Weihe P, Petersen MS. Long COVID in the Long Run-23-Month Follow-up Study of Persistent Symptoms. Open Forum Infect Dis. 2022 Jun 6;9(7):ofac270. doi: 10.1093/ofid/ofac270. PMID: 35891696; PMCID: PMC9308378. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9308378/ (Full text)

Long COVID syndrome after SARS-CoV-2 survival in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

Abstract:

Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) patients have a more severe COVID-19 course than the general population. Many patients report different persistent symptoms after SARS-CoV-2 infection. The aim of our study is to analyze the prevalence of long COVID-19 symptoms and assess if COVID-19 affects pulmonary hypertension (PH) prognosis.

PAH/CTEPH patients who survived COVID-19 for at least 3 months before visiting the PH centers were included in the study. The patients were assessed for symptoms in acute phase of SARS-CoV-2 infection and persisting in follow-up visit, WHO functional class, 6-min walk distance, NT-proBNP concentration. The COMPERA 2.0 model was used to calculate 1-year risk of death due to PH at baseline and at follow-up. Sixty-nine patients-54 (77.3%) with PAH and 15 (21.7%) with CTEPH, 68% women, with a median age of 47.5 years (IQR 37-68)-were enrolled in the study.

About 17.1% of patients were hospitalized due to COVID-19 but none in an ICU. At follow-up (median: 155 days after onset of SARS-CoV-2 symptoms), 62% of patients reported at least 1 COVID-19-related symptom and 20% at least 5 symptoms. The most frequently reported symptoms were: fatigue (30%), joint pain (23%), muscle pain (17%), nasal congestion (17%), anosmia (13%), insomnia (13%), and dyspnea (12%).

Seventy-two percent of PH patients had a low or intermediate-low risk of 1-year death due to PH at baseline, and 68% after COVID-19 at follow-up. Over 60% of PAH/CTEPH patients who survived COVID-19 suffered from long COVID-19 syndrome, but the calculated 1-year risk of death due to PH did not change significantly after surviving mild or moderate COVID-19.

Source: Wieteska-Miłek M, Kuśmierczyk-Droszcz B, Betkier-Lipińska K, Szmit S, Florczyk M, Zieliński P, Hoffman P, Krzesińki P, Kurzyna M. Long COVID syndrome after SARS-CoV-2 survival in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Pulm Circ. 2023 May 31;13(2):e12244. doi: 10.1002/pul2.12244. PMID: 37266140; PMCID: PMC10232226. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10232226/ (Full text)

Long-COVID: A Chronic Fatigue Condition: Case Report

Abstract:

For the growing number of patients suffering from post-COVID-19 syndrome, there is little definitive guidance for treatment protocols or prognosis. Neurologic manifestations following acute COVID-19 infection are continually surfacing in the literature, with fatigue being the most common persistent symptom.

This case study follows a 44-year-old female experiencing debilitating fatigue and neurologic symptoms persisting after the resolution of an acute SARS-COV-2 infection. The complex medical history of this patient, including past Epstein-Barr Virus (EBV) infection and Myalgic Encephalomyelitis, commonly known as Chronic Fatigue Syndrome, suggests a potential predisposition for the development of neurologic long-COVID.

Through investigation of current research and treatment responses, this case report aims to gain an understanding of the complicated nature of this illness, and to propose treatments that address this specific subset of post-acute SARS-COV-2 sequelae.

Source: Lavelle , M., & Brusewitz , N. D. J. (2023). Long-COVID: A Chronic Fatigue Condition: Case Report. Journal of Complementary and Alternative Medical Research, 22(3), 1–7. https://doi.org/10.9734/jocamr/2023/v22i3457 http://stmlibrary.uk/id/eprint/2217/1/Lavelle2232023JOCAMR100443.pdf (Full text)