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Müller K, Poppele I, Ottiger M, Wastlhuber A, Weber RC, Stegbauer M, Schlesinger T. Long-term course and factors influencing work ability and return to work in post-COVID patients 12 months after inpatient rehabilitation. J Occup Med Toxicol 2024; 19:43. [PMID: 39487519 PMCID: PMC11529184 DOI: 10.1186/s12995-024-00443-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 10/21/2024] [Indexed: 11/04/2024] Open
Abstract
BACKGROUND Rehabilitation plays a crucial role in restoring work ability and facilitating the reintegration of post-COVID patients into the workforce. The impact of rehabilitation on work ability and return to work (RTW) of post-COVID patients remains poorly understood. This study was conducted to assess the work ability and RTW of post-COVID patients before rehabilitation and 12 months after rehabilitation and to identify physical and neuropsychological health factors influencing RTW 12 months after rehabilitation. METHODS This longitudinal observational study included 114 post-COVID patients with work-related SARS-CoV-2 infection who underwent inpatient post-COVID rehabilitation with indicative focus on pulmonology and/or psychotraumatology (interval between date of SARS-CoV-2 infection and start of rehabilitation: M = 412.90 days). Employment status, work ability, and the subjective prognosis of employment (SPE) scale were assessed before rehabilitation (T1) and 12 months after rehabilitation (T4). The predictors analysed at T4 were functional exercise capacity, physical activity, subjective physical and mental health status, fatigue, depression, and cognitive function. Longitudinal analyses were performed via the Wilcoxon signed-rank test. Logistic and linear regression analyses identified predictors of work ability and return to work (RTW), whereas mediation analyses examined the relationships between these predictors and work ability. RESULTS At T4, the median of WAI total score indicated poor work ability, which significantly worsened over time (p < 0.001; r = 0.484). The SPE scale significantly increased from T1 to T4 (p = 0.022, r = -0.216). A total of 48.6% of patients had returned to work 12 months after rehabilitation. Fatigue was identified as the main predictor of reduced work ability and RTW, with each unit increase in fatigue severity decreasing the odds of RTW by 3.1%. In addition, physical capacity and subjective health status were significant predictors of perceived work ability. CONCLUSIONS The findings highlight the significant challenges that post-COVID patients face in regaining work ability and achieving successful RTW 12 months after rehabilitation. Fatigue appears to be an important predictor of work ability and RTW. To optimize recovery and enhance both biopsychosocial health and work ability, it is crucial to develop and implement personalised interventions that address fatigue, improve physical capacity, and support mental health. TRIAL REGISTRATION This study is registered in the German Clinical Trials Register under DRKS00022928.
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Affiliation(s)
- Katrin Müller
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107, Chemnitz, Germany.
| | - Iris Poppele
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107, Chemnitz, Germany
| | - Marcel Ottiger
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107, Chemnitz, Germany
| | - Alois Wastlhuber
- BG Hospital for Occupational Disease Bad Reichenhall, 83435, Bad Reichenhall, Germany
| | | | - Michael Stegbauer
- BG Hospital for Occupational Disease Bad Reichenhall, 83435, Bad Reichenhall, Germany
| | - Torsten Schlesinger
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107, Chemnitz, Germany
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2
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Gogoll C, Peters E, Köllner V, Koczulla R. [S1 guideline long/post-COVID syndrome]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:1158-1161. [PMID: 38886205 DOI: 10.1007/s00120-024-02373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Christian Gogoll
- Ambulante Dienste, Ev. Lungenklinik Berlin, Berlin, Deutschland.
| | - Eva Peters
- Universitätsklinik Gießen und Marburg, Gießen und Marburg, Deutschland
- Schwerpunkt Psychoneuroimmunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Volker Köllner
- Forschungsgruppe Psychosomatische Rehabilitation & Rehazentrum Seehof der Deutschen Rentenversicherung mit aktuell Entwicklung eines kardiopsychosomatischen ambulanten Rehakonzeptes für Post-COVID Patienten, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Rembert Koczulla
- Schön Klinik Berchtesgadener Land, Forschungsinstitut für Pneumologische Rehabilitation, Philipps-Universität Marburg, Marburg, Deutschland
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3
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Mfouth Kemajou P, Besse-Hammer T, Lebouc C, Coppieters Y. Cluster analysis identifies long COVID subtypes in Belgian patients. Biol Methods Protoc 2024; 9:bpae076. [PMID: 39478809 PMCID: PMC11522879 DOI: 10.1093/biomethods/bpae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 09/23/2024] [Accepted: 10/07/2024] [Indexed: 11/02/2024] Open
Abstract
Severe acute respiratory syndrome coronavirus infection presents complications known as long COVID, a multisystemic organ disease which allows multidimensional analysis. This study aims to uncover clusters of long COVID cases and establish their correlation with the clinical classification developed at the Clinical Research Unit of Brugmann University Hospital, Brussels. Such an endeavour is instrumental in customizing patient management strategies tailored to the unique needs of each distinct group. A two-stage multidimensional exploratory analysis was performed on a retrospective cohort of 205 long COVID patients, involving a factorial analysis of mixed data, and then hierarchical clustering post component analysis. The study's sample comprised 76% women, with an average age of 44.5 years. Three clinical forms were identified: long, persistent, and post-viral syndrome. Multidimensional analysis using demographic, clinical, and biological variables identified three clusters of patients. Biological data did not provide sufficient differentiation between clusters. This emphasizes the importance of identifying or classifying long COVID patients according to their predominant clinical syndrome. Long COVID phenotypes, as well as clinical forms, appear to be associated with distinct pathophysiological mechanisms or genetic predispositions. This underscores the need for further research.
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Affiliation(s)
- Pamela Mfouth Kemajou
- School of Public Health, Centre for Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles (ULB), B-1070 Brussels, Belgium
| | - Tatiana Besse-Hammer
- Department of Internal Medicine, Faculty of Medicine, Universite Libre de Bruxelles (ULB), B-1070, Brussels, Belgium
- Clinical Research Unit, Centre Hospitalier Universitaire Brugmann, 1020, Brussels, Belgium
| | - Claire Lebouc
- Clinical Research Unit, Centre Hospitalier Universitaire Brugmann, 1020, Brussels, Belgium
| | - Yves Coppieters
- School of Public Health, Centre for Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles (ULB), B-1070 Brussels, Belgium
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4
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Appel KS, Nürnberger C, Bahmer T, Förster C, Polidori MC, Kohls M, Kraus T, Hettich-Damm N, Petersen J, Blaschke S, Bröhl I, Butzmann J, Dashti H, Deckert J, Dreher M, Fiedler K, Finke C, Geisler R, Hanses F, Hopff SM, Jensen BEO, Konik M, Lehnert K, de Miranda SMN, Mitrov L, Miljukov O, Reese JP, Rohde G, Scherer M, Tausche K, Tebbe JJ, Vehreschild JJ, Voit F, Wagner P, Weigl M, Lemhöfer C. Definition of the Post-COVID syndrome using a symptom-based Post-COVID score in a prospective, multi-center, cross-sectoral cohort of the German National Pandemic Cohort Network (NAPKON). Infection 2024; 52:1813-1829. [PMID: 38587752 PMCID: PMC11499320 DOI: 10.1007/s15010-024-02226-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The objective examination of the Post-COVID syndrome (PCS) remains difficult due to heterogeneous definitions and clinical phenotypes. The aim of the study was to verify the functionality and correlates of a recently developed PCS score. METHODS The PCS score was applied to the prospective, multi-center cross-sectoral cohort (in- and outpatients with SARS-CoV-2 infection) of the "National Pandemic Cohort Network (NAPKON, Germany)". Symptom assessment and patient-reported outcome measure questionnaires were analyzed at 3 and 12 months (3/12MFU) after diagnosis. Scores indicative of PCS severity were compared and correlated to demographic and clinical characteristics as well as quality of life (QoL, EQ-5D-5L). RESULTS Six hundred three patients (mean 54.0 years, 60.6% male, 82.0% hospitalized) were included. Among those, 35.7% (215) had no and 64.3% (388) had mild, moderate, or severe PCS. PCS severity groups differed considering sex and pre-existing respiratory diseases. 3MFU PCS worsened with clinical severity of acute infection (p = .011), and number of comorbidities (p = .004). PCS severity was associated with poor QoL at the 3MFU and 12MFU (p < .001). CONCLUSION The PCS score correlated with patients' QoL and demonstrated to be instructive for clinical characterization and stratification across health care settings. Further studies should critically address the high prevalence, clinical relevance, and the role of comorbidities. TRAIL REGISTRATION NUMBER The cohort is registered at www. CLINICALTRIALS gov under NCT04768998.
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Affiliation(s)
- Katharina S Appel
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Carolin Nürnberger
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Christian Förster
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Maria Cristina Polidori
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Mirjam Kohls
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Tanja Kraus
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Nora Hettich-Damm
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Julia Petersen
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Sabine Blaschke
- Emergency Department, University Medical Center Göttingen, Göttingen, Germany
| | - Isabel Bröhl
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jana Butzmann
- Medical Faculty, Institute of Medical Microbiology and Hospital Hygiene, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Hiwa Dashti
- Practice for General Medicine Dashti, Eberswalde, Germany
| | - Jürgen Deckert
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Karin Fiedler
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Carsten Finke
- Department of Neurology, Charité Berlin, Berlin, Germany
| | - Ramsia Geisler
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Frank Hanses
- Emergency Department and Department for Infection Control an Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Sina M Hopff
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Björn-Erik O Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Margarethe Konik
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Kristin Lehnert
- DZHK (German Center for Cardiovascular Research), University Medicine Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Susana M Nunes de Miranda
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Lazar Mitrov
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Olga Miljukov
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Jens-Peter Reese
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine, Goethe University Frankfurt, University Hospital, Medical Clinic I, Frankfurt/Main, Germany
| | - Margarete Scherer
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Kristin Tausche
- Department of Internal Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Johannes J Tebbe
- Department of Gastroenterology and Infectious Diseases, Klinikum Lippe, Lippe, Germany
| | - Jörg Janne Vehreschild
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Florian Voit
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Patricia Wagner
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin Weigl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
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5
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Holland J, Sheehan D, Brown S, O'Flanagan S, Savenelli S, O'Keeffe F, Bramham J. Immune response and cognitive impairment in Post-COVID Syndrome: A systematic review. Am J Med 2024:S0002-9343(24)00613-2. [PMID: 39362575 DOI: 10.1016/j.amjmed.2024.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 07/23/2024] [Accepted: 09/16/2024] [Indexed: 10/05/2024]
Abstract
BACKGROUND Altered immune response and cognitive difficulties have been demonstrated in studies of post-COVID syndrome, including differences in immune status and cognitive functioning in the months following infection. This review aimed to examine immune status and cognitive differences in post-COVID Syndrome twelve or more weeks after COVID-19 infection. A further aim of this review was to explore a link between immune response and the cognitive deficits observed in this group. METHODS A systematic review was carried out of PubMed, PsychInfo, EMBASE and Web of Science electronic databases of observational studies 12+ weeks after COVID-19 infection, with assessment of immune status and cognitive function in post-COVID Syndrome samples. This review protocol was recorded on PROSPERO with registration number CRD42022366920. RESULTS Following eligibility screening, eleven studies met inclusion criteria and were selected for our review. Six of eight studies which examined between group differences in specific domains suggested impaired cognition in the Post COVID Syndrome population, with the domains of executive function particularly affected. Of the eleven studies with immune data, nine studies reported increased markers of inflammation in the Post COVID Syndrome group, when compared to an age and gender matched "healthy control" sample, or population norms. Finally, when immune function and cognition are examined together, six studies presented results indicating a significant association between elevated immune response and cognitive function. CONCLUSION This review highlights the frequency of cognitive difficulties months after COVID-19 infection and explores heighted immune response as a predictor of this change. Six studies suggest that immune status is a predictor of cognitive function, examining a marker of immune function and objective cognitive performance at 12 or more weeks following infection. Future studies of cognitive function in Post COVID Syndrome are needed to explore this relationship, and underlying mechanisms leading to changes in cognitive performance.
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Affiliation(s)
| | | | | | | | | | - Fiadhnait O'Keeffe
- Department of Psychology, St Vincent's University Hospital; University College Dublin
| | - Jessica Bramham
- Department of Psychology, St Vincent's University Hospital; University College Dublin
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6
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Archambault PM, Rosychuk RJ, Audet M, Hau JP, Graves L, Décary S, Perry JJ, Brooks SC, Morrison LJ, Daoust R, Yeom DS, Wiemer H, Fok PT, McRae AD, Chandra K, Kho ME, Stacey D, Vissandjée B, Menear M, Mercier E, Vaillancourt S, Aziz S, Zakaria D, Davis P, Dainty KN, Paquette JS, Leeies M, Goulding S, Berger Pelletier E, Hohl CM. Post-COVID-19 condition symptoms among emergency department patients tested for SARS-CoV-2 infection. Nat Commun 2024; 15:8449. [PMID: 39349926 PMCID: PMC11442466 DOI: 10.1038/s41467-024-52404-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 09/05/2024] [Indexed: 10/04/2024] Open
Abstract
Symptoms of the Post-COVID-19 Condition are often non-specific making it a challenge to distinguish them from symptoms due to other medical conditions. In this study, we compare the proportion of emergency department patients who developed symptoms consistent with the World Health Organization's Post-COVID-19 Condition clinical case definition between those who tested positive for Severe Acute Respiratory Syndrome Coronavirus-2 infection and time-matched patients who tested negative. Our results show that over one-third of emergency department patients with a proven acute infection meet Post-COVID-19 Condition criteria 3 months post-index visit. However, one in five test-negative patients who claim never having been infected also report symptoms consistent with Post-COVID-19 Condition highlighting the lack of specificity of the clinical case definition. Testing for SARS-CoV-2 during the acute phase of a suspected infection should continue until specific biomarkers of Post-COVID-19 Condition become available for diagnosis and treatment.
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Affiliation(s)
- Patrick M Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada.
- Centre de recherche intégrée pour un système de santé apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada.
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada.
| | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Martyne Audet
- Centre de recherche intégrée pour un système de santé apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Jeffrey P Hau
- Department of Emergency Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Lorraine Graves
- Patient Engagement Committee, Canadian COVID-19 Emergency Department Rapid Response Network, The University of British Columbia, Vancouver, BC, Canada
| | - Simon Décary
- École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Steven C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Laurie J Morrison
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Raoul Daoust
- Département de médecine de famille et de médecine d'urgence, Université de Montréal, Montréal, QC, Canada
- Département de médecine d'urgence, Hôpital du Sacré-Cœur-de-Montréal, Montréal, QC, Canada
| | - David Seonguk Yeom
- Department of Emergency Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Hana Wiemer
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Patrick T Fok
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Andrew D McRae
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kavish Chandra
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- The Research Institute of St. Joe's Hamilton, Hamilton, ON, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | | | - Matthew Menear
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
| | - Eric Mercier
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine d'urgence, Hôpital de l'Enfant-Jésus, Québec, QC, Canada
| | - Samuel Vaillancourt
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Samina Aziz
- Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Dianne Zakaria
- Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Phil Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Katie N Dainty
- North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Susie Goulding
- Patient Engagement Committee, Canadian COVID-19 Emergency Department Rapid Response Network, The University of British Columbia, Vancouver, BC, Canada
- COVID Long-Haulers Support Group Canada, Oakville, ON, Canada
| | - Elyse Berger Pelletier
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, The University of British Columbia, Vancouver, BC, Canada
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7
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Wood MS, Halmer N, Bertolli J, Amsden LB, Nugent JR, Lin JMS, Rothrock G, Nadle J, Chai SJ, Cope JR, Champsi JH, Yang J, Unger ER, Skarbinski J. Impact of COVID-19 on myalgic encephalomyelitis/chronic fatigue syndrome-like illness prevalence: A cross-sectional survey. PLoS One 2024; 19:e0309810. [PMID: 39292671 PMCID: PMC11410243 DOI: 10.1371/journal.pone.0309810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/20/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) can be triggered by infectious agents including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the impact of the coronavirus disease 2019 (COVID-19) pandemic on ME/CFS prevalence is not well characterized. METHODS In this population-based cross-sectional study, we enrolled a stratified random sample of 9,825 adult participants in the Kaiser Permanente Northern California (KPNC) integrated health system from July to October 2022 to assess overall ME/CFS-like illness prevalence and the proportion that were identified following COVID-19 illness. We used medical record and survey data to estimate the prevalence of ME/CFS-like illness based on self-reported symptoms congruent with the 2015 Institute of Medicine ME/CFS criteria. History of COVID-19 was based on a positive SARS-CoV-2 nucleic acid amplification test or ICD-10 diagnosis code in the medical record, or self-report of prior COVID-19 on a survey. RESULTS Of 2,745,374 adults in the eligible population, an estimated 45,892 (95% confidence interval [CI]: 32,869, 58,914) or 1.67% (CI 1.20%, 2.15%) had ME/CFS-like illness. Among those with ME/CFS-like illness, an estimated 14.12% (CI 3.64%, 24.6%) developed the illness after COVID-19. Among persons who had COVID-19, those with ME/CFS-like illness after COVID-19 were more likely to be unvaccinated and to have had COVID-19 before June 1, 2021. All persons with ME/CFS-like illness had significant impairment in physical, mental, emotional, social, and occupational functioning compared to persons without ME/CFS-like illness. CONCLUSIONS In a large, integrated health system, 1.67% of adults had ME/CFS-like illness and 14.12% of all persons with ME/CFS-like illness developed it after COVID-19. Though COVID-19 did not substantially increase ME/CFS-like illness in the KPNC population during the study time period, ME/CFS-like illness nevertheless affects a notable portion of this population and is consistent with estimates of ME/CFS prevalence in other populations. Additional attention is needed to improve awareness, diagnosis, and treatment of ME/CFS.
