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Jang S, Hong W, Moon Y. Obesity-compromised immunity in post-COVID-19 condition: a critical control point of chronicity. Front Immunol 2024; 15:1433531. [PMID: 39188722 PMCID: PMC11345197 DOI: 10.3389/fimmu.2024.1433531] [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: 05/16/2024] [Accepted: 07/25/2024] [Indexed: 08/28/2024] Open
Abstract
Post-COVID-19 condition is recognized as a multifactorial disorder, with persistent presence of viral antigens, discordant immunity, delayed viral clearance, and chronic inflammation. Obesity has emerged as an independent risk factor for both SARS-CoV-2 infection and its subsequent sequelae. In this study, we aimed to predict the molecular mechanisms linking obesity and post-COVID-19 distress. Viral antigen-exposed adipose tissues display remarkable levels of viral receptors, facilitating viral entry, deposition, and chronic release of inflammatory mediators and cells in patients. Subsequently, obesity-associated inflammatory insults are predicted to disturb cellular and humoral immunity by triggering abnormal cell differentiation and lymphocyte exhaustion. In particular, the decline in SARS-CoV-2 antibody titers and T-cell exhaustion due to chronic inflammation may account for delayed virus clearance and persistent activation of inflammatory responses. Taken together, obesity-associated defective immunity is a critical control point of intervention against post-COVID-19 progression, particularly in subjects with chronic metabolic distress.
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Affiliation(s)
- Soonwoo Jang
- Laboratory of Mucosal Exposome and Biomodulation, Department of Integrative Biomedical Sciences, Pusan National University, Yangsan, Republic of Korea
- Department of Medicine, Pusan National University, Yangsan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Yangsan, Republic of Korea
| | - Wooyoung Hong
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, United States
| | - Yuseok Moon
- Laboratory of Mucosal Exposome and Biomodulation, Department of Integrative Biomedical Sciences, Pusan National University, Yangsan, Republic of Korea
- Department of Medicine, Pusan National University, Yangsan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Yangsan, Republic of Korea
- Graduate Program of Genomic Data Sciences, Pusan National University, Yangsan, Republic of Korea
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2
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Wang Y, Su B, Alcalde-Herraiz M, Barclay NL, Tian Y, Li C, Wareham NJ, Paredes R, Xie J, Prieto-Alhambra D. Modifiable lifestyle factors and the risk of post-COVID-19 multisystem sequelae, hospitalization, and death. Nat Commun 2024; 15:6363. [PMID: 39075060 PMCID: PMC11286928 DOI: 10.1038/s41467-024-50495-7] [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: 03/03/2024] [Accepted: 07/09/2024] [Indexed: 07/31/2024] Open
Abstract
Effective prevention strategies for post-COVID complications are crucial for patients, clinicians, and policy makers to mitigate their cumulative burden. This study evaluated the association of modifiable lifestyle factors (smoking, alcohol intake, BMI, physical activity, sedentary time, sleep duration, and dietary habits) with COVID-19 multisystem sequelae, death, and hospitalization in the UK Biobank cohort (n = 68,896). A favorable lifestyle (6-10 healthy factors; 46.4%) was associated with a 36% lower risk of multisystem sequelae (HR, 0.64; 95% CI, 0.58-0.69; ARR at 210 days, 7.08%; 95% CI, 5.98-8.09) compared to an unfavorable lifestyle (0-4 factors; 12.3%). Risk reductions spanned all 10 organ systems, including cardiovascular, coagulation, metabolic, gastrointestinal, kidney, mental health, musculoskeletal, respiratory disorders, and fatigue. This beneficial effect was largely attributable to direct lifestyle impacts independent of corresponding pre-infection comorbidities (71% for any sequelae). A favorable lifestyle was also related to the risk of post-COVID death (HR 0.59, 0.52-0.66) and hospitalization (HR 0.78, 0.73-0.84). These associations persisted across acute and post-acute infection phases, irrespective of hospitalization status, vaccination, or SARS-CoV-2 variant. These findings underscore the clinical and public health importance of adhering to a healthy lifestyle in mitigating long-term COVID-19 adverse impacts and enhancing future pandemic preparedness.
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Affiliation(s)
- Yunhe Wang
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Binbin Su
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Marta Alcalde-Herraiz
- Centre for Statistics in Medicine and NIHR Biomedical Research Centre Oxford, NDORMS, University of Oxford, Oxford, UK
| | - Nicola L Barclay
- Centre for Statistics in Medicine and NIHR Biomedical Research Centre Oxford, NDORMS, University of Oxford, Oxford, UK
| | - Yaohua Tian
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunxiao Li
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Roger Paredes
- Department of Infectious Diseases & irsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Catalonia, Spain
- Center for Global Health and Diseases, Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, US
| | - Junqing Xie
- Centre for Statistics in Medicine and NIHR Biomedical Research Centre Oxford, NDORMS, University of Oxford, Oxford, UK.
