1
|
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.
Collapse
Affiliation(s)
| | | | | | | | | | - Sacha Satram
- Vir Biotechnology, Inc., San Francisco, CA, United States
| | | | | |
Collapse
|
2
|
Casal-Guisande M, Comesaña-Campos A, Núñez-Fernández M, Torres-Durán M, Fernández-Villar A. Proposal and Definition of an Intelligent Clinical Decision Support System Applied to the Prediction of Dyspnea after 12 Months of an Acute Episode of COVID-19. Biomedicines 2024; 12:854. [PMID: 38672208 PMCID: PMC11047904 DOI: 10.3390/biomedicines12040854] [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: 12/28/2023] [Revised: 03/01/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Long COVID is a condition that affects a significant proportion of patients who have had COVID-19. It is characterised by the persistence of associated symptoms after the acute phase of the illness has subsided. Although several studies have investigated the risk factors associated with long COVID, identifying which patients will experience long-term symptoms remains a complex task. Among the various symptoms, dyspnea is one of the most prominent due to its close association with the respiratory nature of COVID-19 and its disabling consequences. This work proposes a new intelligent clinical decision support system to predict dyspnea 12 months after a severe episode of COVID-19 based on the SeguiCovid database from the Álvaro Cunqueiro Hospital in Vigo (Galicia, Spain). The database is initially processed using a CART-type decision tree to identify the variables with the highest predictive power. Based on these variables, a cascade of expert systems has been defined with Mamdani-type fuzzy-inference engines. The rules for each system were generated using the Wang-Mendel automatic rule generation algorithm. At the output of the cascade, a risk indicator is obtained, which allows for the categorisation of patients into two groups: those with dyspnea and those without dyspnea at 12 months. This simplifies follow-up and the performance of studies aimed at those patients at risk. The system has produced satisfactory results in initial tests, supported by an AUC of 0.75, demonstrating the potential and usefulness of this tool in clinical practice.
Collapse
Affiliation(s)
- Manuel Casal-Guisande
- Fundación Pública Galega de Investigación Biomédica Galicia Sur, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (M.N.-F.); (A.F.-V.)
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain;
| | - Alberto Comesaña-Campos
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain;
- Design, Expert Systems and Artificial Intelligent Solutions Group (DESAINS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
| | - Marta Núñez-Fernández
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (M.N.-F.); (A.F.-V.)
- Pulmonary Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
| | - María Torres-Durán
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (M.N.-F.); (A.F.-V.)
- Pulmonary Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
- Centro de Investigación Biomédica en Red, CIBERES ISCIII, 28029 Madrid, Spain
| | - Alberto Fernández-Villar
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (M.N.-F.); (A.F.-V.)
- Pulmonary Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
- Centro de Investigación Biomédica en Red, CIBERES ISCIII, 28029 Madrid, Spain
| |
Collapse
|
3
|
Shenoy PU, Udupa H, KS J, Babu S, K N, Jain N, Das R, Upadhyai P. The impact of COVID-19 on pulmonary, neurological, and cardiac outcomes: evidence from a Mendelian randomization study. Front Public Health 2023; 11:1303183. [PMID: 38155884 PMCID: PMC10752946 DOI: 10.3389/fpubh.2023.1303183] [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: 09/27/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Background Long COVID is a clinical entity characterized by persistent health problems or development of new diseases, without an alternative diagnosis, following SARS-CoV-2 infection that affects a significant proportion of individuals globally. It can manifest with a wide range of symptoms due to dysfunction of multiple organ systems including but not limited to cardiovascular, hematologic, neurological, gastrointestinal, and renal organs, revealed by observational studies. However, a causal association between the genetic predisposition to COVID-19 and many post-infective abnormalities in long COVID remain unclear. Methods Here we employed Mendelian randomization (MR), a robust genetic epidemiological approach, to investigate the potential causal associations between genetic predisposition to COVID-19 and long COVID symptoms, namely pulmonary (pneumonia and airway infections including bronchitis, emphysema, asthma, and rhinitis), neurological (headache, depression, and Parkinson's disease), cardiac (heart failure and chest pain) diseases, and chronic fatigue. Using two-sample MR, we leveraged genetic data from a large COVID-19 genome-wide association study and various disorder-specific datasets. Results This analysis revealed that a genetic predisposition to COVID-19 was significantly causally linked to an increased risk of developing pneumonia, airway infections, headache, and heart failure. It also showed a strong positive correlation with chronic fatigue, a frequently observed symptom in long COVID patients. However, our findings on Parkinson's disease, depression, and chest pain were inconclusive. Conclusion Overall, these findings provide valuable insights into the genetic underpinnings of long COVID and its diverse range of symptoms. Understanding these causal associations may aid in better management and treatment of long COVID patients, thereby alleviating the substantial burden it poses on global health and socioeconomic systems.