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Affiliation(s)
- Mariah S Wood
- Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, United States of America
| | - Nicole Halmer
- Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, United States of America
| | - Jeanne Bertolli
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Laura B Amsden
- Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, United States of America
| | - Joshua R Nugent
- Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, United States of America
| | - Jin-Mann S Lin
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Gretchen Rothrock
- California Emerging Infections Program, Oakland, CA, United States of America
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, CA, United States of America
| | - Shua J Chai
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- California Emerging Infections Program, Oakland, CA, United States of America
| | - Jennifer R Cope
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Jamila H Champsi
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, United States of America
- Department of Infectious Diseases, South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco, CA, United States of America
| | - James Yang
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, United States of America
- Department of Adult and Family Medicine, Roseville Riverside Medical Offices, Kaiser Permanente Northern California, Roseville, CA, United States of America
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, United States of America
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, United States of America
- Department of Infectious Diseases, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA, United States of America
- Physician Researcher Program, Kaiser Permanente Northern California, Oakland, CA, United States of America
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8
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Koller K, Kastel-Hoffmann S, Herold R, Morawa E, Lieb M, Krehbiel J, Hohberger B, Erim Y. A prospective non-randomized controlled trial testing the effectiveness of psychotherapeutic inpatient treatment of Post-COVID-19 syndrome - study protocol. BMC Psychol 2024; 12:486. [PMID: 39285491 PMCID: PMC11404027 DOI: 10.1186/s40359-024-01974-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 08/29/2024] [Indexed: 09/22/2024] Open
Abstract
INTRODUCTION In addition to physical symptoms such as dyspnea, fatigue, post-exertional malaise, and pain, a subgroup of patients with Post-COVID-19 syndrome (Post-Acute Sequelae of COVID-19, PASC) suffers from mental illnesses such as anxiety, depression, and neurocognitive impairments. To date, there are no causal treatments available for PASC. While initial studies show that psychotherapy improves psychological symptoms, PASC-related fatigue, and psychosocial functioning, further research is needed to evaluate the effectiveness of psychotherapeutic treatment for PASC. METHODS AND ANALYSIS This study presents a non-randomized controlled trial aimed at evaluating the effectiveness of a five-week multimodal inpatient psychosomatic treatment program for individuals experiencing PASC symptoms and comorbid mental illness. A total of 118 patients presented at the Post-COVID Center at the Universitätsklinikum Erlangen will be assigned to the intervention group receiving inpatient psychosomatic treatment or the control group receiving treatment as usual. The inclusion criteria for the intervention group are a diagnosis of PASC and at least one condition of mental distress and problems with coping with illness. The primary objective of the intervention is to reduce mental ailments, including depression and anxiety, as well as neurocognitive deficits, and to address PASC symptoms such as fatigue and pain. The core elements of the treatment are psychotherapy in individual and group settings, medical treatment, neurocognitive training, and physical therapy, adapted to the individual's capacity and oriented towards the concept of pacing. After enrollment, participants will undergo a 6-month follow-up to assess long-term results and the sustainability of the intervention effects. DISCUSSION This study examines the effectiveness of inpatient psychotherapeutic treatment in PASC patients with comorbid mental illness in comparison with a control group based on treatment as usual. The results of the study can contribute to the development of evidence-based interventions to address the complex needs of patients with PASC and comorbid mental illness. TRIAL REGISTRATION German Clinical Trial Register (DRKS), retrospectively registered 15.02.2024 DRKSID DRKS00033562.
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Affiliation(s)
- Katharina Koller
- Department of Psychosomatic Medicine and Psychotherapy, Universitätsklinikum Erlangen, Friedrich- Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
- Post-COVID Center, Universitätsklinikum Erlangen, Erlangen, Germany.
| | - Silke Kastel-Hoffmann
- Department of Psychosomatic Medicine and Psychotherapy, Universitätsklinikum Erlangen, Friedrich- Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Post-COVID Center, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Regina Herold
- Department of Psychosomatic Medicine and Psychotherapy, Universitätsklinikum Erlangen, Friedrich- Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Post-COVID Center, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, Universitätsklinikum Erlangen, Friedrich- Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Post-COVID Center, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Marietta Lieb
- Department of Psychosomatic Medicine and Psychotherapy, Universitätsklinikum Erlangen, Friedrich- Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Post-COVID Center, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Johannes Krehbiel
- Department of Psychosomatic Medicine and Psychotherapy, Universitätsklinikum Erlangen, Friedrich- Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Post-COVID Center, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Bettina Hohberger
- Department of Ophthalmology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, Universitätsklinikum Erlangen, Friedrich- Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Post-COVID Center, Universitätsklinikum Erlangen, Erlangen, Germany
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9
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Yoon CS, Park HK, Lee JK, Kho BG, Kim TO, Shin HJ, Kwon YS, Lim SC, Kim YI. Corticosteroid Therapy Duration and Dosage According to the Timing of Treatment Initiation for Post-COVID-19 Organizing Pneumonia. Chonnam Med J 2024; 60:166-173. [PMID: 39381118 PMCID: PMC11458313 DOI: 10.4068/cmj.2024.60.3.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 08/12/2024] [Accepted: 09/03/2024] [Indexed: 10/10/2024] Open
Abstract
COVID-19 can lead to pulmonary complications, including organizing pneumonia. Steroids are essential in treating post-COVID-19 organizing pneumonia. However, research on the clinical benefits of initiating steroid treatment early for this condition is limited. To investigate the steroid initiation time in its association with treatment duration and corticosteroid dose for treating post-COVID-19 organizing pneumonia, we analyzed the data of 91 patients with post-COVID-19 organizing pneumonia at Chonnam National University Hospital between October 2020 and December 2022. Patients were categorized into early and late groups based on time from COVID-19 diagnosis to steroid initiation time for organizing pneumonia. The mean time interval between COVID-19 infection and steroid initiation time for treating organizing pneumonia, was 18.4±8.6 days. Within the early treatment group (treatment initiated <18.4 days after COVID-19), which included 55 patients, the mean duration of steroid treatment was 43.1±18.3days. In contrast, the late treatment group (initiated ≥18.4 days after COVID-19), which consisted of 36 patients, had a longer mean duration of steroid treatment 59.1±22.6 days) (p<0.01). Regarding corticosteroid dosing, the early treatment group had an average dosage of 0.5±0.3 mg/kg/day, in contrast to the late group, which averaged 0.8±0.3 mg/kg/day (p<0.01). Regression analysis showed steroid initiation time significantly influenced treatment duration (β=0.80 , p<0.01) and dosage (β=0.03, p<0.01). The clinical benefits of early steroid treatment for post-COVID-19 organizing pneumonia may lie in its association with reduced steroid treatment duration and dosage.
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Affiliation(s)
- Chang-Seok Yoon
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hwa-Kyung Park
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jae-Kyeong Lee
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Bo-Gun Kho
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Tae-Ok Kim
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hong-Joon Shin
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Soo Kwon
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Chul Lim
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yu-Il Kim
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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10
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Evering TH, Moser C, Jilg N, Ritz J, Wohl DA, Li JZ, Margolis D, Javan AC, Eron JJ, Currier JS, Daar ES, Smith DM, Hughes MD, Chew KW. Post-acute COVID-19 outcomes including participant-reported long COVID: amubarvimab/romlusevimab versus placebo in the ACTIV-2 trial. EClinicalMedicine 2024; 75:102787. [PMID: 39252866 PMCID: PMC11381616 DOI: 10.1016/j.eclinm.2024.102787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 09/11/2024] Open
Abstract
Background It is unknown if early COVID-19 monoclonal antibody (mAb) therapy can reduce risk of Long COVID. The mAbs amubarvimab/romlusevimab were previously demonstrated to reduce risk of hospitalization/death by 79%. This study assessed the impact of amubarvimab/romlusevimab on late outcomes, including Long COVID. Methods Non-hospitalized high-risk adults within 10 days of COVID-19 symptom onset enrolled in a randomized, double-blind, placebo-controlled phase 2/3 trial of amubarvimab/romlusevimab for COVID-19 treatment. Late symptoms, assessed using a participant-completed symptom diary, were a pre-specified exploratory endpoint. The primary outcome for this analysis was the composite of Long COVID by participant self-report (presence of COVID-19 symptoms as recorded in the diary at week 36) or hospitalization or death by week 36. Inverse probability weighting (IPW) was used to address incomplete outcome ascertainment, giving weighted risk ratios (wRR) comparing amubarvimab/romlusevimab to placebo. Findings Participants received amubarvimab/romlusevimab (n = 390) or placebo (n = 390) between January and July 2021. Median age was 49 years, 52% were female, 18% Black/African American, 49% Hispanic/Latino, and 9% COVID-19-vaccinated at entry. At week 36, 103 (13%) had incomplete outcome ascertainment, and 66 (17%) on amubarvimab/romlusevimab and 92 (24%) on placebo met the primary outcome (wRR = 0.70, 95% confidence interval (CI) 0.53-0.93). The difference was driven by fewer hospitalizations/deaths with amubarvimab/romlusevimab (4%) than placebo (13%). Among 652 participants with available diary responses, 53 (16%) on amubarvimab/romlusevimab and 44 (14%) on placebo reported presence of Long COVID. Interpretation Amubarvimab/romlusevimab treatment, while highly effective in preventing hospitalizations/deaths, did not reduce risk of Long COVID. Additional interventions are needed to prevent Long COVID. Funding National Institute of Allergy and Infectious Diseases of the National Institutes of Health. Amubarvimab and romlusevimab supplied by Brii Biosciences.
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Affiliation(s)
| | - Carlee Moser
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nikolaus Jilg
- Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justin Ritz
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Jonathan Z. Li
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Eric S. Daar
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | | | - Kara W. Chew
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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11
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Kratzer B, Gattinger P, Trapin D, Ettel P, Körmöczi U, Rottal A, Stieger RB, Sehgal ANA, Feichter M, Borochova K, Tulaeva I, Grabmeier-Pfistershammer K, Tauber PA, Perkmann T, Fae I, Wenda S, Kundi M, Fischer GF, Valenta R, Pickl WF. Differential decline of SARS-CoV-2-specific antibody levels, innate and adaptive immune cells, and shift of Th1/inflammatory to Th2 serum cytokine levels long after first COVID-19. Allergy 2024; 79:2482-2501. [PMID: 39003594 DOI: 10.1111/all.16210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND SARS-CoV-2 has triggered a pandemic and contributes to long-lasting morbidity. Several studies have investigated immediate cellular and humoral immune responses during acute infection. However, little is known about long-term effects of COVID-19 on the immune system. METHODS We performed a longitudinal investigation of cellular and humoral immune parameters in 106 non-vaccinated subjects ten weeks (10 w) and ten months (10 m) after their first SARS-CoV-2 infection. Peripheral blood immune cells were analyzed by multiparametric flow cytometry, serum cytokines were examined by multiplex technology. Antibodies specific for the Spike protein (S), the receptor-binding domain (RBD) and the nucleocapsid protein (NC) were determined. All parameters measured 10 w and 10 m after infection were compared with those of a matched, noninfected control group (n = 98). RESULTS Whole blood flow cytometric analyses revealed that 10 m after COVID-19, convalescent patients compared to controls had reduced absolute granulocyte, monocyte, and lymphocyte counts, involving T, B, and NK cells, in particular CD3+CD45RA+CD62L+CD31+ recent thymic emigrant T cells and non-class-switched CD19+IgD+CD27+ memory B cells. Cellular changes were associated with a reversal from Th1- to Th2-dominated serum cytokine patterns. Strong declines of NC- and S-specific antibody levels were associated with younger age (by 10.3 years, p < .01) and fewer CD3-CD56+ NK and CD19+CD27+ B memory cells. Changes of T-cell subsets at 10 m such as normalization of effector and Treg numbers, decline of RTE, and increase of central memory T cell numbers were independent of antibody decline pattern. CONCLUSIONS COVID-19 causes long-term reduction of innate and adaptive immune cells which is associated with a Th2 serum cytokine profile. This may provide an immunological mechanism for long-term sequelae after COVID-19.
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Affiliation(s)
- Bernhard Kratzer
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria
| | - Pia Gattinger
- Center for Pathophysiology, Infectiology and Immunology, Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Doris Trapin
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria
| | - Paul Ettel
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria
| | - Ulrike Körmöczi
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria
| | - Arno Rottal
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria
| | - Robert B Stieger
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria
| | - Al Nasar Ahmed Sehgal
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria
| | - Melanie Feichter
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria
| | - Kristina Borochova
- Center for Pathophysiology, Infectiology and Immunology, Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Inna Tulaeva
- Center for Pathophysiology, Infectiology and Immunology, Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
- Laboratory for Immunopathology, Department of Clinical Immunology and Allergology, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Peter A Tauber
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria
| | - Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Ingrid Fae
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria
| | - Sabine Wenda
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Kundi
- Center for Public Health, Department for Environmental Health, Medical University of Vienna, Vienna, Austria
| | - Gottfried F Fischer
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria
| | - Rudolf Valenta
- Center for Pathophysiology, Infectiology and Immunology, Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
- Laboratory for Immunopathology, Department of Clinical Immunology and Allergology, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Winfried F Pickl
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
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12
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Tacchini-Jacquier N, Monnay S, Coquoz N, Bonvin E, Verloo H. Patient-Reported Experiences of Persistent Post-COVID-19 Conditions After Hospital Discharge During the Second and Third Waves of the Pandemic in Switzerland: Cross-Sectional Questionnaire Study. JMIR Public Health Surveill 2024; 10:e47465. [PMID: 39197160 PMCID: PMC11391158 DOI: 10.2196/47465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/08/2023] [Accepted: 05/23/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Hospitalized patients infected with SARS-CoV-2 should recover within a few weeks. However, even those with mild versions can experience symptoms lasting 4 weeks or longer. These post-COVID-19 condition (PCC) comprise various new, returning, or ongoing symptoms that can last for months or years and cause disability. Few studies have investigated PCC using self-reports from discharged patients infected with SARS-CoV-2 to complement clinical and biomarker studies. OBJECTIVE This study aimed to investigate self-reported, persistent PCC among patients infected with SARS-CoV-2 who were discharged during the second and third waves of the COVID-19 pandemic. METHODS We designed, pretested, and posted an ad hoc paper questionnaire to all eligible inpatients discharged between October 2020 and April 2021. At 4 months post discharge, we collected data on PCC and scores for the Multidimensional Fatigue Inventory (MFI), the Patient Health Questionnaire-4 (PHQ-4), a Brief Memory Screening Scale (Q3PC), and a posttraumatic stress disorder scale (PCL-5). Descriptive, inferential, and multivariate linear regression statistics assessed PCC symptomatology, associations, and differences regarding sociodemographic characteristics and hospital length of stay (LOS). We examined whether our variables of interest significantly predicted MFI scores. RESULTS Of the 1993 valid questionnaires returned, 245 were from discharged patients with SARS-CoV-2 (median age 71, IQR 62.7-77 years). Only 28.2% (69/245) of respondents were symptom-free after 4 months. Women had significantly more persistent PCC symptoms than men (P≤.001). Patients with a hospital LOS ≥11 days had more PCC symptoms as well (P<.001)-women had more symptoms and longer LOS. No significant differences were found between age groups (18-64, 65-74, and ≥75 years old; P=.50) or between intensive care units and other hospitalization units (P=.09). Patients self-reported significantly higher PHQ-4 scores during their hospitalization than at 4 months later (P<.001). Three-fourth (187/245, 76.4%) of the respondents reported memory loss and concentration disorders (Q3PC). No significant differences in the median MFI score (56, IQR 1-3, range 50-60]) were associated with sociodemographic variables. Patients with a hospital LOS of ≥11 days had a significantly higher median PCL-5 score (P<.001). Multivariate linear regression allowed us to calculate that the combination of PHQ-4, Q3PC, and PCL-5 scores, adjusted for age, sex, and LOS (of either ≥11 days [median 2 symptoms, IQR 1-5] or <11 days), did not significantly predict MFI scores (R2=0.09; F4,7 =1.5; P=.22; adjusted R2=0.06). CONCLUSIONS The majority of inpatients infected with SARS-CoV-2 presented with PCC 4 months after discharge, with complex clinical pictures. Only one-third of them were symptom-free during that time. Based on our findings, MFI scores were not directly related to self-reported depression, anxiety, or posttraumatic scores adjusted for age, sex, or LOS. Further research is needed to explore PCC and fatigue based on self-reported health experiences of discharged inpatients infected with SARS-CoV-2.