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine and NIHR Biomedical Research Centre Oxford, NDORMS, University of Oxford, Oxford, UK
- Department of Medical Informatics, Erasmus Medical Center University, Rotterdam, Netherlands
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3
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Hung CT, Hung YC, Suk CW. Prevalence and characteristics in long COVID among adults with asthma in the United States. J Asthma 2024; 61:736-744. [PMID: 38190281 DOI: 10.1080/02770903.2024.2303756] [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: 12/08/2023] [Accepted: 01/07/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVE The purpose of this study was to assess: (1) the prevalence of long COVID by asthma status, and (2) the characteristics associated with developing long COVID among adults with asthma in the United States. METHODS Data from the 2022 National Health Interview Survey were used. The prevalence of long COVID was reported and stratified by asthma status. The multivariable logistic regression model was conducted to identify the factors associated with developing long COVID. RESULTS In 2022, the overall prevalence of long COVID among U.S. adults was 6.9%. When stratified by asthma status, the prevalence of long COVID was 13.9% among adults with asthma, and 6.2% among adults without asthma. Among adults with asthma, certain characteristics, including age over 55 years, female sex, obesity, problems paying medical bills and a history of asthma attacks, were significantly associated with developing long COVID. CONCLUSIONS This study revealed that the prevalence of long COVID among adults with asthma was much higher than the general adult population in the United States. The limited validity of the collected information in this study should prompt caution when interpreting our findings. Further studies on the association between asthma and long COVID could be valuable for the clinical practice.
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Affiliation(s)
- Chun-Tse Hung
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chien Hung
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chi-Won Suk
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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4
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Grutman AJ, Gilliam K, Maremanda AP, Able C, Choi U, Alshak MN, Kohn TP. Comparing risk of post infection erectile dysfunction following SARS Coronavirus 2 stratified by acute and long COVID, hospitalization status, and vasopressor administration: a U.S. large claims database analysis. Int J Impot Res 2024:10.1038/s41443-024-00913-7. [PMID: 38822168 DOI: 10.1038/s41443-024-00913-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/27/2024] [Accepted: 05/13/2024] [Indexed: 06/02/2024]
Abstract
No study has yet assessed the risk of developing erectile dysfunction (ED) after a diagnosis of long COVID, defined by the Centers for Disease Control and Prevention as the persistence or presence of new symptoms at least 4 weeks after initial SARS-CoV-2 infection, when compared to those diagnosed with acute COVID or cases in which more severe treatment is required. To assess these risks, we queried the TriNetX COVID-19 Research Network from December 1st 2020 through June 2023. Men aged ≥ 18 diagnosed with long COVID were compared to those diagnosed with acute COVID and analyses were performed to compare men who were/were not hospitalized within 1 month of acute COVID diagnosis and men who did/did not need vasopressors. Cohorts were propensity score matched and compared for differences in new ED diagnosis and/or prescription of phosphodiesterase-5 inhibitors (PDE5i). After propensity score matching, the long and acute COVID cohorts included 2839 men with an average age of 54.5±16.7 and 55.1±17.1 years respectively (p = 0.21). Men with long COVID were more likely to develop ED or be prescribed PDE5i (3.63%) when compared to men with only acute COVID infections (2.61%) [RR 1.39; 95% CI 1.04, 1.87]. There was no statistically significant risk of developing ED or being prescribed PDE5i for individuals who received vasopressors [RR 0.92; 95% CI 0.77,1.10] or were hospitalized [RR 0.93; 95% CI 0.82,1.06].
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Affiliation(s)
- Aurora J Grutman
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelli Gilliam
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX, USA
| | - Ankith P Maremanda
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Corey Able
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX, USA
| | - Una Choi
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark N Alshak
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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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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Wu X, Xiang M, Jing H, Wang C, Novakovic VA, Shi J. Damage to endothelial barriers and its contribution to long COVID. Angiogenesis 2024; 27:5-22. [PMID: 37103631 PMCID: PMC10134732 DOI: 10.1007/s10456-023-09878-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/16/2023] [Indexed: 04/28/2023]
Abstract
The world continues to contend with COVID-19, fueled by the emergence of viral variants. At the same time, a subset of convalescent individuals continues to experience persistent and prolonged sequelae, known as long COVID. Clinical, autopsy, animal and in vitro studies all reveal endothelial injury in acute COVID-19 and convalescent patients. Endothelial dysfunction is now recognized as a central factor in COVID-19 progression and long COVID development. Different organs contain different types of endothelia, each with specific features, forming different endothelial barriers and executing different physiological functions. Endothelial injury results in contraction of cell margins (increased permeability), shedding of glycocalyx, extension of phosphatidylserine-rich filopods, and barrier damage. During acute SARS-CoV-2 infection, damaged endothelial cells promote diffuse microthrombi and destroy the endothelial (including blood-air, blood-brain, glomerular filtration and intestinal-blood) barriers, leading to multiple organ dysfunction. During the convalescence period, a subset of patients is unable to fully recover due to persistent endothelial dysfunction, contributing to long COVID. There is still an important knowledge gap between endothelial barrier damage in different organs and COVID-19 sequelae. In this article, we mainly focus on these endothelial barriers and their contribution to long COVID.