Collapse
Affiliation(s)
- Pooja U. Shenoy
- Division of Data Analytics, Bioinformatics and Structural Biology, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - Hrushikesh Udupa
- Department of Community Medicine, Yenepoya Medical College and Hospital, Yenepoya (Deemed to be University), Mangalore, India
| | - Jyothika KS
- Department of Statistics, Yenepoya (Deemed to be University), Mangalore, India
| | - Sangeetha Babu
- Department of Statistics, Yenepoya (Deemed to be University), Mangalore, India
| | - Nikshita K
- Department of Statistics, Yenepoya (Deemed to be University), Mangalore, India
| | - Neha Jain
- Department of Statistics, Yenepoya (Deemed to be University), Mangalore, India
| | - Ranajit Das
- Division of Data Analytics, Bioinformatics and Structural Biology, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - Priyanka Upadhyai
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
4
|
Mojtahedi Z, Yoo J, Kim P, Kim Y, Shen JJ, Wang BL. Changes in characteristics of inpatient respiratory conditions from 2019 to 2021 (before and during the COVID-19 pandemic). Front Public Health 2023; 11:1268321. [PMID: 38026399 PMCID: PMC10665887 DOI: 10.3389/fpubh.2023.1268321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background The COVID-19 pandemic has resulted in an increase in the number of individuals with respiratory conditions that require hospitalization, posing new challenges for the healthcare system. Recent respiratory condition studies have been focused on the COVID-19 period, with no comparison of respiratory conditions before and during the pandemic. This study aimed to examine hospital-setting respiratory conditions regarding potential changes in length of stay (LOS), mortality, and total charge, as well as socioeconomic disparities before and during the pandemic. Methods The study employed a pooled cross-sectional design based on the State Inpatient Data Nevada for 2019 (prior to the COVID-19 pandemic) and 2020-2021 (during the pandemic) and investigated all respiratory conditions, identified by the International Classification of Disease, 10th Revision codes (n = 227,338). Descriptive analyses were carried out for the three years. Generalized linear regression models were used for multivariable analyses. Outcome measures were hospital LOS, mortality, and total charges. Results A total of 227,338 hospitalizations with a respiratory condition were included. Hospitalizations with a respiratory condition increased from 65,896 in 2019 to 80,423 in 2020 and 81,018 in 2021. The average LOS also increased from 7.9 days in 2019 to 8.8 days in 2020 but decreased to 8.1 days in 2021; hospital mortality among patients with respiratory conditions increased from 7.7% in 2019 to 10.2% but decreased to 9.6% in 2021; and the total charges per discharge were $159,119, $162,151, and $161,733 from 2019 to 2021, respectively (after adjustment for the inflation rate). Hispanic, Asian, and other race patients with respiratory conditions were 1-3 times more likely than white patients to have higher mortality and LOS. Medicaid patients and non-White patients were predictors of a higher respiratory-related hospital total charge. Conclusion Demographic and socioeconomic factors were significantly associated with respiratory-related hospital utilization in terms of LOS, mortality, and total charge.