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Affiliation(s)
| | - Sévrine Monnay
- Social Affairs and Human Resources, Valais Hospitals, Sion, Switzerland
| | | | - Eric Bonvin
- General Direction, Valais Hospitals, Sion, Switzerland
| | - Henk Verloo
- Department of Nursing, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Sion, Switzerland
- Valais Hospitals, Sion, Switzerland
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13
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Baba K, Kawai S, Iwase S, Ushida T, Tamura Y, Arimoto M, Nojiri M, Watanabe D, Ban N. Symptoms, Course, and Factors Related to Long-Term Morbidity, Including Differences between Infection Strains, in Patients with Long COVID in a Primary Care Clinic in Japan: An Observational Study. J Clin Med 2024; 13:5019. [PMID: 39274232 PMCID: PMC11396328 DOI: 10.3390/jcm13175019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 08/10/2024] [Accepted: 08/22/2024] [Indexed: 09/16/2024] Open
Abstract
Objectives: The objectives were to investigate the clinical characteristics and course of long COVID, defined as the persistence of symptoms at least one month after the onset of COVID-19, in outpatients and to clarify differences in symptoms between SARS CoV-2 mutant strains. Methods: Our observational study in a primary care institution in Japan included 1053 patients with long COVID who visited our outpatient clinic between April 2021 and March 2023. Symptom distribution, performance status, and patient background at the time of the first outpatient visit were compared between infectious strains (Delta and before group and Omicron group). Background factors and symptoms related to time to remission were also analyzed. Results: The severity of COVID-19 in the acute phase was mild, moderate, and severe in 82.2%, 14.9%, and 2.9% in the Delta and before group; and in 97.6%, 1.7%, and 0.4% in the Omicron group, respectively. Vaccination coverage was significantly different between the Delta and before (37.1%) and Omicron groups (73.1%) (p < 0.001), probably due to the period of vaccine unavailability in the former group. Symptoms of fatigue and headache occurred most frequently, irrespective of infectious strain. The mean number of symptoms per patient was significantly higher in the Delta and before group than the Omicron group (3.4 vs. 2.7, p < 0.0001). The median time overall to remission of long COVID was 169 days. Cox hazard model analysis identified female sex, high body mass index, and dyspnea (but not infectious strain) as significant factors prolonging the time to remission (p < 0.05). Conclusions: Differences in the number of symptoms between infectious strains may be related to differences in viral virulence and/or vaccination coverage. However, the clinical course was found to be minimally influenced by the infectious strain. The present results should improve the understanding of prognosis in patients with long COVID from both the clinical and social perspectives.
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Affiliation(s)
- Kenji Baba
- Department of General Medicine, Medical Center, Aichi Medical University, 17-33 Kawagoe, Niki-cho, Okazaki 444-2148, Aichi, Japan
| | - Seiko Kawai
- Center of Medical Education, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Satoshi Iwase
- Department of Neurology, Konan Kosei Hospital, 137 Omatsubara, Takaya-cho, Konan 483-8704, Aichi, Japan
| | - Takahiro Ushida
- Department of Pain Relief Surgery & Multidisciplinary Pain Center, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Yasuhiro Tamura
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Mariko Arimoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Makiko Nojiri
- Department of Dermatology, Medical Center, Aichi Medical University, 17-33 Kawagoe, Niki-cho, Okazaki 444-2148, Aichi, Japan
| | - Daisuke Watanabe
- Department of Dermatology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Nobutaro Ban
- Department of General Medicine, Medical Center, Aichi Medical University, 17-33 Kawagoe, Niki-cho, Okazaki 444-2148, Aichi, Japan
- Center of Medical Education, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
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14
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Schäfer IC, Krehbiel J, Adler W, Borho A, Herold R, Greiner B, Reuner M, Morawa E, Erim Y. Three-Month Follow-Up of the Post-COVID Syndrome after Admission to a Specialised Post-COVID Centre-A Prospective Study Focusing on Mental Health with Patient Reported Outcome Measures (PROMs). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1076. [PMID: 39200685 PMCID: PMC11354797 DOI: 10.3390/ijerph21081076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 09/02/2024]
Abstract
BACKGROUND AND OBJECTIVE The impairments and duration of PASC (post-acute sequelae of COVID-19) symptoms in mental health have, to date, not been comprehensively examined. Our objective is to provide longitudinal data on the mental health of Post-COVID patients and to identify risk and protective factors associated with a severe or prolonged course. METHODS The mental health of 265 Post-COVID patients of the outpatient Post-COVID centre of the University Hospital Erlangen was assessed 17.1 (T0) and 22.5 months after infection (T1). An online survey with validated questionnaires for Post-COVID symptoms (Post-COVID Syndrome Score), depression (Patient Health Questionnaire-9), somatic symptoms (Patient Health Questionnaire-15), anxiety (Generalized Anxiety Disorder-7), fatigue (Fatigue Severity Scale) and Post-Exertional Malaise (PEM) (DePaul Post-Exertional Malaise Screening) was conducted in the home environment. RESULTS In total, 80% of patients experienced severe PASC at follow-up. Clinically relevant symptoms of depression, persistent somatic symptoms, anxiety and fatigue were reported by 55.8%, 72.5%, 18.9% and 89.4% of patients, respectively. Depressive, anxiety and somatic symptom severity decreased significantly over time; fatigue and PEM remained at an unchanged high level. The risk factor for higher depression scores was older age; prior psychiatric illness treated with psychotherapy was associated with more severe depressive, somatic, anxiety and PASC symptoms. PEM symptoms were significantly associated with longer duration between acute infection and initial presentation in the Post-COVID centre. CONCLUSIONS Our findings align with previous research, claiming severe mental health symptoms in PASC syndrome, lasting for months after infection. In-depth assessment of risk and protective factors for the mental health implications of PASC is needed for the planning of health services and disease prevention.
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Affiliation(s)
- Isabel Cecil Schäfer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (J.K.); (W.A.); (A.B.); (R.H.); (B.G.); (M.R.); (E.M.); (Y.E.)
| | - Johannes Krehbiel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (J.K.); (W.A.); (A.B.); (R.H.); (B.G.); (M.R.); (E.M.); (Y.E.)
- Post-COVID Centre, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Werner Adler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (J.K.); (W.A.); (A.B.); (R.H.); (B.G.); (M.R.); (E.M.); (Y.E.)
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (J.K.); (W.A.); (A.B.); (R.H.); (B.G.); (M.R.); (E.M.); (Y.E.)
| | - Regina Herold
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (J.K.); (W.A.); (A.B.); (R.H.); (B.G.); (M.R.); (E.M.); (Y.E.)
| | - Brigitte Greiner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (J.K.); (W.A.); (A.B.); (R.H.); (B.G.); (M.R.); (E.M.); (Y.E.)
- Post-COVID Centre, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Miriam Reuner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (J.K.); (W.A.); (A.B.); (R.H.); (B.G.); (M.R.); (E.M.); (Y.E.)
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (J.K.); (W.A.); (A.B.); (R.H.); (B.G.); (M.R.); (E.M.); (Y.E.)
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (J.K.); (W.A.); (A.B.); (R.H.); (B.G.); (M.R.); (E.M.); (Y.E.)
- Post-COVID Centre, University Hospital Erlangen, 91054 Erlangen, Germany
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15
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Khodanovich M, Svetlik M, Kamaeva D, Usova A, Kudabaeva M, Anan’ina T, Vasserlauf I, Pashkevich V, Moshkina M, Obukhovskaya V, Kataeva N, Levina A, Tumentceva Y, Vasilieva S, Schastnyy E, Naumova A. Demyelination in Patients with POST-COVID Depression. J Clin Med 2024; 13:4692. [PMID: 39200834 PMCID: PMC11355865 DOI: 10.3390/jcm13164692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Depression is one of the most severe sequelae of COVID-19, with major depressive disorder often characterized by disruption in white matter (WM) connectivity stemming from changes in brain myelination. This study aimed to quantitatively assess brain myelination in clinically diagnosed post-COVID depression (PCD) using the recently proposed MRI method, macromolecular proton fraction (MPF) mapping. Methods: The study involved 63 recovered COVID-19 patients (52 mild, 11 moderate, and 2 severe) at 13.5 ± 10.0 months post-recovery, with matched controls without prior COVID-19 history (n = 19). A post-COVID depression group (PCD, n = 25) was identified based on psychiatric diagnosis, while a comparison group (noPCD, n = 38) included participants with neurological COVID-19 complications, excluding clinical depression. Results: Fast MPF mapping revealed extensive demyelination in PCD patients, particularly in juxtacortical WM (predominantly occipital lobe and medial surface), WM tracts (inferior fronto-occipital fasciculus (IFOF), posterior thalamic radiation, external capsule, sagittal stratum, tapetum), and grey matter (GM) structures (hippocampus, putamen, globus pallidus, and amygdala). The noPCD group also displayed notable demyelination, but with less magnitude and propagation. Multiple regression analysis highlighted IFOF demyelination as the primary predictor of Hamilton scores, PCD presence, and severity. The number of post-COVID symptoms was a significant predictor of PCD presence, while the number of acute symptoms was a significant predictor of PCD severity. Conclusions: This study, for the first time, reveals extensive demyelination in numerous WM and GM structures in PCD, outlining IFOF demyelination as a key biomarker.
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Affiliation(s)
- Marina Khodanovich
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia
| | - Mikhail Svetlik
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia
| | - Daria Kamaeva
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk 634014, Russia
| | - Anna Usova
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia
- Cancer Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 12/1 Savinykh Street, Tomsk 634028, Russia
| | - Marina Kudabaeva
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia
| | - Tatyana Anan’ina
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia
| | - Irina Vasserlauf
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia
| | - Valentina Pashkevich
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia
| | - Marina Moshkina
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia
| | - Victoria Obukhovskaya
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia
- Department of Fundamental Psychology and Behavioral Medicine, Siberian State Medical University, 2 Moskovskiy Trakt, Tomsk 634050, Russia
| | - Nadezhda Kataeva
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia
- Department of Neurology and Neurosurgery, Siberian State Medical University, 2 Moskovskiy Trakt, Tomsk 634028, Russia
| | - Anastasia Levina
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia
- Medica Diagnostic and Treatment Center, 86 Sovetskaya Street, Tomsk 634510, Russia
| | - Yana Tumentceva
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia
| | - Svetlana Vasilieva
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk 634014, Russia
| | - Evgeny Schastnyy
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk 634014, Russia
| | - Anna Naumova
- Department of Radiology, School of Medicine, South Lake Union Campus, University of Washington, 850 Republican Street, Seattle, WA 98109, USA
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16
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Barnekow T, Peters C, Dulon M, Nienhaus A. Impact of pre-existing conditions on the severity of post-COVID syndrome among workers in healthcare and social services in Germany. J Occup Med Toxicol 2024; 19:32. [PMID: 39090746 PMCID: PMC11293209 DOI: 10.1186/s12995-024-00431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The underlying mechanisms of post-COVID syndrome (PCS) are still not fully understood. While pre-existing conditions have been described as a risk factor for severe PCS in the general population, data specific to different occupational groups in this context is lacking. This study aimed to investigate the impact of pre-existing conditions on severe post-COVID syndrome among the occupational group of healthcare and social services employees. METHODS Baseline data from a longitudinal, observational study were analysed. In February 2021, health workers who had a COVID-19 infection in 2020 were surveyed about sequelae of the infection. Factors influencing severe PCS with at least one persistent symptom categorised as severe were subjected to a multivariate logistic regression analysis. RESULTS Of a total of 2,053 participants, 21.5% had severe PCS. Underlying respiratory (OR 1.94; CI 1.44-2.61), cardiovascular (OR 1.35; CI 1.04-1.77) and urogenital (OR 1.79; CI 1.10-2.91) disease were risk factors for severe PCS overall. Respiratory and mental illnesses had a statistically significant impact on persistent fatigue/exhaustion, concentration/memory difficulties and shortness of breath categorised as severe. Urogenital disease was associated with severe fatigue/exhaustion. Other significant risk factors for severe PCS were female sex, smoking, physical exercise and hospitalisation due to COVID-19 infection. CONCLUSION Workers in healthcare and social services with pre-existing conditions may face a higher risk of developing severe PCS. Additional analyses performed as part of the longitudinal study will show if and how this result changes over time.
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Affiliation(s)
- Tiana Barnekow
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246, Hamburg, Germany.
| | - Claudia Peters
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246, Hamburg, Germany
| | - Madeleine Dulon
- Department of Occupational Medicine, Hazardous Substances and Public Health, Institution for Statutory Accident Insurance and Prevention in the Healthcare and Welfare Services, 22089, Hamburg, Germany
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246, Hamburg, Germany
- Department of Occupational Medicine, Hazardous Substances and Public Health, Institution for Statutory Accident Insurance and Prevention in the Healthcare and Welfare Services, 22089, Hamburg, Germany
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17
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Gutzeit J, Weiß M, Nürnberger C, Lemhöfer C, Appel KS, Pracht E, Reese JP, Lehmann C, Polidori MC, Hein G, Deckert J. Definitions and symptoms of the post-COVID syndrome: an updated systematic umbrella review. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01868-y. [PMID: 39052056 DOI: 10.1007/s00406-024-01868-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
Post-COVID syndrome (PCS) describes a persistent complex of symptoms following a COVID-19 episode, lasting at least 4 to 12 weeks, depending on the specific criteria used for its definition. It is often associated with moderate to severe impairments of daily life and represents a major burden for many people worldwide. However, especially during the first two years of the COVID-19 pandemic, therapeutic and diagnostic uncertainties were prominent due to the novelty of the disease and non-specific definitions that overlooked functional deficits and lacked objective assessment. The present work comprehensively examines the status of PCS definitions as depicted in recent reviews and meta-analyses, alongside exploring associated symptoms and functional impairments. We searched the database Pubmed for reviews and meta-analysis evaluating PCS in the period between May 31, 2022, to December 31, 2023. Out of 95 studies, 33 were selected for inclusion in our analyses. Furthermore, we extended upon prior research by systematically recording the symptoms linked with PCS as identified in the studies. We found that fatigue, neurological complaints, and exercise intolerance were the most frequently reported symptoms. In conclusion, over the past eighteen months, there has been a notable increase in quantity and quality of research studies on PCS. However, there still remains a clear need for improvement, particularly with regard to the definition of the symptoms necessary for diagnosing this syndrome. Enhancing this aspect will render future research more comparable and precise, thereby advancing and understanding PCS.
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Affiliation(s)
- Julian Gutzeit
- Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany.
- Department of Psychology III - Psychological Methods, Cognition, and Applied Research, Julius-Maximilians-Universität Würzburg, Röntgenring 11, 97070, Würzburg, Germany.
| | - M Weiß
- Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
- Department of Psychology I - Biological Psychology, Clinical Psychology and Psychotherapy, Julius-Maximilians-Universität Würzburg, Marcusstraße 11, 97070, Würzburg, Germany
| | - C Nürnberger
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - C Lemhöfer
- Institute for Physical and Rehabilitative Medicine, University Hospital Jena, Jena, Germany
| | - K S Appel
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Frankfurt, Germany
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Cologne, Germany
| | - E Pracht
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Cologne, Germany
| | - J-P Reese
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - C Lehmann
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Cologne, Germany
- German Center for Infection Research, Partner site Bonn-Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - M C Polidori
- Aging Clinical Research, Department II of Internal Medicine, Center for Molecular Medicine Cologne, Faculty of Medicine, University Hospital Cologne, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress- Responses in Aging- Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - G Hein
- Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - J Deckert
- Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
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18
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Müller K, Ottiger M, Poppele I, Wastlhuber A, Stegbauer M, Schlesinger T. Physical Health in Patients with Post-COVID-19 6 and 12 Months after an Inpatient Rehabilitation: An Observational Study. J Clin Med 2024; 13:3988. [PMID: 38999552 PMCID: PMC11242682 DOI: 10.3390/jcm13133988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/04/2024] [Accepted: 07/06/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Rehabilitation is an effective and feasible approach for post-COVID patients to improve physical health. However, knowledge regarding the long-term impact of rehabilitation on the physical health of these patients is lacking. Methods: Changes in physical health of 127 patients with COVID-19 as an occupational disease or work accident were assessed in a longitudinal observational study. Post-COVID symptoms, functional status, functional exercise capacity, endurance capacity, physical performance, quadricep strength, handgrip strength, motor balance ability, and self-reported physical performance were examined at the beginning as well as 6 and 12 months after the rehabilitation. Group differences concerning sex, age, acute COVID status, comorbidities prior to COVID-19, and aftercare interventions were also analysed. Results: Even 12 months after rehabilitation, the prevalence of post-COVID symptoms (28.6-94.7%) remained remarkably high in the study population. Significant improvements in various aspects of physical health were observed 6 (r = 0.288-0.755) and 12 months (r = 0.189-0.681) after the rehabilitation. Participants demonstrated enhanced endurance, strength, and balance function, as well as improvement in subjective physical ability. Significant group differences were observed between younger and older patients, those with mild-moderate and severe-critical COVID-19, and patients with and without pre-existing cardiovascular disease, metabolic disease, psychological disease, neuro-sensory disease, musculoskeletal disease, and exercising in an outpatient group. Conclusions: The study identifies persistent challenges in COVID-19 recovery, despite significant improvements in physical health 6 and 12 months after rehabilitation. Further research and the implementation of standardised approaches are required to enhance the outcomes of post-COVID rehabilitation, with a focus on developing personalised care strategies for long-term recovery.
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Affiliation(s)
- Katrin Müller
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany; (M.O.); (I.P.); (T.S.)
| | - Marcel Ottiger
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany; (M.O.); (I.P.); (T.S.)
| | - Iris Poppele
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany; (M.O.); (I.P.); (T.S.)
| | - Alois Wastlhuber
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany; (A.W.); (M.S.)
| | - Michael Stegbauer
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany; (A.W.); (M.S.)
| | - Torsten Schlesinger
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany; (M.O.); (I.P.); (T.S.)