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Affiliation(s)
- Xiaoming Wu
- Department of Hematology, The First Hospital, Harbin Medical University, 150001, Harbin, China
| | - Mengqi Xiang
- Department of Hematology, The First Hospital, Harbin Medical University, 150001, Harbin, China
| | - Haijiao Jing
- Department of Hematology, The First Hospital, Harbin Medical University, 150001, Harbin, China
| | - Chengyue Wang
- Department of Hematology, The First Hospital, Harbin Medical University, 150001, Harbin, China
| | - Valerie A Novakovic
- Department of Research, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA
| | - Jialan Shi
- Department of Hematology, The First Hospital, Harbin Medical University, 150001, Harbin, China.
- Department of Research, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, MA, Boston, USA.
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7
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Cojocaru DC, Mitu F, Leon MM, Dima-Cozma LC, Adam CA, Cumpăt CM, Negru RD, Maștaleru A, Onofrei V. Beyond the Acute Phase: Long-Term Impact of COVID-19 on Functional Capacity and Prothrombotic Risk-A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:51. [PMID: 38256314 PMCID: PMC10819578 DOI: 10.3390/medicina60010051] [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: 11/22/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Assessment of the prothrombotic, proinflammatory, and functional status of a cohort of COVID-19 patients at least two years after the acute infection to identify parameters with potential therapeutic and prognostic value. Materials and Methods: We conducted a retrospective, descriptive study that included 117 consecutive patients admitted to Iasi Pulmonary Rehabilitation Clinic for reassessment and a rehabilitation program at least two years after a COVID-19 infection. The cohort was divided into two groups based on the presence (n = 49) or absence (n = 68) of pulmonary fibrosis, documented through high-resolution computer tomography. Results: The cohort comprises 117 patients, 69.23% females, with a mean age of 65.74 ± 10.19 years and abnormal body mass index (31.42 ± 5.71 kg/m2). Patients with pulmonary fibrosis have significantly higher levels of C-reactive protein (CRP) (p < 0.05), WBC (7.45 ± 7.86/mm3 vs. 9.18 ± 17.24/mm3, p = 0.053), neutrophils (4.68 ± 7.88/mm3 vs. 9.07 ± 17.44/mm3, p < 0.05), mean platelet volume (MPV) (7.22 ± 0.93 vs. 10.25 ± 0.86 fL, p < 0.05), lactate dehydrogenase (p < 0.05), and D-dimers (p < 0.05), but not ferritin (p = 0.470), reflecting the chronic proinflammatory and prothrombotic status. Additionally, patients with associated pulmonary fibrosis had a higher mean heart rate (p < 0.05) and corrected QT interval (p < 0.05). D-dimers were strongly and negatively correlated with diffusion capacity corrected for hemoglobin (DLCO corr), and ROC analysis showed that the persistence of high D-dimers values is a predictor for low DLCO values (ROC analysis: area under the curve of 0.772, p < 0.001). The results of pulmonary function tests (spirometry, body plethysmography) and the 6-minute walk test demonstrated no significant difference between groups, without notable impairment within either group. Conclusions: Patients with COVID-19-related pulmonary fibrosis have a persistent long-term proinflammatory, prothrombotic status, despite the functional recovery. The persistence of elevated D-dimer levels could emerge as a predictive factor associated with impaired DLCO.
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Affiliation(s)
- Doina-Clementina Cojocaru
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular and Respiratory Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular and Respiratory Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
- Academy of Medical Sciences, 030167 Bucharest, Romania
- Academy of Romanian Scientists, 700050 Iasi, Romania
| | - Maria-Magdalena Leon
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular and Respiratory Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Lucia Corina Dima-Cozma
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular and Respiratory Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Cristina Andreea Adam
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular and Respiratory Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Carmen Marinela Cumpăt
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular and Respiratory Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Robert D. Negru
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular and Respiratory Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Alexandra Maștaleru
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular and Respiratory Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Viviana Onofrei
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, Cardiology Department Independence Boulevard No. 1, 700111 Iasi, Romania
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Liu TH, Huang PY, Wu JY, Chuang MH, Hsu WH, Tsai YW, Kao PH, Lai CC. Post-COVID-19 condition risk in patients with intellectual and developmental disabilities: a retrospective cohort study involving 36,308 patients. BMC Med 2023; 21:505. [PMID: 38114989 PMCID: PMC10731815 DOI: 10.1186/s12916-023-03216-8] [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: 08/02/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND To date, no studies have investigated the prevalence of post-COVID-19 conditions in patients with Intellectual and Developmental Disabilities (IDD). Addressing this research gap is crucial, as understanding post-COVID-19 conditions in IDD patients can improve care planning, and it is essential not to overlook this vulnerable population in COVID-19 studies. This study was aimed at investigating the prevalence of post-COVID-19 conditions in patients with IDD and compare their risk with that of the general population. METHODS Using the TriNetX network, we identified patients with and without an IDD who had COVID-19. Subsequently, we compared the risk of developing any post-COVID-19 condition between these two groups, during the 90-180-day follow-up after SARS-CoV-2 infection. RESULTS During the follow-up, patients with an IDD exhibited a significantly higher prevalence of post-COVID-19 conditions compared to the general population (hazard ratio [HR], 1.120; 95% confidence interval [CI]: 1.053-1.191). Specifically, COVID-19 survivors with IDD had a significantly increased risk of experiencing abnormal breathing (HR, 1.216; 95% CI: 1.077-1.373), abdominal symptoms (HR, 1.259; 95% CI: 1.128-1.406), fatigue (HR, 1.397; 95% CI: 1.216-1.606), anxiety/depression (HR, 1.157; 95% CI: 1.050-1.274), cognitive symptoms (HR, 1.828; 95% CI: 1.529-2.186), myalgia (HR, 1.325; 95% CI: 1.077-1.631), sleep disturbances (HR, 1.481; 95% CI: 1.148-1.910), and cough (HR, 1.315; 95% CI: 1.146-1.508) compared to the non-IDD group. CONCLUSIONS Patients with IDD might be associated with a higher risk of post-COVID-19 conditions following SARS-CoV-2 infection compared to the general population.