Collapse
Affiliation(s)
- Zahra Mojtahedi
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, United States
| | - Ji Yoo
- School of Medicine, University of Nevada, Las Vegas, NV, United States
| | - Pearl Kim
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, United States
| | - Yonsu Kim
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, United States
| | - Jay J. Shen
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, United States
| | - Bing-Long Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
5
|
Luchian ML, Higny J, Benoit M, Robaye B, Berners Y, Henry JP, Colle B, Xhaët O, Blommaert D, Droogmans S, Motoc AI, Cosyns B, Gabriel L, Guedes A, Demeure F. Unmasking Pandemic Echoes: An In-Depth Review of Long COVID's Unabated Cardiovascular Consequences beyond 2020. Diagnostics (Basel) 2023; 13:3368. [PMID: 37958264 PMCID: PMC10647305 DOI: 10.3390/diagnostics13213368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
At the beginning of 2020, coronavirus disease 2019 (COVID-19) emerged as a new pandemic, leading to a worldwide health crisis and overwhelming healthcare systems due to high numbers of hospital admissions, insufficient resources, and a lack of standardized therapeutic protocols. Multiple genetic variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been detected since its first public declaration in 2020, some of them being considered variants of concern (VOCs) corresponding to several pandemic waves. Nevertheless, a growing number of COVID-19 patients are continuously discharged from hospitals, remaining symptomatic even months after their first episode of COVID-19 infection. Long COVID-19 or 'post-acute COVID-19 syndrome' emerged as the new pandemic, being characterized by a high variability of clinical manifestations ranging from cardiorespiratory and neurological symptoms such as chest pain, exertional dyspnoea or cognitive disturbance to psychological disturbances, e.g., depression, anxiety or sleep disturbance with a crucial impact on patients' quality of life. Moreover, Long COVID is viewed as a new cardiovascular risk factor capable of modifying the trajectory of current and future cardiovascular diseases, altering the patients' prognosis. Therefore, in this review we address the current definitions of Long COVID and its pathophysiology, with a focus on cardiovascular manifestations. Furthermore, we aim to review the mechanisms of acute and chronic cardiac injury and the variety of cardiovascular sequelae observed in recovered COVID-19 patients, in addition to the potential role of Long COVID clinics in the medical management of this new condition. We will further address the role of future research for a better understanding of the actual impact of Long COVID and future therapeutic directions.
Collapse
Affiliation(s)
- Maria-Luiza Luchian
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Julien Higny
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Martin Benoit
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Benoit Robaye
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Yannick Berners
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Jean-Philippe Henry
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Benjamin Colle
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Olivier Xhaët
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Dominique Blommaert
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Steven Droogmans
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Andreea Iulia Motoc
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Laurence Gabriel
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Antoine Guedes
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Fabian Demeure
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| |
Collapse
|
6
|
McCarthy MW. Paxlovid as a potential treatment for long COVID. Expert Opin Pharmacother 2023; 24:1839-1843. [PMID: 37731377 DOI: 10.1080/14656566.2023.2262387] [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: 08/17/2023] [Accepted: 09/20/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION On 31 July 2023, the United States Department of Health and Human Services announced the formation of the Office of Long COVID Research and Practice and the United States National Institutes of Health opened enrollment for RECOVER-Vital, a randomized study to evaluate new treatment options for long Coronavirus (long COVID). AREAS COVERED The RECOVER Initiative is a $1.15 billion research platform intended to describe, categorize, treat, and prevent long-term symptoms following infection by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‑CoV‑2), the virus that causes Coronavirus (COVID-19). More than 200 symptoms have been associated with long COVID, potentially affecting nearly all body systems, and current estimates suggest that between 7 million and 23 million Americans have developed long COVID. However, there are no approved treatments for this condition. EXPERT OPINION The first prospective, randomized study of the RECOVER research initiative, RECOVER-Vital, will evaluate the SARS-CoV-2 antiviral nirmatrelvir/ritonavir (Paxlovid) as a potential treatment for long COVID. This manuscript explores what is known about Paxlovid to treat and prevent long COVID and examines the rationale for addressing this condition with an antiviral agent.
Collapse
|
7
|
McCarthy MW. Intravenous immunoglobulin as a potential treatment for long COVID. Expert Opin Biol Ther 2023; 23:1211-1217. [PMID: 38100573 DOI: 10.1080/14712598.2023.2296569] [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: 10/21/2023] [Accepted: 12/14/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION On 31 July 2023, the United States Department of Health and Human Services announced the formation of the Office of Long COVID Research and Practice and the United States National Institutes of Health (NIH) opened enrollment for the therapeutic arm of the RECOVER initiative, a prospective, randomized study to evaluate new treatment options for long coronavirus disease 2019 (long COVID). AREAS COVERED One of the first drugs to be studied in this nationwide initiative is intravenous immunoglobulin (IVIG), which will be a treatment option for subjects enrolled in RECOVER-AUTO, a randomized trial to investigate therapeutic strategies for autonomic dysfunction related to long COVID. EXPERT OPINION IVIG is a mixture of human antibodies (human immunoglobulin) that has been widely used to treat a variety of diseases, including immune thrombocytopenia purpura, Kawasaki disease, chronic inflammatory demyelinating polyneuropathy, and certain infections such as influenza, human immunodeficiency virus, and measles. However, the role of IVIG in the treatment of post-COVID-19 conditions is uncertain. This manuscript examines what is known about IVIG in the treatment of long COVID and explores how this therapeutic agent may be used in the future to address this condition.
Collapse
|