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19
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Gudziol H, Giszas B, Schade U, Bitter T, Reuken PA, Stallmach A, Guntinas-Lichius O. [Post-COVID patients with persistent chemosensory symptoms are rare in the general population]. Laryngorhinootologie 2024; 103:514-521. [PMID: 38387482 DOI: 10.1055/a-2246-2357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
OBJECTIVE The prevalence of long-/post-COVID-associated chemosensory symptoms is reported in the literature to be significantly higher than clinical reality reflects. METHODS 1. N= 4062 adults acutely infected with SARS-CoV-2 and their symptoms transmitted by the Jena health office to the Robert Koch Institute between March 2020 and September 2021 were evaluated. 2. Part of the same cohort (N = 909 of 4062) answered an extensive questionnaire at least 3 months after the start of the infection, including existing chemosensory post-COVID-associated complaints. 3. Fourteen post-COVID Jena patients with chemosensory symptoms who had become acutely infected during the same period were diagnosed, treated and advised in our ENT specialist outpatient clinic. RESULTS The prevalence of chemosensory symptoms at the onset of infection was 19% (600/3187). About every second written respondent of the formerly acutely infected (441/890) remembered chemosensory symptoms during their COVID-19 infection. Of these, around 38% (167/441) complained of persistent chemosensory post-COVID symptoms after an average of 14.5 months. Only 2.3% (14/600) of the previously acutely infected patients with chemosensory symptoms sought medical help in a special consultation. Quantitative chemosensory damage could only be objectified in half, i.e. 1.2% (7/600) of the total cohort. CONCLUSIONS Despite a high prevalence of subjective chemosensory symptoms in acutely and formerly SARS-CoV-2 infected people, there is only a low need for specialized treatment, so that, unlike other post-COVID-associated complaints, the healthcare system as a whole appears to be less significantly burdened.
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Affiliation(s)
- Hilmar Gudziol
- Klinik für Hals-, Nasen- und Ohrenkrankheiten, Uniklinikum, DE 07747 Jena, Germany
| | - Benjamin Giszas
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie, Infektiologie), Uniklinikum, DE 07747 Jena, Germany
| | - Ulrike Schade
- Klinik für Hals-, Nasen- und Ohrenkrankheiten, Uniklinikum, DE 07747 Jena, Germany
| | - Thomas Bitter
- Klinik für Hals-, Nasen- und Ohrenkrankheiten, Uniklinikum, DE 07747 Jena, Germany
| | - Philipp A Reuken
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie, Infektiologie), Uniklinikum, DE 07747 Jena, Germany
| | - Andreas Stallmach
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie, Infektiologie), Uniklinikum, DE 07747 Jena, Germany
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20
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Liu X, Liu M, Ai G, Hu N, Liu W, Lai C, Xu F, Xie Z. Sleep and mental health during the COVID-19 pandemic: findings from an online questionnaire survey in China. Front Neurol 2024; 15:1396673. [PMID: 38952466 PMCID: PMC11215081 DOI: 10.3389/fneur.2024.1396673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/27/2024] [Indexed: 07/03/2024] Open
Abstract
Introduction The online study investigated the sleep, psychological conditions, and risk factors during the wave of transmission of COVID-19 since December 7, 2022. Methods We distributed questionnaires through networking mediums to residents to gather information about COVID-19 infection, sleep, and mental status. Results During the extraordinary period in China, 91.9% of 1094 participants claimed to be infected with COVID-19, 36.8% reported poor sleep quality, 75.9% reported anxiety, and 65.5% reported depression. In retrospect, people have experienced lower sleep quality, longer sleep latency, enhanced rising time, and decreased sleep efficiency after the infection wave. After adjusting confounding factors, the elderly, women, urban residents, people with comorbidity, anxiety, depression, stress state, and COVID-19 infection have high risks for sleep disorders during the period. Discussion The survey indicates that sleep disturbance caused by COVID-19 involves multiple dimensions, such as physiology, psychology, and society. The COVID-19 infection-related sleep problem should be taken seriously. Apart from conventional treatment, psychological issues of insomnia can not be ignored.
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Affiliation(s)
- Xuqian Liu
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mingyue Liu
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guangyuan Ai
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Naijun Hu
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenhan Liu
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chao Lai
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Feng Xu
- School of Management, Shandong University, Jinan, China
| | - Zhaohong Xie
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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21
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Lemhöfer C, Koczulla AR, Meissner W, Häuser W. [Updated S1 guideline on long/post-COVID: relevant aspects for pain medicine]. Schmerz 2024; 38:175-182. [PMID: 36929455 PMCID: PMC10019417 DOI: 10.1007/s00482-023-00704-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The S1 guideline on long/post-COVID of the AWMF [German Association of the Medical Scientific Societies] registration number 020-027) was updated in August 2022. METHODS Under the coordination of the German Society of Pneumology, the guideline was updated by 21 scientific associations, two professional associations and clinical centers each and one institute and statutory accident insurance each. Each scientific association was responsible for its own chapter. The German Pain Society prepared the chapter "Pain". The coordinators of each chapter performed a selective literature search and also received approval for the chapter within their scientific association. During an internal period of comments, all representatives of the participating institutions could comment on all chapters. The AWMF task force commented on the draft of the guideline, which was then finally approved by the boards of all participating institutions. RESULTS Coronavirus disease 2019 (COVID-19) increases the risk of persistent headache and musculoskeletal pain. Long/Post-COVID pain is frequently associated with fatigue and cognitive problems. A specialist assessment might be considered if symptoms with limitations of daily activities persist 3 months after the infection. The diagnostic workup of long/post-COVID-associated pain should be performed according to the standards of pain medicine. Management should follow the pain guidelines of the AWMF. CONCLUSIONS The updated S1 guideline on long/post-COVID is a clinical manual which offers orientation for diagnostics and treatment despite limited data.
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Affiliation(s)
- Christina Lemhöfer
- Institut für Physikalische und Rehabilitative Medizin, Universitätsklinikum Jena, Jena, Deutschland
| | | | - Winfried Meissner
- Fachbereich Schmerztherapie, Klinik für Anästhesiologie und Intensivtherapie und Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Winfried Häuser
- Innere Medizin 1, Klinikum Saarbrücken, 66119, Saarbrücken, Deutschland.
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22
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Lapin B, Li Y, Englund K, Katzan IL. Health-Related Quality of Life for Patients with Post-Acute COVID-19 Syndrome: Identification of Symptom Clusters and Predictors of Long-Term Outcomes. J Gen Intern Med 2024; 39:1301-1309. [PMID: 38424349 PMCID: PMC11169186 DOI: 10.1007/s11606-024-08688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Following COVID-19 infection, as many as a third of patients have long-term symptoms, known as post-acute sequelae (PASC). The mechanisms contributing to PASC remain largely unknown and, due to the heterogeneity of symptoms, treating PASC provides unique challenges. OBJECTIVE Our study sought to (1) identify clinical symptom profiles based on PROMIS Global Health (GH) items, (2) evaluate demographic and clinical differences across profiles, and (3) identify predictors of change in health-related quality of life (HRQL) over time. DESIGN This was an observational cohort study of patients with PASC who completed PROMIS-GH between 2/11/21 and 12/3/21 as part of routine care, with data extracted from the electronic health record. PARTICIPANTS There were 1407 adult patients (mean age 49.6 ± 13.7, 73% female, 81% White race) with PASC seen in the recovery clinic between 2/11/21 and 12/3/21, with 1129 (80.2%) completing PROMIS-GH as routine care. MAIN MEASURES HRQL was measured with PROMIS-GH at initial visit and after 12 months. KEY RESULTS Latent profile analysis identified symptom classes based on five PROMIS-GH items (mental health, ability to carry out physical activities, pain, fatigue, and emotional problems). Four latent profiles were identified: (1) "Poor HRQL" (n = 346), (2) "Mixed HRQL: good mental/poor physical" (n = 232), (3) "Mixed HRQL: poor mental/good physical" (n = 324), and (4) "Good HRQL" (n = 227). Demographics and comorbidities varied significantly across profile with patients with more severe COVID-19 infection more likely to be in profiles 1 and 2. Overall, patients improved 2 T-score points on PROMIS-GH after 12 months, with differences by profile. Predictors of improved HRQL included profile, lower body mass index, and fewer COVID symptoms. CONCLUSIONS Patients with PASC have distinct HRQL symptom profiles which were able to differentiate across COVID-19 severity and symptoms. Improvement over 12 months differed by profile. These profiles may be used to better understand the mechanisms behind PASC. Future research should evaluate their ability to guide treatment decisions to improve HRQL.
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Affiliation(s)
- Brittany Lapin
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Yadi Li
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kristin Englund
- Department of Infectious Disease, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Irene L Katzan
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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23
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Poppele I, Ottiger M, Stegbauer M, Schlesinger T, Müller K. Device-assessed physical activity and sleep quality of post-COVID patients undergoing a rehabilitation program. BMC Sports Sci Med Rehabil 2024; 16:122. [PMID: 38811993 PMCID: PMC11134673 DOI: 10.1186/s13102-024-00909-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND An infection with SARS-CoV-2 can lead to persistent symptoms more than three months after the acute infection and has also an impact on patients' physical activity behaviour and sleep quality. There is evidence, that inpatient post-COVID rehabilitation can improve physical capacity and mental health impairments, but less is known about the change in physical behaviour and sleep quality. METHODS This longitudinal observational study used accelerometery to assess the level of physical activity and sleep quality before and after an inpatient rehabilitation program. The study sample consists of 100 post-COVID patients who acquired COVID-19 in the workplace. Group differences related to sex, age, COVID-19 severity, and pre-existing diseases were also analysed. RESULTS Level of physical activity and sleep quality didn't increase after rehabilitation. Overall, there is a high extent of inactivity time and poor sleep quality at both measurement points. Regarding group differences, male patients showed a significantly higher inactivity time before rehabilitation, and younger patients (< 55 years) spend significant more time in vigorous physical activity than older patients. Post-COVID patients with pre-existing cardiovascular, respiratory, and metabolic disease show slightly less physical activity than post-COVID patients without these comorbidities. Female patients and younger patients showed better sleep quality in some sleep parameters at both measurement points. However, no differences could be detected related to COVID-19 severity. CONCLUSIONS Ongoing strategies should be implemented to address the high amount of inactivity time and the poor sleep quality in post-COVID patients.
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Affiliation(s)
- Iris Poppele
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107, Chemnitz, Germany.
| | - Marcel Ottiger
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107, Chemnitz, Germany
| | - Michael Stegbauer
- BG Hospital for Occupational Disease Bad Reichenhall, 83435, Bad Reichenhall, Germany
| | - Torsten Schlesinger
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107, Chemnitz, Germany
| | - Katrin Müller
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107, Chemnitz, Germany
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24
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Gelhorn HL, Ghafoori P, Cutts K, Birch H, Savva Y, Satram S, Lloyd E, Chen WH. Characterizing health-related quality of life and identifying disease predictors among patients suspected of having long COVID: an analysis of COMET-ICE clinical trial data. Front Public Health 2024; 12:1278106. [PMID: 38784592 PMCID: PMC11111858 DOI: 10.3389/fpubh.2024.1278106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Long COVID affects health-related quality of life (HRQoL). Here, we investigate the extent to which symptoms experienced during the acute phase of COVID-19 are significant predictors of the presence of long COVID at 12 weeks. Methods Post-hoc analysis of COMET-ICE trial data, which assessed sotrovimab vs. placebo for treatment of mild-to-moderate COVID-19 among high-risk patients. Patient-reported outcome measures were completed during the trial, including the inFLUenza Patient-Reported Outcome Plus (FLU-PRO Plus), the 12-Item Short Form (SF-12) Hybrid questionnaire, and the Work Productivity and Activity Impairment Questionnaire: General Health (WPAI:GH). COVID-19 symptoms and impacts (measured by the FLU-PRO Plus) and HRQoL (measured by SF-12 Hybrid and WPAI:GH) were compared between the acute phase (Days 1-21 and 29) and long-COVID phase (at Week 12) among patients with and without long COVID based on COMET-ICE data. Subgroups experiencing long COVID were derived using "All," "Returning," and "Persisting" symptomatic definitions. Long-COVID predictors were identified using a multivariate logistic regression model; odds ratios (ORs) and 95% CIs were calculated. Results Long-COVID subgroups had significantly higher baseline scores for most FLU-PRO Plus domains and Total Score compared with the non-long-COVID group. WPAI:GH and SF-12 Hybrid scores generally showed significantly more impairment for the long-COVID subgroups at baseline and Week 12 vs. the non-long-COVID group. In the univariate analyses, all FLU-PRO Plus domains were significant predictors of long COVID (all p < 0.05), with the exception of the Sense domain. Older age increased the risk of long COVID (OR 1.02, 95% CI 1.00-1.04, p < 0.05). Non-White patients were significantly less likely to have long COVID by the Returning and Persisting definitions vs. White patients (all p < 0.05). In the multivariate analysis, higher scores for the Nose domain (ORs 3.39-5.60, all p < 0.01) and having COPD (ORs 3.75-6.34, all p < 0.05) were significant long-COVID predictors. Conclusion Patients who progressed to long COVID had higher symptom severity during the acute disease phase and showed significantly greater negative impact on HRQoL over an extended time period from initial infection through at least the subsequent 3 months. The FLU-PRO Plus Nose domain and having COPD were significant predictors of long COVID.
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Affiliation(s)
| | | | | | | | | | - Sacha Satram
- Vir Biotechnology, Inc., San Francisco, CA, United States
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25
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Singh A, Adam A, Aditi, Peng BH, Yu X, Zou J, Kulkarni VV, Kan P, Jiang W, Shi PY, Samir P, Cisneros I, Wang T. A murine model of post-acute neurological sequelae following SARS-CoV-2 variant infection. Front Immunol 2024; 15:1384516. [PMID: 38765009 PMCID: PMC11099216 DOI: 10.3389/fimmu.2024.1384516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/15/2024] [Indexed: 05/21/2024] Open
Abstract
Viral variant is one known risk factor associated with post-acute sequelae of COVID-19 (PASC), yet the pathogenesis is largely unknown. Here, we studied SARS-CoV-2 Delta variant-induced PASC in K18-hACE2 mice. The virus replicated productively, induced robust inflammatory responses in lung and brain tissues, and caused weight loss and mortality during the acute infection. Longitudinal behavior studies in surviving mice up to 4 months post-acute infection revealed persistent abnormalities in neuropsychiatric state and motor behaviors, while reflex and sensory functions recovered over time. In the brain, no detectable viral RNA and minimal residential immune cell activation was observed in the surviving mice post-acute infection. Transcriptome analysis revealed persistent activation of immune pathways, including humoral responses, complement, and phagocytosis, and gene expression levels associated with ataxia telangiectasia, impaired cognitive function and memory recall, and neuronal dysfunction and degeneration. Furthermore, surviving mice maintained potent systemic T helper 1 prone cellular immune responses and strong sera neutralizing antibodies against Delta and Omicron variants months post-acute infection. Overall, our findings suggest that infection in K18-hACE2 mice recapitulates the persistent clinical symptoms reported in long-COVID patients and provides new insights into the role of systemic and brain residential immune factors in PASC pathogenesis.
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Affiliation(s)
- Ankita Singh
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Awadalkareem Adam
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Aditi
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Bi-Hung Peng
- Department of Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, United States
| | - Xiaoying Yu
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, United States
| | - Jing Zou
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, United States
| | - Vikram V. Kulkarni
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, United States
| | - Wei Jiang
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
| | - Pei-Yong Shi
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, United States
| | - Parimal Samir
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Irma Cisneros
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
- NeuroInfectious Diseases, University of Texas Medical Branch, Galveston, TX, United States
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, United States
| | - Tian Wang
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
- NeuroInfectious Diseases, University of Texas Medical Branch, Galveston, TX, United States
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, United States
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26
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Weiß M, Gutzeit J, Appel KS, Bahmer T, Beutel M, Deckert J, Fricke J, Hanß S, Hettich-Damm N, Heuschmann PU, Horn A, Jauch-Chara K, Kohls M, Krist L, Lorenz-Depiereux B, Otte C, Pape D, Reese JP, Schreiber S, Störk S, Vehreschild JJ, Hein G. Depression and fatigue six months post-COVID-19 disease are associated with overlapping symptom constellations: A prospective, multi-center, population-based cohort study. J Affect Disord 2024; 352:296-305. [PMID: 38360365 DOI: 10.1016/j.jad.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Depression and fatigue are commonly observed sequelae following viral diseases such as COVID-19. Identifying symptom constellations that differentially classify post-COVID depression and fatigue may be helpful to individualize treatment strategies. Here, we investigated whether self-reported post-COVID depression and post-COVID fatigue are associated with the same or different symptom constellations. METHODS To address this question, we used data from COVIDOM, a population-based cohort study conducted as part of the NAPKON-POP platform. Data were collected in three different German regions (Kiel, Berlin, Würzburg). We analyzed data from >2000 individuals at least six months past a PCR-confirmed COVID-19 disease, using elastic net regression and cluster analysis. The regression model was developed in the Kiel data set, and externally validated using data sets from Berlin and Würzburg. RESULTS Our results revealed that post-COVID depression and fatigue are associated with overlapping symptom constellations consisting of difficulties with daily activities, perceived health-related quality of life, chronic exhaustion, unrestful sleep, and impaired concentration. Confirming the overlap in symptom constellations, a follow-up cluster analysis could categorize individuals as scoring high or low on depression and fatigue but could not differentiate between both dimensions. LIMITATIONS The data presented are cross-sectional, consisting primarily of self-reported questionnaire or medical records rather than biometric data. CONCLUSIONS In summary, our results suggest a strong link between post-COVID depression and fatigue, highlighting the need for integrative treatment approaches.