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Affiliation(s)
- Ting-Hui Liu
- Department of Psychiatry, Chi Mei Medical Center, No 901, Chunghwa Road, Yongkang District, Tainan City 710, Taiwan
| | - Po-Yu Huang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan
| | - Min-Hsiang Chuang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Wan-Hsuan Hsu
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ya-Wen Tsai
- Center for Integrative Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Pei-Hsin Kao
- Department of Psychiatry, Chi Mei Medical Center, No 901, Chunghwa Road, Yongkang District, Tainan City 710, Taiwan.
- Department of Geriatric Psychiatry, Chi-Mei Medical Center, Tainan, Taiwan.
| | - Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan.
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Krishna B, Wills M, Sithole N. Long COVID: what is known and what gaps need to be addressed. Br Med Bull 2023; 147:6-19. [PMID: 37434326 PMCID: PMC10502447 DOI: 10.1093/bmb/ldad016] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 05/12/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Long COVID is a chronic condition that follows after acute COVID-19 and is characterized by a wide range of persistent, cyclic symptoms. SOURCES OF DATA PubMed search for publications featuring 'Long COVID' or 'post-acute sequelae of COVID-19'. AREAS OF AGREEMENT Long COVID occurs frequently post-acute COVID-19, with a majority of people experiencing at least one symptom (such as cough, fatigue, myalgia, anosmia and dyspnoea) 4 weeks after infection. AREAS OF CONTROVERSY The specific symptoms and the minimum duration of symptoms required to be defined as Long COVID. GROWING POINTS There is a consistent reduction in Long COVID incidence amongst vaccinated individuals, although the extent of this effect remains unclear. AREAS TIMELY FOR DEVELOPING RESEARCH There is an urgent need to understand the causes of Long COVID, especially extreme fatigue more than 6 months after infection. We must understand who is at risk and whether reinfections similarly risk Long COVID.
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Affiliation(s)
- Benjamin Krishna
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge CB2 0AW, UK
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Mark Wills
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge CB2 0AW, UK
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Nyaradzai Sithole
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge CB2 0AW, UK
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
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10
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Singh SJ, Baldwin MM, Daynes E, Evans RA, Greening NJ, Jenkins RG, Lone NI, McAuley H, Mehta P, Newman J, Novotny P, Smith DJF, Stanel S, Toshner M, Brightling CE. Respiratory sequelae of COVID-19: pulmonary and extrapulmonary origins, and approaches to clinical care and rehabilitation. THE LANCET. RESPIRATORY MEDICINE 2023; 11:709-725. [PMID: 37216955 PMCID: PMC10198676 DOI: 10.1016/s2213-2600(23)00159-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023]
Abstract
Although the exact prevalence of post-COVID-19 condition (also known as long COVID) is unknown, more than a third of patients with COVID-19 develop symptoms that persist for more than 3 months after SARS-CoV-2 infection. These sequelae are highly heterogeneous in nature and adversely affect multiple biological systems, although breathlessness is a frequently cited symptom. Specific pulmonary sequelae, including pulmonary fibrosis and thromboembolic disease, need careful assessment and might require particular investigations and treatments. COVID-19 outcomes in people with pre-existing respiratory conditions vary according to the nature and severity of the respiratory disease and how well it is controlled. Extrapulmonary complications such as reduced exercise tolerance and frailty might contribute to breathlessness in post-COVID-19 condition. Non-pharmacological therapeutic options, including adapted pulmonary rehabilitation programmes and physiotherapy techniques for breathing management, might help to attenuate breathlessness in people with post-COVID-19 condition. Further research is needed to understand the origins and course of respiratory symptoms and to develop effective therapeutic and rehabilitative strategies.
