1
|
Sbierski-Kind J, Schlickeiser S, Feldmann S, Ober V, Grüner E, Pleimelding C, Gilberg L, Brand I, Weigl N, Ahmed MIM, Ibarra G, Ruzicka M, Benesch C, Pernpruner A, Valdinoci E, Hoelscher M, Adorjan K, Stubbe HC, Pritsch M, Seybold U, Roider J. Persistent immune abnormalities discriminate post-COVID syndrome from convalescence. Infection 2024:10.1007/s15010-023-02164-y. [PMID: 38326527 DOI: 10.1007/s15010-023-02164-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/19/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Innate lymphoid cells (ILCs) are key organizers of tissue immune responses and regulate tissue development, repair, and pathology. Persistent clinical sequelae beyond 12 weeks following acute COVID-19 disease, named post-COVID syndrome (PCS), are increasingly recognized in convalescent individuals. ILCs have been associated with the severity of COVID-19 symptoms but their role in the development of PCS remains poorly defined. METHODS AND RESULTS Here, we used multiparametric immune phenotyping, finding expanded circulating ILC precursors (ILCPs) and concurrent decreased group 2 innate lymphoid cells (ILC2s) in PCS patients compared to well-matched convalescent control groups at > 3 months after infection or healthy controls. Patients with PCS showed elevated expression of chemokines and cytokines associated with trafficking of immune cells (CCL19/MIP-3b, FLT3-ligand), endothelial inflammation and repair (CXCL1, EGF, RANTES, IL-1RA, PDGF-AA). CONCLUSION These results define immunological parameters associated with PCS and might help find biomarkers and disease-relevant therapeutic strategies.
Collapse
Affiliation(s)
- Julia Sbierski-Kind
- Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
- The M3 Research Center, University Clinic Tübingen (UKT), Medical Faculty, Otfried-Müllerstr. 37, Tübingen, Germany
| | - Stephan Schlickeiser
- Charité, Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität Zu Berlin, Institute of Medical Immunology, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH) at Charité, Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117, Berlin, Germany
| | - Svenja Feldmann
- Department of Infectious Diseases, Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Veronica Ober
- Department of Infectious Diseases, Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Eva Grüner
- Department of Infectious Diseases, Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Claire Pleimelding
- Department of Infectious Diseases, Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Leonard Gilberg
- Department of Infectious Diseases, Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Isabel Brand
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Nikolas Weigl
- Department of Medicine IV, Division of Clinical Pharmacology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mohamed I M Ahmed
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Gerardo Ibarra
- The M3 Research Center, University Clinic Tübingen (UKT), Medical Faculty, Otfried-Müllerstr. 37, Tübingen, Germany
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michael Ruzicka
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christopher Benesch
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Medicine II, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anna Pernpruner
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Medicine II, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Elisabeth Valdinoci
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Medicine II, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michael Hoelscher
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kristina Adorjan
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Hans Christian Stubbe
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Medicine II, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michael Pritsch
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ulrich Seybold
- Department of Infectious Diseases, Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julia Roider
- Department of Infectious Diseases, Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
| |
Collapse
|
2
|
Ruzicka M, Ibarra Fonseca GJ, Sachenbacher S, Heimkes F, Grosse-Wentrup F, Wunderlich N, Benesch C, Pernpruner A, Valdinoci E, Rueb M, Uebleis AO, Karch S, Bogner J, Mayerle J, von Bergwelt-Baildon M, Subklewe M, Heindl B, Stubbe HC, Adorjan K. Substantial differences in perception of disease severity between post COVID-19 patients, internists, and psychiatrists or psychologists: the Health Perception Gap and its clinical implications. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01700-z. [PMID: 37955681 DOI: 10.1007/s00406-023-01700-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023]
Abstract
Patient-reported outcome measures (PROMs) such as the Numeric Pain Rating Scale (NPRS) or Likert scales addressing various domains of health are important tools to assess disease severity in Post COVID-19 (PC) patients. By design, they are subjective in nature and prone to bias. Our findings reveal substantial differences in the perception of disease severity between patients (PAT), their attending internists (INT) and psychiatrists/psychologists (PSY). Patients rated almost all aspects of their health worse than INT or PSY. Most of the differences were statistically highly significant. The presence of fatigue and mood disorders correlated negatively with health perception. The physical health section of the WHO Quality of Life Assessment (WHOQoL-BREF) and Karnofsky index correlated positively with overall and mental health ratings by PAT and INT. Health ratings by neither PAT, PSY nor INT were associated with the number of abnormal findings in diagnostic procedures. This study highlights how strongly perceptions of disease severity diverge between PC patients and attending medical staff. Imprecise communication, different experiences regarding health and disease, and confounding psychological factors may explain these observations. Discrepancies in disease perception threaten patient-physician relationships and pose strong confounders in clinical studies. Established scores (e.g., WHOQoL-BREF, Karnofsky index) may represent an approach to overcome these discrepancies. Physicians and psychologists noting harsh differences between a patient's and their own perception of the patient's health should apply screening tools for mood disorders (i.e., PHQ-9, WHOQoL-BREF), psychosomatic symptom burden (SSD-12, FCV-19) and consider further psychological evaluation. An interdisciplinary approach to PC patients remains imperative. Trial Registration Number & Date of Registration: DRKS00030974, 22 Dec 2022, retrospectively registered.
Collapse
Affiliation(s)
- Michael Ruzicka
- Department of Medicine III, Ludwig Maximilian University (LMU) University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | | | - Simone Sachenbacher
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Fides Heimkes
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Fabienne Grosse-Wentrup
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Nora Wunderlich
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christopher Benesch
- Department of Medicine II, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Anna Pernpruner
- Department of Medicine II, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Elisabeth Valdinoci
- Department of Medicine II, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Mike Rueb
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Aline Olivia Uebleis
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Johannes Bogner
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael von Bergwelt-Baildon
- Department of Medicine III, Ludwig Maximilian University (LMU) University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, Ludwig Maximilian University (LMU) University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Bernhard Heindl
- Stabstelle Strategische Unternehmenssteuerung, LMU Munich, Munich, Germany
| | - Hans Christian Stubbe
- Department of Medicine II, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|