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Affiliation(s)
- Martin Weiß
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany.
| | - Julian Gutzeit
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
| | - Katharina S Appel
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Frankfurt, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Thomas Bahmer
- Department I of Internal Medicine, UKSH Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany; Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927 Großhansdorf, Germany
| | - Manfred Beutel
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Jürgen Deckert
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | - Sabine Hanß
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Nora Hettich-Damm
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, Department of Internal Medicine I, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany; Clinical Trial Center Würzburg (CTC/ZKS), University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Institute of Medical Data Science, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Anna Horn
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Institute of Medical Data Science, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Kamila Jauch-Chara
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Mirjam Kohls
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | | | - Christian Otte
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany
| | - Daniel Pape
- Department I of Internal Medicine, UKSH Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Institute of Medical Data Science, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Stefan Schreiber
- Department I of Internal Medicine, UKSH Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, Department of Internal Medicine I, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Jörg Janne Vehreschild
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Frankfurt, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, Cologne, Germany; German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Grit Hein
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
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27
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Delgado-Alonso C, Delgado-Alvarez A, Díez-Cirarda M, Oliver-Mas S, Cuevas C, Montero-Escribano P, Ramos-Leví AM, Gil-Moreno MJ, López-Carbonero JI, Hermann BP, Matias-Guiu J, Matias-Guiu JA. Cognitive profile in multiple sclerosis and post-COVID condition: a comparative study using a unified taxonomy. Sci Rep 2024; 14:9806. [PMID: 38684843 PMCID: PMC11059260 DOI: 10.1038/s41598-024-60368-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
Post-COVID condition (PCC) and multiple sclerosis (MS) share some clinical and demographic features, including cognitive symptoms and fatigue. Some pathophysiological mechanisms well-known in MS, such as autoimmunity, neuroinflammation and myelin damage, have also been implicated in PCC. In this study, we aimed to compare the cognitive phenotypes of two large cohorts of patients with PCC and MS, and to evaluate the relationship between fatigue and cognitive performance. Cross-sectional study including 218 patients with PCC and 218 with MS matched by age, sex, and years of education. Patients were evaluated with a comprehensive neuropsychological protocol and were categorized according to the International Classification of Cognitive Disorders system. Fatigue and depression were also assessed. Cognitive profiles of PCC and MS largely overlapped, with a greater impairment in episodic memory in MS, but with small effect sizes. The most salient deficits in both disorders were in attention and processing speed. The severity of fatigue was greater in patients with PCC. Still, the correlations between fatigue severity and neuropsychological tests were more prominent in the case of MS. There were no differences in the severity of depression among groups. Our study found similar cognitive profiles in PCC and MS. Fatigue was more severe in PCC, but was more associated with cognitive performance in MS. Further comparative studies addressing the mechanisms related to cognitive dysfunction and fatigue may be of interest to advance the knowledge of these disorders and develop new therapies.
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Affiliation(s)
- Cristina Delgado-Alonso
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Alfonso Delgado-Alvarez
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - María Díez-Cirarda
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Silvia Oliver-Mas
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Constanza Cuevas
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Paloma Montero-Escribano
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Ana Maria Ramos-Leví
- Department of Endocrinology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), Madrid, Spain
| | - María José Gil-Moreno
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Juan Ignacio López-Carbonero
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Bruce P Hermann
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Jorge Matias-Guiu
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain
| | - Jordi A Matias-Guiu
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria "San Carlos" (IdISSC), C/Profesor Martín Lagos, 28040, Madrid, Spain.
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28
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Padilla S, Ledesma C, García-Abellán J, García JA, Fernández-González M, de la Rica A, Galiana A, Gutiérrez F, Masiá M. Long COVID across SARS-CoV-2 variants, lineages, and sublineages. iScience 2024; 27:109536. [PMID: 38585665 PMCID: PMC10995878 DOI: 10.1016/j.isci.2024.109536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/09/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
This prospective study aimed to determine the prevalence of long COVID in patients hospitalized for SARS-CoV-2 infection from March 2020 to July 2022 and assess the impact of different viral lineages. A total of 2,524 patients were followed up for 12 months, with persistent symptoms reported in 35.2% at one month, decreasing thereafter. Omicron variant patients initially showed higher symptom intensity, but this trend diminished over time. Certain viral lineages, notably Delta lineages AY.126 and AY.43, and Omicron sublineages BA.1.17, BA.2.56, and BA.5.1, consistently correlated with more severe symptoms. Overall, long COVID prevalence and severity were similar across SARS-CoV-2 variants. Specific lineages may influence post-COVID sequelae persistence and severity.
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Affiliation(s)
- Sergio Padilla
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
- Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Christian Ledesma
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
| | - Javier García-Abellán
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
- Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - José Alberto García
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Fernández-González
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Alba de la Rica
- Microbiology Service, Hospital General Universitario de Elche, Alicante, Spain
| | - Antonio Galiana
- Microbiology Service, Hospital General Universitario de Elche, Alicante, Spain
| | - Félix Gutiérrez
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
- Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Masiá
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
- Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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Kirchberger I, Meisinger C, Warm TD, Hyhlik-Dürr A, Linseisen J, Goßlau Y. Longitudinal course and predictors of health-related quality of life, mental health, and fatigue, in non-hospitalized individuals with or without post COVID-19 syndrome. Health Qual Life Outcomes 2024; 22:32. [PMID: 38616282 PMCID: PMC11017651 DOI: 10.1186/s12955-024-02245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 03/22/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Long-term information on health-related quality of life (HRQOL) and mental health of non-hospitalized individuals with "post COVID-19 syndrome" (PCS) is scarce. Thus, the objectives of the present study were to compare HRQOL and mental health of individuals with and without PCS in a German sample of non-hospitalized persons after SARS-CoV-2 infection, to characterize the long-term course up to 2 years and to identify predictors for post COVID-19 impairments. METHODS Individuals with past SARS-CoV-2 infection were examined at the University Hospital of Augsburg from November 2020 to May 2021 and completed a postal questionnaire between June and November 2022. Participants who self-reported the presence of fatigue, dyspnea on exertion, memory problems or concentration problems were classified as having PCS. HRQOL was assessed using the Veterans RAND 12-Item Health Survey, mental health was measured by the Patient Health Questionnaire and the Fatigue Asessment Scale was used to assess fatigue severity. Multivariable linear regression models with inverse probability weighting were used to determine the association between PCS and health outcomes. RESULTS From the 304 participants (58.2% women, median age 52 years), 210 (69.1%) were classified as having PCS in median 26 months after SARS-CoV-2 infection. Persons with PCS showed significantly more often depressive and anxiety disorders. PCS was independently and significantly associated with higher levels of depression, post-traumatic stress and fatigue, as well as poorer physical and mental HRQOL in median 9 months as well as 26 months after SARS-CoV-2 infection. A large number of acute symptoms and a prior diagnosis of depression were independently associated with poor mental health and HRQOL. While post-traumatic stress and mental HRQOL improved from 9 months to 26 months post infection onset, depressiveness, fatigue and physical HRQOL remained stable in both, persons with and without PCS. CONCLUSIONS PCS in non-hospitalized persons after SARS-CoV-2 infection is often associated with long-term impairments of mental health and HRQOL outcomes.
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Affiliation(s)
- Inge Kirchberger
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital of Augsburg, Stenglinstraße 2, Augsburg, Germany.
| | - Christine Meisinger
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital of Augsburg, Stenglinstraße 2, Augsburg, Germany
| | - Tobias D Warm
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | | | - Jakob Linseisen
- Epidemiology, Faculty of Medicine, University of Augsburg, University Hospital of Augsburg, Stenglinstraße 2, Augsburg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, LMU Munich, Munich, Germany
| | - Yvonne Goßlau
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Augsburg, Germany
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Greenstein YY, Hubel K, Froess J, Wisniewski SR, Venugopal V, Lai YH, Berger JS, Chang SY, Colovos C, Shah F, Kornblith LZ, Lawler PR, Gaddh M, Guerrero RM, Nkemdirim W, Lopes RD, Reynolds HR, Amigo JS, Wahid L, Zahra A, Goligher EC, Zarychanski R, Leifer E, Huang DT, Neal MD, Hochman JS, Cushman M, Gong MN. Symptoms and Impaired Quality of Life After COVID-19 Hospitalization: Effect of Therapeutic Heparin in Non-ICU Patients in the Accelerating COVID-19 Therapeutic Interventions and Vaccines 4 Acute Trial: Effect on 3-Month Symptoms and Quality of Life. Chest 2024; 165:785-799. [PMID: 37979717 PMCID: PMC11026170 DOI: 10.1016/j.chest.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/06/2023] [Accepted: 11/11/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Therapeutic-dose heparin decreased days requiring organ support in noncritically ill patients hospitalized for COVID-19, but its impact on persistent symptoms or quality of life (QOL) is unclear. RESEARCH QUESTION In the Accelerating COVID-19 Therapeutic Interventions and Vaccines 4 ACUTE (ACTIV-4a) trial, was randomization of patients hospitalized for COVID-19 illness to therapeutic-dose vs prophylactic heparin associated with fewer symptoms and better QOL at 90 days? STUDY DESIGN AND METHODS This was an open-label randomized controlled trial at 34 hospitals in the United States and Spain. A total of 727 noncritically ill patients hospitalized for COVID-19 from September 2020 to June 2021 were randomized to therapeutic-dose vs prophylactic heparin. Only patients with 90-day data on symptoms and QOL were analyzed. We ascertained symptoms and QOL by the EQ-5D-5L at 90-day follow-up in a preplanned analysis for the ACTIV-4a trial. Individual domains assessed by the EQ-5D-5L included mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Univariate and multivariate analyses were performed. RESULTS Among 571 patients, 288 (50.4%) reported at least one symptom. Among 410 patients, 148 (36.1%) reported moderate to severe impairment in one or more domains of the EQ-5D-5L. The presence of 90-day symptoms was associated with moderate-severe impairment in the EQ-5D-5L domains of mobility (adjusted OR [aOR], 2.37; 95% CI, 1.22-4.59), usual activities (aOR, 3.66; 95% CI, 1.75-7.65), pain (aOR, 2.43; 95% CI, 1.43-4.12), and anxiety (aOR, 4.32; 95% CI, 2.06-9.02), compared with patients reporting no symptoms There were no differences in symptoms or in the overall EQ-5D-5L index score between treatment groups. Therapeutic-dose heparin was associated with less moderate-severe impairment in all physical functioning domains (mobility, self-care, usual activities) but was independently significant only in the self-care domain (aOR, 0.32; 95% CI, 0.11-0.96). INTERPRETATION In a randomized controlled trial of hospitalized noncritically ill patients with COVID-19, therapeutic-dose heparin was associated with less severe impairment in the self-care domain of EQ-5D-5L. However, this type of impairment was uncommon, affecting 23 individuals. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT04505774; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
| | | | - Joshua Froess
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | | | - Vidya Venugopal
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Yu-Hsuan Lai
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | | | - Steven Y Chang
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Christos Colovos
- University of Vermont Larner College of Medicine, Burlington, VT
| | - Faraaz Shah
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Patrick R Lawler
- Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada; McGill University Health Centre, Montreal, QC, Canada
| | - Manila Gaddh
- Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | | | - Lana Wahid
- Duke University School of Medicine, Durham, NC
| | | | | | | | - Eric Leifer
- National Heart, Lung, and Blood Institute, Bethesda, MD
| | - David T Huang
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Matthew D Neal
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Mary Cushman
- University of Vermont Larner College of Medicine, Burlington, VT
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31
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Schilling C, Nieters A, Schredl M, Peter RS, Rothenbacher D, Brockmann SO, Göpel S, Kindle G, Merle U, Steinacker JM, Kern W. Pre-existing sleep problems as a predictor of post-acute sequelae of COVID-19. J Sleep Res 2024; 33:e13949. [PMID: 37227000 DOI: 10.1111/jsr.13949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/13/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
Several months after COVID-19 many individuals still report persisting symptoms, the so-called 'post-COVID-19 syndrome'. An immunological dysfunction is one of the main pathophysiological hypotheses. As sleep is central to the functioning of the immune system, we investigated whether self-reported pre-existing sleep disturbance might be an independent risk factor for the development of post-COVID-19 syndrome. A total of 11,710 participants of a cross-sectional survey (all tested positive for severe acute respiratory syndrome coronavirus-2) were classified into probable post-COVID-19 syndrome, an intermediate group, and unaffected participants at an average of 8.5 months after infection. The case definition was based on newly occurring symptoms of at least moderate severity and ≥20% reduction in health status and/or working capacity. Unadjusted and adjusted odds ratios were calculated to investigate the association between pre-existing sleep disturbances and subsequent development of post-COVID-19 syndrome while controlling for a variety of demographic, lifestyle, and health factors. Pre-existing sleep disturbances were found to be an independent predictor of subsequent probable post-COVID-19 syndrome (adjusted odds ratio 2.7, 95% confidence interval 2.27-3.24). Sleep disturbances as part of the post-COVID-19 syndrome were reported by more than half of the participants and appeared to be a new symptom and to occur independent of a mood disorder in most cases. Recognition of disturbed sleep as an important risk factor for post-COVID-19 syndrome should promote improved clinical management of sleep disorders in the context of COVID-19. Further, it may stimulate further research on the effect of improving sleep on the prognosis of COVID-19 long-term sequelae and other post-viral conditions.
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Affiliation(s)
- Claudia Schilling
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Sleep Laboratory, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Alexandra Nieters
- Institute for Immunodeficiency, Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany
| | - Michael Schredl
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Sleep Laboratory, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Stefan O Brockmann
- Department of Health Protection, Infection Control and Epidemiology, Baden-Wuerttemberg Federal State Health Office, Ministry of Social Affairs, Health and Integration Stuttgart, Stuttgart, Germany
| | - Siri Göpel
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Gerhard Kindle
- Institute for Immunodeficiency, Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany
| | - Uta Merle
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Medicine, Ulm University Hospital, Ulm, Germany
| | - Winfried Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany
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32
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Allwang C, Frank T, Bruckmann P, Dinkel A, Binneboese M, Wallis H, Elgner M, Giel KE, Schurr M, Gündel H, Wedekind L, Kuhn J, Lahmann C, Müller AM, Beckmann P, Massag J, Mikolajczyk R, Junne F. Addressing psychosocial needs in patients with Long-COVID (PsyLoCo-Study): study protocol of a pilot-study of a specialized modular intervention. Front Psychiatry 2024; 15:1305691. [PMID: 38510801 PMCID: PMC10951091 DOI: 10.3389/fpsyt.2024.1305691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction After an acute infection with the corona virus 10-20% of those affected suffer from ongoing or new symptoms. A causal therapy for the phenomenon known as Long/Post-COVID is still lacking and specific therapies addressing psychosocial needs of these patients are imperatively needed. The aim of the PsyLoCo-study is developing and piloting a psychotherapeutic manual, which addresses Long/Post-COVID-related psychosocial needs and supports in coping with persistent bodily symptoms as well as depressive or anxiety symptoms. Methods and analysis This pilot trial implements a multi-centre, 2-arm (N=120; allocation ratio: 1:1), parallel group, randomised controlled design. The pilot trial is designed to test the feasibility and estimate the effect of 1) a 12-session psychotherapeutic intervention compared to 2) a wait-list control condition on psychosocial needs as well as bodily and affective symptoms in patients suffering from Long/Post-COVID. The intervention uses an integrative, manualized, psychotherapeutic approach. The primary study outcome is health-related quality of life. Outcome variables will be assessed at three timepoints, pre-intervention (t1), post-intervention (t2) and three months after completed intervention (t3). To determine the primary outcome, changes from t1 to t2 are examined. The analysis will be used for the planning of the RCT to test the efficacy of the developed intervention. Discussion The pilot study will evaluate a 12-session treatment manual for Long/Post-COVID sufferers and the therapy components it contains. The analysis will provide insights into the extent to which psychotherapeutic treatment approaches improve the symptoms of Long/Post-COVID sufferers. The treatment manual is designed to be carried out by psychotherapists as well as people with basic training in psychotherapeutic techniques. This approach was chosen to enable a larger number of practitioners to provide therapeutic support for Long/Post-COVID patients. After completion of the pilot study, it is planned to follow up with a randomized controlled study and to develop a treatment guideline for general practitioners and interested specialists. Trial registration The pilot trial has been registered with the German Clinical Trials Register (Deutsches Register Klinischer Studien; Trial-ID: DRKS00030866; URL: https://drks.de/search/de/trial/DRKS00030866) on March 7, 2023.
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Affiliation(s)
- Christine Allwang
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Tamara Frank
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Paul Bruckmann
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Marius Binneboese
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Hannah Wallis
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Melanie Elgner
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Katrin E. Giel
- Department of Psychosomatic Medicine and Psychotherapy, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Marisa Schurr
- Department of Psychosomatic Medicine and Psychotherapy, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Lisa Wedekind
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Julia Kuhn
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Anne-Maria Müller
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Pauline Beckmann
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Janka Massag
- Medical Faculty, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Medical Faculty, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- German Center for Mental Health (DZPG), partner site Halle-Jena-Magdeburg, Halle, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- German Center for Mental Health (DZPG), partner Site Halle-Jena-Magdeburg, Magdeburg, Germany
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Gheorghita R, Soldanescu I, Lobiuc A, Caliman Sturdza OA, Filip R, Constantinescu – Bercu A, Dimian M, Mangul S, Covasa M. The knowns and unknowns of long COVID-19: from mechanisms to therapeutical approaches. Front Immunol 2024; 15:1344086. [PMID: 38500880 PMCID: PMC10944866 DOI: 10.3389/fimmu.2024.1344086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has been defined as the greatest global health and socioeconomic crisis of modern times. While most people recover after being infected with the virus, a significant proportion of them continue to experience health issues weeks, months and even years after acute infection with SARS-CoV-2. This persistence of clinical symptoms in infected individuals for at least three months after the onset of the disease or the emergence of new symptoms lasting more than two months, without any other explanation and alternative diagnosis have been named long COVID, long-haul COVID, post-COVID-19 conditions, chronic COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Long COVID has been characterized as a constellation of symptoms and disorders that vary widely in their manifestations. Further, the mechanisms underlying long COVID are not fully understood, which hamper efficient treatment options. This review describes predictors and the most common symptoms related to long COVID's effects on the central and peripheral nervous system and other organs and tissues. Furthermore, the transcriptional markers, molecular signaling pathways and risk factors for long COVID, such as sex, age, pre-existing condition, hospitalization during acute phase of COVID-19, vaccination, and lifestyle are presented. Finally, recommendations for patient rehabilitation and disease management, as well as alternative therapeutical approaches to long COVID sequelae are discussed. Understanding the complexity of this disease, its symptoms across multiple organ systems and overlapping pathologies and its possible mechanisms are paramount in developing diagnostic tools and treatments.