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Affiliation(s)
- Sally J Singh
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK.
| | - Molly M Baldwin
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Enya Daynes
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Rachael A Evans
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Neil J Greening
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - R Gisli Jenkins
- Imperial College London National Heart and Lung Institute, London, UK
| | - Nazir I Lone
- Department of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Hamish McAuley
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, UK
| | - Joseph Newman
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Petr Novotny
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | | | - Stefan Stanel
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Mark Toshner
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Christopher E Brightling
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
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11
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Tsampasian V, Elghazaly H, Chattopadhyay R, Debski M, Naing TKP, Garg P, Clark A, Ntatsaki E, Vassiliou VS. Risk Factors Associated With Post-COVID-19 Condition: A Systematic Review and Meta-analysis. JAMA Intern Med 2023; 183:566-580. [PMID: 36951832 PMCID: PMC10037203 DOI: 10.1001/jamainternmed.2023.0750] [Citation(s) in RCA: 242] [Impact Index Per Article: 242.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/19/2023] [Indexed: 03/24/2023]
Abstract
Importance Post-COVID-19 condition (PCC) is a complex heterogeneous disorder that has affected the lives of millions of people globally. Identification of potential risk factors to better understand who is at risk of developing PCC is important because it would allow for early and appropriate clinical support. Objective To evaluate the demographic characteristics and comorbidities that have been found to be associated with an increased risk of developing PCC. Data sources Medline and Embase databases were systematically searched from inception to December 5, 2022. Study Selection The meta-analysis included all published studies that investigated the risk factors and/or predictors of PCC in adult (≥18 years) patients. Data Extraction and Synthesis Odds ratios (ORs) for each risk factor were pooled from the selected studies. For each potential risk factor, the random-effects model was used to compare the risk of developing PCC between individuals with and without the risk factor. Data analyses were performed from December 5, 2022, to February 10, 2023. Main Outcomes and Measures The risk factors for PCC included patient age; sex; body mass index, calculated as weight in kilograms divided by height in meters squared; smoking status; comorbidities, including anxiety and/or depression, asthma, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, immunosuppression, and ischemic heart disease; previous hospitalization or ICU (intensive care unit) admission with COVID-19; and previous vaccination against COVID-19. Results The initial search yielded 5334 records of which 255 articles underwent full-text evaluation, which identified 41 articles and a total of 860 783 patients that were included. The findings of the meta-analysis showed that female sex (OR, 1.56; 95% CI, 1.41-1.73), age (OR, 1.21; 95% CI, 1.11-1.33), high BMI (OR, 1.15; 95% CI, 1.08-1.23), and smoking (OR, 1.10; 95% CI, 1.07-1.13) were associated with an increased risk of developing PCC. In addition, the presence of comorbidities and previous hospitalization or ICU admission were found to be associated with high risk of PCC (OR, 2.48; 95% CI, 1.97-3.13 and OR, 2.37; 95% CI, 2.18-2.56, respectively). Patients who had been vaccinated against COVID-19 with 2 doses had a significantly lower risk of developing PCC compared with patients who were not vaccinated (OR, 0.57; 95% CI, 0.43-0.76). Conclusions and Relevance This systematic review and meta-analysis demonstrated that certain demographic characteristics (eg, age and sex), comorbidities, and severe COVID-19 were associated with an increased risk of PCC, whereas vaccination had a protective role against developing PCC sequelae. These findings may enable a better understanding of who may develop PCC and provide additional evidence for the benefits of vaccination. Trial Registration PROSPERO Identifier: CRD42022381002.
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Affiliation(s)
- Vasiliki Tsampasian
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Hussein Elghazaly
- Imperial College London and Imperial College National Health Service Trust, London, UK
| | - Rahul Chattopadhyay
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Department of Cardiology, Cambridge University Hospitals, Cambridge, UK
| | - Maciej Debski
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Thin Kyi Phyu Naing
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Eleana Ntatsaki
- Department of Rheumatology, Ipswich Hospital, East Suffolk and North Essex National Health Service Foundation Trust, Ipswich, UK
- Department of Medicine, University College London, London, UK
| | - Vassilios S. Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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12
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Lulli LG, Baldassarre A, Chiarelli A, Mariniello A, Paolini D, Grazzini M, Mucci N, Arcangeli G. Physical Impact of SARS-CoV-2 Infection in a Population of Italian Healthcare Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4506. [PMID: 36901516 PMCID: PMC10002388 DOI: 10.3390/ijerph20054506] [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: 12/30/2022] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