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Affiliation(s)
- Roxana Gheorghita
- Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Biomedical Sciences, College of Medicine and Biological Science, University of Suceava, Suceava, Romania
| | - Iuliana Soldanescu
- Integrated Center for Research, Development and Innovation for Advanced Materials, Nanotechnologies, Manufacturing and Control Distributed Systems (MANSiD), University of Suceava, Suceava, Romania
| | - Andrei Lobiuc
- Department of Biomedical Sciences, College of Medicine and Biological Science, University of Suceava, Suceava, Romania
| | - Olga Adriana Caliman Sturdza
- Department of Biomedical Sciences, College of Medicine and Biological Science, University of Suceava, Suceava, Romania
- Suceava Emergency Clinical County Hospital, Suceava, Romania
| | - Roxana Filip
- Department of Biomedical Sciences, College of Medicine and Biological Science, University of Suceava, Suceava, Romania
- Suceava Emergency Clinical County Hospital, Suceava, Romania
| | - Adela Constantinescu – Bercu
- Department of Biomedical Sciences, College of Medicine and Biological Science, University of Suceava, Suceava, Romania
- Institute of Cardiovascular Science, Hemostasis Research Unit, University College London (UCL), London, United Kingdom
| | - Mihai Dimian
- Integrated Center for Research, Development and Innovation for Advanced Materials, Nanotechnologies, Manufacturing and Control Distributed Systems (MANSiD), University of Suceava, Suceava, Romania
- Department of Computer, Electronics and Automation, University of Suceava, Suceava, Romania
| | - Serghei Mangul
- Department of Clinical Pharmacy, USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, United States
- Department of Quantitative and Computational Biology, USC Dornsife College of Letters, Arts and Sciences, University of Southern California (USC), Los Angeles, CA, United States
| | - Mihai Covasa
- Department of Biomedical Sciences, College of Medicine and Biological Science, University of Suceava, Suceava, Romania
- Department of Basic Medical Sciences, Western University of Health Sciences, College of Osteopathic Medicine, Pomona, CA, United States
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Khodanovich M, Naumova A, Kamaeva D, Obukhovskaya V, Vasilieva S, Schastnyy E, Kataeva N, Levina A, Kudabaeva M, Pashkevich V, Moshkina M, Tumentceva Y, Svetlik M. Neurocognitive Changes in Patients with Post-COVID Depression. J Clin Med 2024; 13:1442. [PMID: 38592295 PMCID: PMC10933987 DOI: 10.3390/jcm13051442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Depression and cognitive impairment are recognized complications of COVID-19. This study aimed to assess cognitive performance in clinically diagnosed post-COVID depression (PCD, n = 25) patients using neuropsychological testing. Methods: The study involved 71 post-COVID patients with matched control groups: recovered COVID-19 individuals without complications (n = 18) and individuals without prior COVID-19 history (n = 19). A post-COVID depression group (PCD, n = 25) was identified based on psychiatric diagnosis, and a comparison group (noPCD, n = 46) included participants with neurological COVID-19 complications, excluding clinical depression. Results: The PCD patients showed gender-dependent significant cognitive impairment in the MoCA, Word Memory Test (WMT), Stroop task (SCWT), and Trail Making Test (TMT) compared to the controls and noPCD patients. Men with PCD showed worse performances on the SCWT, in MoCA attention score, and on the WMT (immediate and delayed word recall), while women with PCD showed a decline in MoCA total score, an increased processing time with less errors on the TMT, and worse immediate recall. No differences between groups in Sniffin's stick test were found. Conclusions: COVID-related direct (post-COVID symptoms) and depression-mediated (depression itself, male sex, and severity of COVID-19) predictors of decline in memory and information processing speed were identified. Our findings may help to personalize the treatment of depression, taking a patient's gender and severity of previous COVID-19 disease into account.
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Affiliation(s)
- Marina Khodanovich
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
| | - Anna Naumova
- Department of Radiology, School of Medicine, South Lake Union Campus, University of Washington, 850 Republican Street, Seattle, WA 98109, USA;
| | - Daria Kamaeva
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
- Laboratory of Molecular Genetics and Biochemistry, Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 4 Aleutskaya Street, Tomsk 634014, Russia
| | - Victoria Obukhovskaya
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
- Department of Fundamental Psychology and Behavioral Medicine, Siberian State Medical University, 2 Moskovskiy Trakt, Tomsk 6340505, Russia
| | - Svetlana Vasilieva
- Department of Affective States, Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 4 Aleutskaya Street, Tomsk 634014, Russia; (S.V.); (E.S.)
| | - Evgeny Schastnyy
- Department of Affective States, Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 4 Aleutskaya Street, Tomsk 634014, Russia; (S.V.); (E.S.)
| | - Nadezhda Kataeva
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
- Department of Neurology and Neurosurgery, Siberian State Medical University, 2 Moskovskiy Trakt, Tomsk 6340505, Russia
| | - Anastasia Levina
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
- Medica Diagnostic and Treatment Center, 86 Sovetskaya Street, Tomsk 634510, Russia
| | - Marina Kudabaeva
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
| | - Valentina Pashkevich
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
| | - Marina Moshkina
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
| | - Yana Tumentceva
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
| | - Mikhail Svetlik
- Laboratory of Neurobiology, Research Institute of Biology and Biophysics, Tomsk State University, 36 Lenina Ave., Tomsk 634050, Russia; (D.K.); (V.O.); (N.K.); (A.L.); (M.K.); (V.P.); (M.M.); (Y.T.); (M.S.)
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35
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Hartung TJ, Bahmer T, Chaplinskaya-Sobol I, Deckert J, Endres M, Franzpötter K, Geritz J, Haeusler KG, Hein G, Heuschmann PU, Hopff SM, Horn A, Keil T, Krawczak M, Krist L, Lieb W, Maetzler C, Montellano FA, Morbach C, Neumann C, Nürnberger C, Russ AK, Schmidbauer L, Schmidt S, Schreiber S, Steigerwald F, Störk S, Zoller T, Maetzler W, Finke C. Predictors of non-recovery from fatigue and cognitive deficits after COVID-19: a prospective, longitudinal, population-based study. EClinicalMedicine 2024; 69:102456. [PMID: 38333368 PMCID: PMC10847699 DOI: 10.1016/j.eclinm.2024.102456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Background Despite the high prevalence and major disability associated with fatigue and cognitive deficits after SARS-CoV-2 infection, little is known about long-term trajectories of these sequelae. We aimed to assess long-term trajectories of these conditions and to identify risk factors for non-recovery. Methods We analyzed longitudinal data from the population-based COVIDOM/NAPKON-POP cohort in Germany. Participants with confirmed SARS-CoV-2 infection were assessed at least 6 months (baseline) and again at least 18 months (follow-up) after infection using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) Scale (cutoff ≤ 30) and the Montreal Cognitive Assessment (MoCA, cutoff ≤ 25). Predictors of recovery from fatigue or cognitive deficits between assessments were identified through univariate and multivariable logistic regression models. The COVIDOM study is registered at the German registry for clinical studies (DRKS00023742) and at ClinicalTrials.gov (NCT04679584). Findings Between 15 November 2020 and 9 May 2023, a total of 3038 participants were assessed at baseline (median 9 months after infection) and 83% responded to invitations for follow-up (median 26 months after infection). At baseline, 21% (95% confidence interval (CI) [20%, 23%]) had fatigue and 23% (95% CI [22%, 25%]) had cognitive deficits according to cutoff scores on the FACIT-Fatigue or MoCA. Participants with clinically relevant fatigue (at baseline) showed significant improvement in fatigue scores at follow-up (Hedges' g [95% CI] = 0.73 [0.60, 0.87]) and 46% (95% CI [41%, 50%]) had recovered from fatigue. Participants with cognitive deficits showed a significant improvement in cognitive scores (g [95% CI] = 1.12 [0.90, 1.33]) and 57% (95% CI [50%, 64%]) had recovered from cognitive deficits. Patients with fatigue exhibiting a higher depressive symptom burden and/or headache at baseline were significantly less likely to recover. Significant risk factors for cognitive non-recovery were male sex, older age and <12 years of school education. Importantly, SARS-CoV-2 reinfection had no significant impact on recovery from fatigue or cognitive deficits. Interpretation Fatigue and cognitive deficits are common sequelae after SARS-CoV-2 infection. These syndromes improved over time and about half of the patients recovered within two years. The identified risk factors for non-recovery from fatigue and cognitive deficits could play an important role in shaping targeted strategies for treatment and prevention. Funding Funded by the German Federal Ministry of Education and Research (BMBF; grant number 01KX2121) and German Research Foundation (DFG) Excellence Cluster "Position Medicine in Information".
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Affiliation(s)
- Tim J. Hartung
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig Holstein, Campus Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | | | - Jürgen Deckert
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Uniklinik Würzburg, Germany
| | - Matthias Endres
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
- ExcellenceCluster NeuroCure, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
| | | | - Johanna Geritz
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Karl G. Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Grit Hein
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Uniklinik Würzburg, Germany
| | - Peter U. Heuschmann
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
- University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for Medical Data Science, Würzburg, Germany
- University Hospital Würzburg, Clinical Trial Center, Würzburg, Germany
| | - Sina M. Hopff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Germany
| | - Anna Horn
- University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for Medical Data Science, Würzburg, Germany
| | - Thomas Keil
- Charité - Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Lilian Krist
- Charité - Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | | | - Corina Maetzler
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Felipe A. Montellano
- University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Würzburg, Germany
- Germany University Hospital Würzburg, Department of Neurology, Würzburg, Germany
| | - Caroline Morbach
- University Hospital Würzburg, Department for Medicine I and Comprehensive Heart Failure Center, Germany
| | - Christian Neumann
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Carolin Nürnberger
- University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for Medical Data Science, Würzburg, Germany
| | - Anne-Kathrin Russ
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Lena Schmidbauer
- University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for Medical Data Science, Würzburg, Germany
| | - Sein Schmidt
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Clinical Study Center, Germany
| | - Stefan Schreiber
- Internal Medicine Department I, University Hospital Schleswig Holstein, Campus Kiel, Germany
| | - Flo Steigerwald
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Stefan Störk
- University Hospital Würzburg, Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Germany
| | - Thomas Zoller
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory and Critical Care Medicine, Berlin, Germany
| | - Walter Maetzler
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Carsten Finke
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - NAPKON Study Group
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
- Internal Medicine Department I, University Hospital Schleswig Holstein, Campus Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
- Department of Medical Informatics, University Medical Center Göttingen, Germany
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Uniklinik Würzburg, Germany
- Center for Stroke Research Berlin, Berlin, Germany
- ExcellenceCluster NeuroCure, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
- Institute of Epidemiology, Kiel University, Germany
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
- University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for Medical Data Science, Würzburg, Germany
- University Hospital Würzburg, Clinical Trial Center, Würzburg, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Germany
- Charité - Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
- University Hospital Würzburg, Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Würzburg, Germany
- Germany University Hospital Würzburg, Department of Neurology, Würzburg, Germany
- University Hospital Würzburg, Department for Medicine I and Comprehensive Heart Failure Center, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Clinical Study Center, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory and Critical Care Medicine, Berlin, Germany
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Fleischer M, Szepanowski F, Mausberg AK, Asan L, Uslar E, Zwanziger D, Volbracht L, Stettner M, Kleinschnitz C. Cytokines (IL1β, IL6, TNFα) and serum cortisol levels may not constitute reliable biomarkers to identify individuals with post-acute sequelae of COVID-19. Ther Adv Neurol Disord 2024; 17:17562864241229567. [PMID: 38348267 PMCID: PMC10860378 DOI: 10.1177/17562864241229567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Background Post-acute sequelae of COVID-19 (PASC) comprise a broad spectrum of symptoms such as fatigue, general weakness, compromised attention and sleep or anxiety disorders. PASC represents a medical and socio-economic challenge. Objectives Our study evaluated cytokines (IL-1β, IL-6 and TNFα) and cortisol levels in a cohort of typical patients with PASC, suffering concentration problems, fatigue and difficulties finding words. Design This was a prospective cohort study. Four groups were analysed and compared: those who had never contracted SARS-CoV-2 (n = 13), infected but had no PASC (n = 34), infected with former PASC that resolved (n = 40) and patients with ongoing PASC after infection (n = 91). Methods Cytokine and cortisol serum levels were determined in patients' blood samples. Results Cytokine levels of IL-1β, IL-6, TNFα and cortisol levels did not differ between groups analysed. Conclusion This may indicate a non-organic/psychosomatic genesis of PASC; further studies are needed to elucidate the underlying causes of PACS, and non-organic causes should not be overlooked.
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Affiliation(s)
- Michael Fleischer
- Department of Neurology and Center for Translational and Behavioral Neurosciences, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Fabian Szepanowski
- Department of Neurology and Center for Translational and Behavioral Neurosciences, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Anne K Mausberg
- Department of Neurology and Center for Translational and Behavioral Neurosciences, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Livia Asan
- Department of Neurology and Center for Translational and Behavioral Neurosciences, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Ellen Uslar
- Department of Neurology and Center for Translational and Behavioral Neurosciences, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Denise Zwanziger
- Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry – Division of Laboratory Research, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Lothar Volbracht
- Central Laboratory, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Mark Stettner
- Department of Neurology and Center for Translational and Behavioral Neurosciences, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational and Behavioral Neurosciences, University Medicine Essen, Hufelandstr. 55, Essen 45147, Germany
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Kustura L, Bobek D, Poljičanin A, Pavelin S, Buljubašić Šoda M, Šoda J, Aksentijević J, Duka Glavor K, Narančić Knez N, Viali V, Cukrov A, Todorić Laidlaw I, Ipavec N, Vukorepa D, Stipica I, Bakrač K, Bošković B, Mastelić A, Režić Mužinić N, Markotić A, Đogaš Z, Dolić K, Rogić Vidaković M. Psychometric properties and observational data for COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) for post-COVID-19 syndrome. QJM 2024; 117:38-47. [PMID: 37788123 DOI: 10.1093/qjmed/hcad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/14/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The recently developed modified COVID-19 (coronavirus of 2019) Yorkshire Rehabilitation Scale (C19-YRSm) captures comprehensive biopsychosocial components of WHO's International Classification of Functioning, Disability, and Health related to the Long Covid or post-COVID syndrome. The scale response categories on C19-YRSm were done post hoc on data collected from the original version of C19-YRS. AIM To evaluate the C19-YRSm scale using reliability and validity measures. DESIGN Prospective, observational study. METHODS The study includes 369 patients (clinical group) and 426 subjects of the general population (control group) and captures their post-COVID-19 symptoms. In addition, the reliability of C19-YRSm was estimated by Cronbach's alpha coefficients of internal consistency and inter-item correlations for subscales ('Symptom severity, Functional disability, and Other symptoms'). Convergent validity was established using correlations between C19-YRSm and Fatigue Severity Scale (FSS). The incremental validity of C19-YRSm was measured by introducing a hierarchical regression model using the C19-YRSm 'Overall health' subscale and FSS as criterion variables. RESULTS C19-YRSm subscales have excellent internal consistencies (Cronbach's α value 0.81-0.96) and acceptable inter-item correlations (r value 0.23-0.79). Hereafter, the convergent validity of the C19-YRSm is good due to significant correlations between C19-YRSm subscales and FSS and C19-YRSm subscales. Finally, the hierarchical regression analysis supported consistent evidence for the incremental validity of the C19-YRSm subscales. CONCLUSION C19-YRSm is a reliable and valid self-assessment scale for the assessment of post-COVID-19 syndrome.
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Affiliation(s)
- L Kustura
- Department of Psychiatry, University Hospital of Split, Split, Croatia
| | - D Bobek
- Department of Physical and Rehabilitation Medicine with Rheumatology, Dubrava University Hospital, Zagreb, Croatia
| | - A Poljičanin
- Department of Physical Medicine and Rehabilitation with Rheumatology, University Hospital of Split, Split, Croatia
- Department of Health Studies, University of Split, Split, Croatia
| | - S Pavelin
- Department of Neurology, University Hospital of Split, Split, Croatia
| | - M Buljubašić Šoda
- Department of Pediatrics, University Hospital of Split, Split, Croatia
| | - J Šoda
- Department of Marine Electrical Engineering and Information Technologies, Signal Processing, Analysis, and Advanced Diagnostics Research and Education Laboratory (SPAADREL), Faculty of Maritime Studies, University of Split, Split, Croatia
| | - J Aksentijević
- Department of Physical and Rehabilitation Medicine with Rheumatology, Dubrava University Hospital, Zagreb, Croatia
| | - K Duka Glavor
- Department of Neurology, General Hospital Zadar, Zadar, Croatia
- Department of Health Studies, University of Zadar, Zadar, Croatia
| | - N Narančić Knez
- Department of Neurology, General Hospital Zadar, Zadar, Croatia
| | - V Viali
- Family Medicine Vanja Viali, Split, Split-Dalmatia County, Croatia
| | - A Cukrov
- Primary/Family Care Office, Slunj Community Health Centre, Slunj, Croatia
| | - I Todorić Laidlaw
- Department for Forensic Psychiatry, University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - N Ipavec
- Department for Transfusion Medicine, University Hospital of Split, Split, Croatia
| | - D Vukorepa
- Department of Psychiatry, University Hospital of Split, Split, Croatia
| | - I Stipica
- Department of Family Medicine, University of Split School of Medicine, Split, Croatia
| | - K Bakrač
- Institute of Emergency Medicine, Split-Dalmatia County, Split, Croatia
| | - B Bošković
- Department of Otorhinolaryngology, Head and Neck surgery, University Hospital of Split, Split, Croatia
| | - A Mastelić
- Department of Medical Chemistry and Biochemistry, University of Split School of Medicine, Split, Croatia
| | - N Režić Mužinić
- Department of Medical Chemistry and Biochemistry, University of Split School of Medicine, Split, Croatia
| | - A Markotić
- Department of Medical Chemistry and Biochemistry, University of Split School of Medicine, Split, Croatia
| | - Z Đogaš
- Department of Neuroscience, Laboratory for Human and Experimental Neurophysiology (LAHEN), School of Medicine, University of Split, Split, Croatia
- Sleep Medicine Centre, University Hospital of Split, Split, Croatia
| | - K Dolić
- Department of Interventional and Diagnostic Radiology, University Hospital of Split, Split, Croatia
- Department of Radiology, University of Split School of Medicine, Split, Croatia
| | - M Rogić Vidaković
- Department of Neuroscience, Laboratory for Human and Experimental Neurophysiology (LAHEN), School of Medicine, University of Split, Split, Croatia
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38
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van den Houdt SCM, Slurink IAL, Mertens G. Long COVID is not a uniform syndrome: Evidence from person-level symptom clusters using latent class analysis. J Infect Public Health 2024; 17:321-328. [PMID: 38183882 DOI: 10.1016/j.jiph.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The current study aims to enhance insight into the heterogeneity of long COVID by identifying symptom clusters and associated socio-demographic and health determinants. METHODS A total of 458 participants (Mage 36.0 ± 11.9; 46.5% male) with persistent symptoms after COVID-19 completed an online self-report questionnaire including a 114-item symptom list. First, a k-means clustering analysis was performed to investigate overall clustering patterns and identify symptoms that provided meaningful distinctions between clusters. Next, a step-three latent class analysis (LCA) was performed based on these distinctive symptoms to analyze person-centered clusters. Finally, multinominal logistic models were used to identify determinants associated with the symptom clusters. RESULTS From a 5-cluster solution obtained from k-means clustering, 30 distinctive symptoms were selected. Using LCA, six symptom classes were identified: moderate (20.7%) and high (20.7%) inflammatory symptoms, moderate malaise-neurocognitive symptoms (18.3%), high malaise-neurocognitive-psychosocial symptoms (17.0%), low-overall symptoms (13.3%) and high overall symptoms (9.8%). Sex, age, employment, COVID-19 suspicion, COVID-19 severity, number of acute COVID-19 symptoms, long COVID symptom duration, long COVID diagnosis, and impact of long COVID were associated with the different symptom clusters. CONCLUSIONS The current study's findings characterize the heterogeneity in long COVID symptoms and underscore the importance of identifying determinants of different symptom clusters.
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Affiliation(s)
- Sophie C M van den Houdt
- Center of Research on Psychological disorders and Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, PO box 90153, 5000LE Tilburg, the Netherlands
| | - Isabel A L Slurink
- Center of Research on Psychological disorders and Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, PO box 90153, 5000LE Tilburg, the Netherlands
| | - Gaëtan Mertens
- Center of Research on Psychological disorders and Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, PO box 90153, 5000LE Tilburg, the Netherlands.
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39
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Scardua-Silva L, Amorim da Costa B, Karmann Aventurato Í, Batista Joao R, Machado de Campos B, Rabelo de Brito M, Bechelli JF, Santos Silva LC, Ferreira Dos Santos A, Koutsodontis Machado Alvim M, Vieira Nunes Ludwig G, Rocha C, Kaue Alves Silva Souza T, Mendes MJ, Waku T, de Oliveira Boldrini V, Silva Brunetti N, Nora Baptista S, da Silva Schmitt G, Duarte de Sousa JG, Marchiori de Oliveira Cardoso TA, Schwambach Vieira A, Barbosa Santos LM, Dos Santos Farias A, Nogueira MH, Cendes F, Lin Yasuda C. Microstructural brain abnormalities, fatigue, and cognitive dysfunction after mild COVID-19. Sci Rep 2024; 14:1758. [PMID: 38242927 PMCID: PMC10798999 DOI: 10.1038/s41598-024-52005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/12/2024] [Indexed: 01/21/2024] Open
Abstract
Although some studies have shown neuroimaging and neuropsychological alterations in post-COVID-19 patients, fewer combined neuroimaging and neuropsychology evaluations of individuals who presented a mild acute infection. Here we investigated cognitive dysfunction and brain changes in a group of mildly infected individuals. We conducted a cross-sectional study of 97 consecutive subjects (median age of 41 years) without current or history of psychiatric symptoms (including anxiety and depression) after a mild infection, with a median of 79 days (and mean of 97 days) after diagnosis of COVID-19. We performed semi-structured interviews, neurological examinations, 3T-MRI scans, and neuropsychological assessments. For MRI analyses, we included a group of non-infected 77 controls. The MRI study included white matter (WM) investigation with diffusion tensor images (DTI) and functional connectivity with resting-state functional MRI (RS-fMRI). The patients reported memory loss (36%), fatigue (31%) and headache (29%). The quantitative analyses confirmed symptoms of fatigue (83% of participants), excessive somnolence (35%), impaired phonemic verbal fluency (21%), impaired verbal categorical fluency (13%) and impaired logical memory immediate recall (16%). The WM analyses with DTI revealed higher axial diffusivity values in post-infected patients compared to controls. Compared to controls, there were no significant differences in the functional connectivity of the posterior cingulum cortex. There were no significant correlations between neuropsychological scores and neuroimaging features (including DTI and RS-fMRI). Our results suggest persistent cognitive impairment and subtle white matter abnormalities in individuals mildly infected without anxiety or depression symptoms. The longitudinal analyses will clarify whether these alterations are temporary or permanent.
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Affiliation(s)
- Lucas Scardua-Silva
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Beatriz Amorim da Costa
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Ítalo Karmann Aventurato
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Rafael Batista Joao
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Brunno Machado de Campos
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
| | - Mariana Rabelo de Brito
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - José Flávio Bechelli
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Leila Camila Santos Silva
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Alan Ferreira Dos Santos
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Marina Koutsodontis Machado Alvim
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Guilherme Vieira Nunes Ludwig
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Institute of Mathematics, Statistics and Scientific Computing, University of Campinas, Campinas, Brazil
| | - Cristiane Rocha
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Molecular Genetics Laboratory, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Thierry Kaue Alves Silva Souza
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Maria Julia Mendes
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil
| | - Takeshi Waku
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil
| | | | | | - Sophia Nora Baptista
- Autoimmune Research Lab, Institute of Biology, University of Campinas, Campinas, Brazil
| | | | | | | | - André Schwambach Vieira
- Molecular Genetics Laboratory, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Autoimmune Research Lab, Institute of Biology, University of Campinas, Campinas, Brazil
| | | | | | - Mateus Henrique Nogueira
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil.
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil.
| | - Fernando Cendes
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil.
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil.
| | - Clarissa Lin Yasuda
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, Brazil.
- Department of Neurology, Clinics Hospital, University of Campinas, Campinas, Brazil.
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Salandi J, Hayden MC, Heinrichs K, Limbach M, Schultz K, Schwarzl G, Neumeister W, Loerbroks A. Can an educational intervention in the context of inpatient pulmonary rehabilitation improve asthma self-management at work? A study protocol of a randomized controlled trial. BMC Pulm Med 2024; 24:40. [PMID: 38233800 PMCID: PMC10795332 DOI: 10.1186/s12890-024-02847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Asthma self-management (e.g., trigger avoidance or correct medication use) is a cornerstone of therapy. Its successful implementation in everyday working life is determined by psychosocial working conditions, in particular by support from superiors and colleagues and the job decision latitude (i.e., when and how to carry out which tasks). To empower individuals with asthma to modify their working conditions, employees need to use certain communication skills and acquire specific knowledge. Both could be taught as part of patient education during pulmonary rehabilitation. Therefore, the aim of the planned study is the development and multicentre implementation of an education module for individuals with asthma during their rehabilitation and to generate evidence on its effectiveness. METHODS Participants (n ≥ 180) will be recruited, randomized into an intervention and a control group, trained and surveyed in two rehabilitation clinics. The intervention group will receive the supplementary patient education module "Asthma and Work" while the control group will participate in a program on " Eating behaviour" (both 2 × 50 min). The effectiveness of the intervention will be examined based on pre-post measurements (T1 and T2) and a 3-month follow-up (T3). We will consider behavioural intention (T2) and asthma self-management at work (T3) as primary outcomes. Secondary outcomes will include self-management-related knowledge, self-efficacy, number of sick days, number of exacerbations, asthma control (Asthma Control Test), asthma-related quality of life (Marks Asthma Quality of Life Questionnaire), and subjective employment prognosis (Brief Scale Measuring the Subjective Prognosis of Gainful Employment). The pre-post comparisons are to be evaluated using univariate analyses of covariance. DISCUSSION Improving asthma self-management at work could increase the work ability and social participation of employees with asthma. This could reduce costs, e.g. in terms of asthma-related sick leave. TRIAL REGISTRATION German Clinical Trials Register (ID: DRKS00031843).
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Affiliation(s)
- Julia Salandi
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Duesseldorf, Duesseldorf, Germany.
| | - Markus C Hayden
- Clinic Bad Reichenhall, Centre for Rehabilitation, Pneumology and Orthopaedics, Bad Reichenhall, Germany
| | - Katherina Heinrichs
- Institute of Health and Nursing Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Limbach
- Clinic Bad Reichenhall, Centre for Rehabilitation, Pneumology and Orthopaedics, Bad Reichenhall, Germany
| | - Konrad Schultz
- Clinic Bad Reichenhall, Centre for Rehabilitation, Pneumology and Orthopaedics, Bad Reichenhall, Germany
| | - Gabriele Schwarzl
- Clinic Bad Reichenhall, Centre for Rehabilitation, Pneumology and Orthopaedics, Bad Reichenhall, Germany
| | | | - Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Duesseldorf, Duesseldorf, Germany
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Kim Y, Bae S, Chang HH, Kim SW. Characteristics of long COVID and the impact of COVID-19 vaccination on long COVID 2 years following COVID-19 infection: prospective cohort study. Sci Rep 2024; 14:854. [PMID: 38191556 PMCID: PMC10774352 DOI: 10.1038/s41598-023-50024-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024] Open
Abstract
This prospective cohort study aimed to identify characteristics of long COVID and any potential mitigating effects of COVID-19 vaccinations in patients 24 months following COVID-19 infection. Adult patients diagnosed with COVID-19 between February 17, 2020, and March 24, 2020, were scheduled to visit the study hospital four times (6, 12, 18, and 24 months after infection) to assess their symptoms, quality of life, and mental health. Among the 235 patients, 121 (51.5%) completed the study visits. Of these, 59.5% were female, with a median age of 52 years. Mild to moderate disease severity were identified in 101 (83.4%) patients. A total of 75 participants (62.0%) were still experiencing long COVID symptoms 24 months after acute infection. Fatigue, amnesia, difficulty concentrating, and insomnia were the most common symptoms. The frequency of neuropsychiatric symptoms did not differ based on vaccination status or the number of doses received. Quality of life improved over time for the participants, but 32.2% of respondents still reported anxiety/depression at the end of the study. Overall, our cohort demonstrates that long COVID can persist up to 24 months after COVID-19 infection, affecting mental health and quality of life.
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Affiliation(s)
- Yoonjung Kim
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, 130, Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Sohyun Bae
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, 130, Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, 130, Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Shin-Woo Kim
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, 130, Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea.
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Yoon H, Dean LS, Jiyarom B, Khadka VS, Deng Y, Nerurkar VR, Chow DC, Shikuma CM, Devendra G, Koh Y, Park J. Single-cell RNA sequencing reveals characteristics of myeloid cells in post-acute sequelae of SARS-CoV-2 patients with persistent respiratory symptoms. Front Immunol 2024; 14:1268510. [PMID: 38259488 PMCID: PMC10800799 DOI: 10.3389/fimmu.2023.1268510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Background Although our understanding of the immunopathology and subsequent risk and severity of COVID-19 disease is evolving, a detailed account of immune responses that contribute to the long-term consequences of pulmonary complications in COVID-19 infection remains unclear. Few studies have detailed the immune and cytokine profiles associated with post-acute sequelae of SARS-CoV-2 infection (PASC) with persistent pulmonary symptoms. The dysregulation of the immune system that drives pulmonary sequelae in COVID-19 survivors and PASC sufferers remains largely unknown. Results To characterize the immunological features of pulmonary PASC (PPASC), we performed droplet-based single-cell RNA sequencing (scRNA-seq) to study the transcriptomic profiles of peripheral blood mononuclear cells (PBMCs) from a participant naïve to SARS-CoV-2 (Control) (n=1) and infected with SARS-CoV-2 with chronic pulmonary symptoms (PPASC) (n=2). After integrating scRNA-seq data with a naïve participant from a published dataset, 11 distinct cell populations were identified based on the expression of canonical markers. The proportion of myeloid-lineage cells ([MLCs]; CD14+/CD16+monocytes, and dendritic cells) was increased in PPASC (n=2) compared to controls (n=2). MLCs from PPASC displayed up-regulation of genes associated with pulmonary symptoms/fibrosis, while glycolysis metabolism-related genes were downregulated. Similarly, pathway analysis showed that fibrosis-related (VEGF, WNT, and SMAD) and cell death pathways were up-regulated, but immune pathways were down-regulated in PPASC. Further comparison of PPASC with scRNA-seq data with Severe COVID-19 (n=4) data demonstrated enrichment of fibrotic transcriptional signatures. In PPASC, we observed interactive VEGF ligand-receptor pairs among MLCs, and network modules in CD14+ (cluster 4) and CD16+ (Cluster 5) monocytes displayed a significant enrichment for biological pathways linked to adverse COVID-19 outcomes, fibrosis, and angiogenesis. Further analysis revealed a distinct metabolic alteration in MLCs with a down-regulation of glycolysis/gluconeogenesis in PPASC compared to SARS-CoV-2 naïve samples. Conclusion Analysis of a small scRNA-seq dataset demonstrated alterations in the immune response and cellular landscape in PPASC. The presence of elevated MLC levels and their corresponding gene signatures associated with fibrosis, immune response suppression, and altered metabolic states suggests a potential role in PPASC development.
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Affiliation(s)
- Hyundong Yoon
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Logan S. Dean
- Hawaii Center for AIDS, University of Hawai’i at Mānoa, Honolulu, HI, United States
- Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai’i at Manoa, Honolulu, HI, United States
| | - Boonyanudh Jiyarom
- Hawaii Center for AIDS, University of Hawai’i at Mānoa, Honolulu, HI, United States
| | - Vedbar S. Khadka
- Bioinformatics Core, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Mānoa, Honolulu, HI, United States
| | - Youping Deng
- Bioinformatics Core, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Mānoa, Honolulu, HI, United States
| | - Vivek R. Nerurkar
- Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai’i at Manoa, Honolulu, HI, United States
| | - Dominic C. Chow
- Hawaii Center for AIDS, University of Hawai’i at Mānoa, Honolulu, HI, United States
- Department of Medicine, John A. Burns School of Medicine, University of Hawai’i at Mānoa, Honolulu, HI, United States
| | - Cecilia M. Shikuma
- Hawaii Center for AIDS, University of Hawai’i at Mānoa, Honolulu, HI, United States
- Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai’i at Manoa, Honolulu, HI, United States
- Department of Medicine, John A. Burns School of Medicine, University of Hawai’i at Mānoa, Honolulu, HI, United States
| | - Gehan Devendra
- Department of Medicine, John A. Burns School of Medicine, University of Hawai’i at Mānoa, Honolulu, HI, United States
- Department of Pulmonary and Critical Care, Queen’s Medical Center, Honolulu, HI, United States
| | - Youngil Koh
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Juwon Park
- Hawaii Center for AIDS, University of Hawai’i at Mānoa, Honolulu, HI, United States
- Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai’i at Manoa, Honolulu, HI, United States
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Kuo PY, Chen PH, Tsai SF, Lin WL, Hung CT, Huang SM. Psychometric evaluation of an adult post-COVID-19 symptom tool: a development and validation study. Sci Rep 2024; 14:664. [PMID: 38182859 PMCID: PMC10770111 DOI: 10.1038/s41598-024-51287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/03/2024] [Indexed: 01/07/2024] Open
Abstract
The objective of this study was aimed to develop and validate an instrument for post-COVID-19 symptoms in adults. Data were collected from adults with a previous COVID-19 diagnosis in Taiwan. We developed the initial instrument through systematic review and expert feedback. Its validity was tested using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and criterion-related validity, while its reliability was tested using Cronbach's alpha. In total, 310 adults participated in this study. Examination of the EFA clearly classified a five-factor model with 24 items (Kaiser-Meyer-Olkin = 0.903; Bartlett's test of sphericity: X2 = 5242.956, df = 276, p < 0.01). The goodness of fit indices of the CFA were as follows: chi-square = 635.172 (p < 0.01), normed chi-square = 2.669, standardized root mean square residual = 0.077, root mean square error of approximation = 0.073, comparative fit index = 0.922, and Tuker and Lewis index = 0.910. The value of Cronbach's alpha coefficient for the total items was 0.941, and the values for the subscales ranged from 0.813 to 0.924. The instrument exhibited acceptable psychometric properties, proving it to be a valuable tool for evaluating post-COVID-19 symptoms in patients at hospitals.