SARS-CoV-2 infection often causes symptoms and illness that can last for months after the acute phase, i.e., so-called "Long COVID" or Post-acute COVID-19. Due to the high prevalence of SARS-CoV-2 infection among Healthcare Workers (HCWs), post-COVID-19 symptoms can be common and threaten workers' occupational health and healthcare systems' functioning. The aim of this cross-sectional, observational study was to present data related to post-COVID-19 outcomes in a population of HCWs infected by COVID-19 from October 2020 to April 2021, and to identify possible factors associated with the persistence of illness, such as gender, age, previous medical conditions, and features of acute illness. A total of 318 HCWs who had become infected by COVID-19 were examined and interviewed approximately two months after their recovery from the infection. The clinical examinations were performed by Occupational Physicians in accordance with a specific protocol at the Occupational Medicine Unit of a tertiary hospital in Italy. The mean age of the participants was 45 years old, and 66.7% of the workers were women while 33.3% were men; the sample mainly consisted of nurses (44.7%). During the medical examination, more than half of the workers mentioned that they had experienced multiple residual bouts of illness after the acute phase of infection. Men and women were similarly affected. The most reported symptom was fatigue (32.1%), followed by musculoskeletal pain (13.6%) and dyspnea (13.2%). In the multivariate analysis, dyspnea (p < 0.001) and fatigue (p < 0.001) during the acute stage of illness and the presence of any limitation in working activities, in the context of fitness for a work evaluation performed while the occupational medicine surveillance program was being conducted (p = 0.025), were independently associated with any post-COVID-19 symptoms, which were considered final outcomes. The main post-COVID-19 symptoms-dyspnea, fatigue, and musculoskeletal pain-showed significant associations with dyspnea, fatigue, and musculoskeletal pain experienced during the acute stage of infection, with the presence of limitations in working activities, and pre-existing pneumological diseases. A normal weight according to body mass index was a protective factor. The identification of vulnerable workers as those with limitations in working activities, pneumological diseases, a high BMI, and of an older age and the implementation of preventive measures are key factors for preserving Occupational Health. Fitness-to-work evaluations performed by Occupational Physicians can be considered a complex index of overall health and functionality that can identify workers who may suffer from relevant post-COVID-19 symptoms.
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Affiliation(s)
- Lucrezia Ginevra Lulli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Antonio Baldassarre
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Annarita Chiarelli
- Occupational Medicine Unit, Careggi University Hospital, 50134 Florence, Italy
| | | | - Diana Paolini
- Health Direction, Careggi University Hospital, 50134 Florence, Italy
| | | | - Nicola Mucci
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Giulio Arcangeli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
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13
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Mazibas H, Speybroeck N, Dhondt E, Lambrecht S, Goorts K. Long COVID in the Belgian Defence forces: prevalence, risk factors and impact on quality of daily functioning. BMJ Mil Health 2023:military-2022-002280. [PMID: 36828639 DOI: 10.1136/military-2022-002280] [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: 10/05/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Long COVID (LC) is a medical condition first described and documented through anecdotes on social media by patients prior to being recognised by WHO as a disease. Although >50 prolonged symptoms of LC have been described, it remains a diagnostic challenge for military providers and therefore threatens operational readiness. METHODS On 9 September 2021, an online survey was emailed to 2192 Belgian Defence personnel who had previously tested PCR positive for SARS-CoV-2 between 17 August 2020 and 31 May 2021. A total of 718 validated responses were received.Descriptive analyses determined the prevalence of LC and 10 most common symptoms and their duration following infection. In the explanatory analyses, risk factors related to LC were identified. To establish the health-related impact of LC on quality of life (HRQoL), we used the results from the EuroQol 5 Dimension 5 Level questionnaire. RESULTS The most frequent symptoms that were reported for >3 months were fatigue, lack of energy and breathing difficulties.47.35% of the respondents reported at least one persistent symptom, while 21.87% reported more than 3 symptoms lasting for at least 3 months after the initial COVID-19 infection. Most patients with LC suffered from symptoms of a neuropsychiatric nature (71.76%).LC was significantly associated with obesity; pre-existing respiratory disease and blood or immune disorders. Physical activity of >3 hours per week halved the risk of LC.The total QoL is reduced in patients with LC. Considering the five dimensions of the questionnaire, only the self-care dimension was not influenced by the presence of LC. CONCLUSIONS Almost half of Belgian Defence personnel developed LC after a confirmed COVID-19 infection, similar to numbers found in the Belgian population. Patients with LC would likely benefit from a multidisciplinary rehabilitation approach that addresses shortness of breath, fatigue and mood disturbance.
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Affiliation(s)
- Hava Mazibas
- Health & Wellbeing, Defense Belgium, Brussels, Belgium
| | - N Speybroeck
- Faculty of Public Health, Research Institute of Health and Society, UCLouvain, Louvain-la-Neuve, Belgium
| | - E Dhondt
- Health & Wellbeing (Ret.), Defense Belgium, Brussels, Belgium
| | - S Lambrecht
- Health & Wellbeing, Defense Belgium, Brussels, Belgium
| | - K Goorts
- Health & Wellbeing, Defense Belgium, Brussels, Belgium
- Department of Environment and Health, KU Leuven, Leuven, Belgium
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14
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Giannitrapani L, Mirarchi L, Amodeo S, Licata A, Soresi M, Cavaleri F, Casalicchio S, Ciulla G, Ciuppa ME, Cervello M, Barbagallo M, Veronese N. Can Baseline IL-6 Levels Predict Long COVID in Subjects Hospitalized for SARS-CoV-2 Disease? Int J Mol Sci 2023; 24:1731. [PMID: 36675242 PMCID: PMC9866804 DOI: 10.3390/ijms24021731] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/17/2023] Open
Abstract
The immune response to infection plays a crucial role in the pathogenesis of COVID-19, but several patients develop a wide range of persistent symptoms, which is becoming a major global health and economic burden. However, reliable indicators are not yet available to predict the persistence of symptoms typical of the so-called long COVID. Our study aims to explore an eventual role of IL-6 levels as a marker of long COVID. Altogether, 184 patients admitted to the COVID Medicine Unit of the University Hospital in Palermo, Italy, from the 1st of September 2020, were analyzed. Patients were divided into two groups according to the IL-6 serum levels (normal or elevated), considering the serum IL-6 levels measured during the first four days of hospitalization. In our study, higher serum IL-6 levels were associated with a doubled higher risk of long COVID (OR = 2.05; 95% CI: 1.04-4.50) and, in particular, they were associated with a higher incidence of mobility decline (OR = 2.55; 95% CI: 1.08-9.40) and PTSD (OR = 2.38; 95% CI: 1.06-8.61). The analysis of our case series confirmed the prominent role of IL-6 levels in response to SARS-CoV-2 infection, as predictors not only of COVID-19 disease severity and unfavorable outcomes, but also long COVID development trends.
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Affiliation(s)
- Lydia Giannitrapani
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy
- Institute for Biomedical Research and Innovation, National Research Council, 90146 Palermo, Italy
| | - Luigi Mirarchi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy
| | - Simona Amodeo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy
| | - Anna Licata
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy
| | - Maurizio Soresi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy
| | - Francesco Cavaleri
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy
| | - Salvatore Casalicchio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy
| | - Gregorio Ciulla
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy
| | - Maria Elena Ciuppa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy
| | - Melchiorre Cervello
- Institute for Biomedical Research and Innovation, National Research Council, 90146 Palermo, Italy
| | - Mario Barbagallo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy
| | - Nicola Veronese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy
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15
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Buonsenso D, Pazukhina E, Gentili C, Vetrugno L, Morello R, Zona M, De Matteis A, D’Ilario F, Lanni R, Rongai T, del Balzo P, Fonte MT, Valente M, De Rose C, Munblit D, Sigfrid L, Valentini P. The Prevalence, Characteristics and Risk Factors of Persistent Symptoms in Non-Hospitalized and Hospitalized Children with SARS-CoV-2 Infection Followed-Up for up to 12 Months: A Prospective, Cohort Study in Rome, Italy. J Clin Med 2022; 11:6772. [PMID: 36431250 PMCID: PMC9692851 DOI: 10.3390/jcm11226772] [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: 10/18/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
Previous studies assessing the prevalence of COVID-19 sequelae in children have included either a small number of children or a short follow-up period, or have only focused on hospitalized children. We investigated the prevalence of persistent symptoms amongst children and assessed the risk factors, including the impact of variants. A prospective cohort study included children (≤18 years old) with PCR-confirmed SARS-CoV-2 infection. The participants were assessed via telephone and face-to-face visits at 1-5, 6-9 and 12 or more months post-SARS-CoV-2 diagnosis using the ISARIC COVID-19 follow-up survey. Of the 679 children enrolled, 51% were female; 488 were infected during the wild virus wave, and 29 were infected with the Alpha, 42 with the Delta and 120 with the Omicron variants. Fatigue (19%), headache (12%), insomnia (7.5%), muscle pain (6.9%) and confusion with concentration issues (6.8%) were the most common persistent symptoms. Families reported an overall improvement over time, with 0.7% of parents interviewed at 12 months or more of the follow-up period reporting a poor recovery. Patients that had not recovered by 6-9 months had a lower probability of recovering during the next follow-up period. Children infected with a variant or the wild virus had an overall similar rate of persistent symptoms (although the pattern of reported symptoms differed significantly) and recovery rates. Conclusions: Recovery rates after SARS-CoV-2 infection improved as time passed from the initial infection, ranging from 4% of children having poor recovery at 1-5 months' follow-up to 1.3% at 6-9 months and 0.7% at 12 months. The patterns of persistence changed according to the variants involved at the time of infection. This study reinforces that a subgroup of children develop long-lasting persistent symptoms and highlights the need for further studies investigating the reasons behind the development of PCC.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e, Perioperatorie–Sezione di Microbiologia, Università Cattolica del S. Cuore, 00168 Rome, Italy
| | - Ekaterina Pazukhina
- Laboratory of Health Economics, Institute of Applied Economic Studies, The Russian Presidential Academy of National Economy and Public Administration, 127006 Moscow, Russia