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Affiliation(s)
- Po-Yuan Kuo
- Taipei Medical University Hospital, Taipei, Taiwan
| | - Ping-Ho Chen
- Taipei Medical University Hospital, Taipei, Taiwan
| | - Shu-Feng Tsai
- Department of Nursing, MacKay Medical College, No. 46, Section 3, Zhongzheng Road, Sanzhi District, New Taipei City, 252, Taiwan
| | - Wan-Ling Lin
- Taipei Medical University Hospital, Taipei, Taiwan
| | - Chia-Tai Hung
- Department of Nursing, MacKay Medical College, No. 46, Section 3, Zhongzheng Road, Sanzhi District, New Taipei City, 252, Taiwan
| | - Sheng-Miauh Huang
- Department of Nursing, MacKay Medical College, No. 46, Section 3, Zhongzheng Road, Sanzhi District, New Taipei City, 252, Taiwan.
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Singh A, Adam A, Aditi, Peng BH, Yu X, Zou J, Kulkarni VV, Kan P, Jiang W, Shi PY, Samir P, Cisneros I, Wang T. A Murine Model of Post-acute Neurological Sequelae Following SARS-CoV-2 Variant Infection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.03.574064. [PMID: 38260531 PMCID: PMC10802283 DOI: 10.1101/2024.01.03.574064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Viral variant is one known risk factor associated with post-acute sequelae of COVID-19 (PASC), yet the pathogenesis is largely unknown. Here, we studied SARS-CoV-2 Delta variant-induced PASC in K18-hACE2 mice. The virus replicated productively, induced robust inflammatory responses in lung and brain tissues, and caused weight loss and mortality during the acute infection. Longitudinal behavior studies in surviving mice up to 4 months post-acute infection revealed persistent abnormalities in neuropsychiatric state and motor behaviors, while reflex and sensory functions recovered over time. Surviving mice showed no detectable viral RNA in the brain and minimal neuroinflammation post-acute infection. Transcriptome analysis revealed persistent activation of immune pathways, including humoral responses, complement, and phagocytosis, and reduced levels of genes associated with ataxia telangiectasia, impaired cognitive function and memory recall, and neuronal dysfunction and degeneration. Furthermore, surviving mice maintained potent T helper 1 prone cellular immune responses and high neutralizing antibodies against Delta and Omicron variants in the periphery for months post-acute infection. Overall, infection in K18-hACE2 mice recapitulates the persistent clinical symptoms reported in long COVID patients and may be useful for future assessment of the efficacy of vaccines and therapeutics against SARS-CoV-2 variants.
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45
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Chuang HJ, Lin CW, Hsiao MY, Wang TG, Liang HW. Long COVID and rehabilitation. J Formos Med Assoc 2024; 123 Suppl 1:S61-S69. [PMID: 37061399 PMCID: PMC10101546 DOI: 10.1016/j.jfma.2023.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/17/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has caused tremendous morbidity and mortality worldwide. The large number of post-COVID survivors has drawn attention to the management of post-COVID condition, known as long COVID. This review examines current knowledge of long COVID, regarding its epidemiology, mechanism, and clinical presentations in both adults and children. We also review the rehabilitation principles, modules, and effects, and share Taiwan's efforts to provide a top-down, nationwide care framework for long COVID patients. Dyspnea, chronic cough, and fatigue are the most commonly reported symptoms in the first 6 months after infection, but cognitive impairment and psychological symptoms may persist beyond this time. Several possible mechanisms behind these symptoms were proposed, but remained unconfirmed. These symptoms negatively impact individuals' function, activities, participation and quality of life. Rehabilitation is a key element of management to achieve functional improvement. Early management should start with comprehensive evaluation and identification of red flags. Exercise-based therapy, an essential part of management of long COVID, can be conducted with different modules, including telerehabilitation. Post-exertional symptom exacerbation and orthostatic hypotension should be carefully monitored during exercise. Randomized control trials with a large sample size are needed to determine the optimal timing, dosage, and modules.
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Affiliation(s)
- Hung-Jui Chuang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Chia-Wei Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Huey-Wen Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan, ROC.
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46
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Aschman T, Wyler E, Baum O, Hentschel A, Rust R, Legler F, Preusse C, Meyer-Arndt L, Büttnerova I, Förster A, Cengiz D, Alves LGT, Schneider J, Kedor C, Bellmann-Strobl J, Sanchin A, Goebel HH, Landthaler M, Corman V, Roos A, Heppner FL, Radbruch H, Paul F, Scheibenbogen C, Dengler NF, Stenzel W. Post-COVID exercise intolerance is associated with capillary alterations and immune dysregulations in skeletal muscles. Acta Neuropathol Commun 2023; 11:193. [PMID: 38066589 PMCID: PMC10704838 DOI: 10.1186/s40478-023-01662-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 12/18/2023] Open
Abstract
The SARS-CoV-2 pandemic not only resulted in millions of acute infections worldwide, but also in many cases of post-infectious syndromes, colloquially referred to as "long COVID". Due to the heterogeneous nature of symptoms and scarcity of available tissue samples, little is known about the underlying mechanisms. We present an in-depth analysis of skeletal muscle biopsies obtained from eleven patients suffering from enduring fatigue and post-exertional malaise after an infection with SARS-CoV-2. Compared to two independent historical control cohorts, patients with post-COVID exertion intolerance had fewer capillaries, thicker capillary basement membranes and increased numbers of CD169+ macrophages. SARS-CoV-2 RNA could not be detected in the muscle tissues. In addition, complement system related proteins were more abundant in the serum of patients with PCS, matching observations on the transcriptomic level in the muscle tissue. We hypothesize that the initial viral infection may have caused immune-mediated structural changes of the microvasculature, potentially explaining the exercise-dependent fatigue and muscle pain.
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Affiliation(s)
- Tom Aschman
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
| | - Emanuel Wyler
- Max Delbrück Center for Molecular Medicine, Berlin Institute for Medical Systems Biology, Berlin, Germany
| | - Oliver Baum
- Institute of Physiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Andreas Hentschel
- Leibniz-Institut Für Analytische Wissenschaften - ISAS - E.V, Dortmund, Germany
| | - Rebekka Rust
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Franziska Legler
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Corinna Preusse
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Lil Meyer-Arndt
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ivana Büttnerova
- Department of Autoimmune Diagnostics, Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
| | - Alexandra Förster
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Derya Cengiz
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Julia Schneider
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Claudia Kedor
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Judith Bellmann-Strobl
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Aminaa Sanchin
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Department of Neuropathology, Universitätsmedizin Mainz, Mainz, Germany
| | - Markus Landthaler
- Max Delbrück Center for Molecular Medicine, Berlin Institute for Medical Systems Biology, Berlin, Germany
- Institute for Biology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Victor Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Andreas Roos
- Department of Pediatric Neurology, Faculty of Medicine, University Children's Hospital, University of Duisburg-Essen, Essen, Germany
- Department of Neurology Bergmannsheil, Heimer-Institut Für Muskelforschung am Bergmannsheil, Bochum, Germany
| | - Frank L Heppner
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Cluster of Excellence, NeuroCure, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - Helena Radbruch
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Nora F Dengler
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Shi Y, Strobl R, Apfelbacher C, Bahmer T, Geisler R, Heuschmann P, Horn A, Hoven H, Keil T, Krawczak M, Krist L, Lemhöfer C, Lieb W, Lorenz-Depiereux B, Mikolajczyk R, Montellano FA, Reese JP, Schreiber S, Skoetz N, Störk S, Vehreschild JJ, Witzenrath M, Grill E. Persistent symptoms and risk factors predicting prolonged time to symptom-free after SARS‑CoV‑2 infection: an analysis of the baseline examination of the German COVIDOM/NAPKON-POP cohort. Infection 2023; 51:1679-1694. [PMID: 37231313 PMCID: PMC10212223 DOI: 10.1007/s15010-023-02043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE We aimed to assess symptoms in patients after SARS-CoV-2 infection and to identify factors predicting prolonged time to symptom-free. METHODS COVIDOM/NAPKON-POP is a population-based prospective cohort of adults whose first on-site visits were scheduled ≥ 6 months after a positive SARS-CoV-2 PCR test. Retrospective data including self-reported symptoms and time to symptom-free were collected during the survey before a site visit. In the survival analyses, being symptom-free served as the event and time to be symptom-free as the time variable. Data were visualized with Kaplan-Meier curves, differences were tested with log-rank tests. A stratified Cox proportional hazard model was used to estimate adjusted hazard ratios (aHRs) of predictors, with aHR < 1 indicating a longer time to symptom-free. RESULTS Of 1175 symptomatic participants included in the present analysis, 636 (54.1%) reported persistent symptoms after 280 days (SD 68) post infection. 25% of participants were free from symptoms after 18 days [quartiles: 14, 21]. Factors associated with prolonged time to symptom-free were age 49-59 years compared to < 49 years (aHR 0.70, 95% CI 0.56-0.87), female sex (aHR 0.78, 95% CI 0.65-0.93), lower educational level (aHR 0.77, 95% CI 0.64-0.93), living with a partner (aHR 0.81, 95% CI 0.66-0.99), low resilience (aHR 0.65, 95% CI 0.47-0.90), steroid treatment (aHR 0.22, 95% CI 0.05-0.90) and no medication (aHR 0.74, 95% CI 0.62-0.89) during acute infection. CONCLUSION In the studied population, COVID-19 symptoms had resolved in one-quarter of participants within 18 days, and in 34.5% within 28 days. Over half of the participants reported COVID-19-related symptoms 9 months after infection. Symptom persistence was predominantly determined by participant's characteristics that are difficult to modify.
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Affiliation(s)
- Yanyan Shi
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Marchioninistr. 15, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Marchioninistr. 15, 81377, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel (UKSH Kiel), Kiel, Germany
| | - Ramsia Geisler
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt Am Main, Germany
| | - Peter Heuschmann
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Anna Horn
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
| | - Hanno Hoven
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Keil
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, University Hospital Jena, Jena, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bettina Lorenz-Depiereux
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- German Centre for Mental Health, Site Jena-Magdeburg-Halle, Halle, Germany
| | - Felipe A Montellano
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Jens Peter Reese
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
| | - Stefan Schreiber
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel (UKSH Kiel), Kiel, Germany
| | - Nicole Skoetz
- Evidence-Based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center and Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Jörg Janne Vehreschild
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt Am Main, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn‑Cologne, Cologne, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Giessen, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Marchioninistr. 15, 81377, Munich, Germany.
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany.
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48
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Schauenburg H. Post-COVID and ME/CFS - DoWe Need New Disease Theories? ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2023; 69:304-315. [PMID: 37830884 DOI: 10.13109/zptm.2023.69.oa7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Background and Research Question: The SARS-CoV-2 pandemic often resulted in prolonged illness courses. A particular challenge today lies in the clinical presentation resembling that of Myalgic Encephalitis/Chronic Fatigue Syndrome (ME/CFS). Method: We review selected literature concerning the psychosocial factors influencing chronic courses characterized primarily by fatigue. Additionally, we explore the neurobiologically grounded theory of "Predictive Coding" as a possible explanatory framework for complex somato- psychic interactions. Results: Physical findings only partially account for the dynamics and progression of chronic fatigue syndromes, necessitating more intricate disease models that incorporate aspects of bodily perception. Conclusions: Incorporating these newer theories of perception and behavior could provide a more helpful perspective on phenomena such as fatigue, leading to improved therapeutic support measures, all without contributing to premature attributions of "psychological" causes and the associated risk of stigmatization.
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Affiliation(s)
- Henning Schauenburg
- Heidelberg Institute for Psychotherapy at the Department of General Internal Medicine and Psychosomatics University of Heidelberg Vossstr. 9 69115 Heidelberg Deutschland
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49
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Kuchler T, Günthner R, Ribeiro A, Hausinger R, Streese L, Wöhnl A, Kesseler V, Negele J, Assali T, Carbajo-Lozoya J, Lech M, Schneider H, Adorjan K, Stubbe HC, Hanssen H, Kotilar K, Haller B, Heemann U, Schmaderer C. Persistent endothelial dysfunction in post-COVID-19 syndrome and its associations with symptom severity and chronic inflammation. Angiogenesis 2023; 26:547-563. [PMID: 37507580 PMCID: PMC10542303 DOI: 10.1007/s10456-023-09885-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Post-COVID-19 syndrome (PCS) is a lingering disease with ongoing symptoms such as fatigue and cognitive impairment resulting in a high impact on the daily life of patients. Understanding the pathophysiology of PCS is a public health priority, as it still poses a diagnostic and treatment challenge for physicians. METHODS In this prospective observational cohort study, we analyzed the retinal microcirculation using Retinal Vessel Analysis (RVA) in a cohort of patients with PCS and compared it to an age- and gender-matched healthy cohort (n = 41, matched out of n = 204). MEASUREMENTS AND MAIN RESULTS PCS patients exhibit persistent endothelial dysfunction (ED), as indicated by significantly lower venular flicker-induced dilation (vFID; 3.42% ± 1.77% vs. 4.64% ± 2.59%; p = 0.02), narrower central retinal artery equivalent (CRAE; 178.1 [167.5-190.2] vs. 189.1 [179.4-197.2], p = 0.01) and lower arteriolar-venular ratio (AVR; (0.84 [0.8-0.9] vs. 0.88 [0.8-0.9], p = 0.007). When combining AVR and vFID, predicted scores reached good ability to discriminate groups (area under the curve: 0.75). Higher PCS severity scores correlated with lower AVR (R = - 0.37 p = 0.017). The association of microvascular changes with PCS severity were amplified in PCS patients exhibiting higher levels of inflammatory parameters. CONCLUSION Our results demonstrate that prolonged endothelial dysfunction is a hallmark of PCS, and impairments of the microcirculation seem to explain ongoing symptoms in patients. As potential therapies for PCS emerge, RVA parameters may become relevant as clinical biomarkers for diagnosis and therapy management. TRIAL REGISTRATION This study was previously registered at ClinicalTrials ("All Eyes on PCS-Analysis of the Retinal Microvasculature in Patients with Post-COVID-19 Syndrome". NCT05635552. https://clinicaltrials.gov/ct2/show/NCT05635552 ). Persistent endothelial dysfunction in post-COVID-19 syndrome. Acute SARS-CoV-2 infection indirectly or directly causes endotheliitis in patients. N = 41 PCS patients were recruited and retinal vessel analysis was performed to assess microvascular endothelial function. Images of SVA and DVA are illustrative for RVA data analysis. For each PCS patient and healthy cohort, venular vessel diameter of the three measurement cycles was calculated and plotted on a diameter-time curve. Patients exhibited reduced flicker-induced dilation in veins (vFID) measured by dynamic vessel analysis (DVA) and lower central retinal arteriolar equivalent (CRAE) and arteriolar-venular ratio (AVR) and a tendency towards higher central retinal venular equivalent (CRVE) when compared to SARS-CoV-2 infection naïve participants. Created with BioRender.com.
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Affiliation(s)
- Timon Kuchler
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Roman Günthner
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andrea Ribeiro
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Medizinische Klinik Und Poliklinik IV, LMU University Hospital Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Renate Hausinger
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Lukas Streese
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Anna Wöhnl
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Veronika Kesseler
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Johanna Negele
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tarek Assali
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Javier Carbajo-Lozoya
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Maciej Lech
- Medizinische Klinik Und Poliklinik IV, LMU University Hospital Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Heike Schneider
- School of Medicine, Klinikum Rechts Der Isar, Department of Clinical Chemistry and Pathobiochemistry, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Hans Christian Stubbe
- Medizinische Klinik Und Poliklinik II, LMU University Hospital Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, University of Basel, Basel, Switzerland
| | - Konstantin Kotilar
- Aachen University of Applied Sciences, Heinrich-Mussmann-Str. 1, 52428, Jülich, Germany
| | - Bernhard Haller
- School of Medicine, Institute for AI and Informatics in Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Uwe Heemann
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christoph Schmaderer
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
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50
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Lushington GH, Linde A, Melgarejo T. Bacterial Proteases as Potentially Exploitable Modulators of SARS-CoV-2 Infection: Logic from the Literature, Informatics, and Inspiration from the Dog. BIOTECH 2023; 12:61. [PMID: 37987478 PMCID: PMC10660736 DOI: 10.3390/biotech12040061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/19/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023] Open
Abstract
(1) Background: The COVID-19 pandemic left many intriguing mysteries. Retrospective vulnerability trends tie as strongly to odd demographics as to exposure profiles, genetics, health, or prior medical history. This article documents the importance of nasal microbiome profiles in distinguishing infection rate trends among differentially affected subgroups. (2) Hypothesis: From a detailed literature survey, microbiome profiling experiments, bioinformatics, and molecular simulations, we propose that specific commensal bacterial species in the Pseudomonadales genus confer protection against SARS-CoV-2 infections by expressing proteases that may interfere with the proteolytic priming of the Spike protein. (3) Evidence: Various reports have found elevated Moraxella fractions in the nasal microbiomes of subpopulations with higher resistance to COVID-19 (e.g., adolescents, COVID-19-resistant children, people with strong dietary diversity, and omnivorous canines) and less abundant ones in vulnerable subsets (the elderly, people with narrower diets, carnivorous cats and foxes), along with bioinformatic evidence that Moraxella bacteria express proteases with notable homology to human TMPRSS2. Simulations suggest that these proteases may proteolyze the SARS-CoV-2 spike protein in a manner that interferes with TMPRSS2 priming.
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Affiliation(s)
| | - Annika Linde
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA 91766, USA;
| | - Tonatiuh Melgarejo
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA 91766, USA;
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