- Center for Advanced Financial Planning, Macroeconomic Analysis and Financial Statistics, Financial Research Institute of the Ministry of Finance of the Russian Federation, 127006 Moscow, Russia
| | - Carolina Gentili
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Margherita Zona
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Alessia De Matteis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Federico D’Ilario
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Roberta Lanni
- Pediatra di Libera Scelta, Federazione Italiana Medici Pediatri (FIMP), 00168 Rome, Italy
| | - Teresa Rongai
- Pediatra di Libera Scelta, Federazione Italiana Medici Pediatri (FIMP), 00168 Rome, Italy
| | - Patrizia del Balzo
- Pediatra di Libera Scelta, Federazione Italiana Medici Pediatri (FIMP), 00168 Rome, Italy
| | - Maria Teresa Fonte
- Pediatra di Libera Scelta, Federazione Italiana Medici Pediatri (FIMP), 00168 Rome, Italy
| | - Michele Valente
- Pediatra di Libera Scelta, Federazione Italiana Medici Pediatri (FIMP), 00168 Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), 123337 Moscow, Russia
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London W2 1PG, UK
- Research and Clinical Center for Neuropsychiatry, 115419 Moscow, Russia
| | - Louise Sigfrid
- International Severe Acute and emerging Infection Consortium (ISARIC), Global Research Collaboration for Infectious Disease Preparedness, Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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16
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Fernández-de-las-Peñas C, Giordano R, Díaz-Gil G, Gómez-Esquer F, Ambite-Quesada S, Palomar-Gallego MA, Arendt-Nielsen L. Post-COVID Pain Is Not Associated with Inflammatory Polymorphisms in People Who Had Been Hospitalized by COVID-19. J Clin Med 2022; 11:jcm11195645. [PMID: 36233516 PMCID: PMC9570972 DOI: 10.3390/jcm11195645] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 08/31/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Our aim was to assess the association between four inflammatory polymorphisms with the development of post-COVID pain and to associate these polymorphisms with the clinical pain phenotype in individuals who had been hospitalized by COVID-19. Three potential genotypes of IL-6 (rs1800796), IL-10 (rs1800896), TNF-α (rs1800629), and IFITM3 (rs12252) single nucleotide polymorphisms (SNPs) were obtained from no-stimulated saliva samples from 293 (49.5% female, mean age: 55.6 ± 12.9 years) previously hospitalized COVID-19 survivors by polymerase chain reactions. Pain phenotyping consisted of the evaluation of pain features, sensitization-associated symptoms, anxiety levels, depressive levels, sleep quality, catastrophizing, and kinesiophobia levels in patients with post-COVID pain. Analyses were conducted to associate clinical features with genotypes. One hundred and seventeen (39.9%) patients experienced post-COVID pain 17.8 ± 5.2 months after hospital discharge. No significant differences in the distribution of the genotype variants of any SNPs were identified between COVID-19 survivors with and without post-COVID pain (all, p > 0.47). Similarly, the clinical pain phenotype was not significantly different between patients with and without post-COVID pain since no differences in any variable were observed for any SNPs. In conclusion, four SNPs associated with inflammatory and immune responses did not appear to be associated with post-COVID pain in previously hospitalized COVID-19 survivors. Further, neither of the SNPs were involved in the phenotyping features of post-COVID pain.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, 9220 Aalborg, Denmark
- Correspondence:
| | - Rocco Giordano
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Gema Díaz-Gil
- Research group GAMDES, Department of Basic Health Sciences, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain
| | - Francisco Gómez-Esquer
- Research group GAMDES, Department of Basic Health Sciences, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain
| | - Silvia Ambite-Quesada
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Maria A. Palomar-Gallego
- Research group GAMDES, Department of Basic Health Sciences, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, 9220 Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9000 Aalborg, Denmark
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17
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Li Z, Zhang J, Duan X, Zhao G, Zhang M. Celastrol: A Promising Agent Fighting against Cardiovascular Diseases. Antioxidants (Basel) 2022; 11:antiox11081597. [PMID: 36009315 PMCID: PMC9405053 DOI: 10.3390/antiox11081597] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular diseases (CVD) are leading causes of morbidity and mortality worldwide; therefore, seeking effective therapeutics to reduce the global burden of CVD has become increasingly urgent. Celastrol, a bioactive compound isolated from the roots of the plant Tripterygium wilfordii (TW), has been attracting increasing research attention in recent years, as it exerts cardiovascular treatment benefits targeting both CVD and their associated risk factors. Substantial evidence has revealed a protective role of celastrol against a broad spectrum of CVD including obesity, diabetes, atherosclerosis, cerebrovascular injury, calcific aortic valve disease and heart failure through complicated and interlinked mechanisms such as direct protection against cardiomyocyte hypertrophy and death, and indirect action on oxidation and inflammation. This review will mainly summarize the beneficial effects of celastrol against CVD, largely based on in vitro and in vivo preclinical studies, and the potential underlying mechanisms. We will also briefly discuss celastrol’s pharmacokinetic limitations, which hamper its further clinical applications, and prospective future directions.
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Affiliation(s)
- Zhexi Li
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Jingyi Zhang
- School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London British Heart Foundation Centre of Research Excellence, London SE5 9NU, UK
| | - Xulei Duan
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Guoan Zhao
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Min Zhang
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
- School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London British Heart Foundation Centre of Research Excellence, London SE5 9NU, UK
- Correspondence: ; Tel.: +44-207848-5319; Fax: +44-207848-5193
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