Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies

Dani, Melanie; Dirksen, Andreas; Taraborrelli, Patricia; Torocastro, Miriam; Panagopoulos, Dimitrios; Sutton, Richard; Lim, Phang Boon

doi:10.7861/clinmed.2020-0896

Cited by 545 publications

(608 citation statements)

References 28 publications

Supporting

Mentioning

482

Contrasting

Unclassified

Order By: Relevance

“…It has been suggested that SARS-COV-2 infection may impair cognitive function that would lead to brain fog via selective targeting of the mitochondria of the neurons (96). Dani et al described long COVID symptoms, such as, tachycardia, palpitation, orthostatic intolerance, breathlessness, and chest pain as the consequences of autonomic nervous system instability caused by deconditioning hypovolemia or immune-or virus-mediated autonomic nervous system destruction (102). In a case report of a COVID-19 patient with anti-microbial resistant Pseudomonas Aeruginosa infection, it was documented that 6 weeks after clearing of the viral infection, a significant number of activated T-cells and T-cells-specific for unrelated antigens were present, suggesting "a significant amount of by stander activation" which might contribute to recurring anti-bacterial-resistant infections (152).…”

Section: ) Pathophysiologymentioning

confidence: 99%

<strong>Long COVID, A Comprehensive Systematic Scoping Review</strong>

Akbarialiabad¹,

Taghrir²,

Abdollahi³

et al. 2021

Preprint

View full text Add to dashboard Cite

Introduction: Despite more than one year passed since the first cases of SARS-CoV-2 were reported, there is still no consensus on the definition and clinical management of post-acute-COVID-19. The condition has heterogeneously been named as Chronic COVID syndrome, Post COVID-19 Syndrome, post-acute sequela of SARS-CoV-2 (PASC), and the more familiar long COVID. Method: In order to capture all relevant published studies, we undertook a multi-step search with no language restriction. The following four-step search strategy was utilized: First, a preliminary (limited) search was conducted on January 20, 2021, in Google Scholar and PubMed to identify the appropriate keywords. Then, on January 30, 2021, we adopted a search strategy of electronic databases from Cochrane Library, PsycINFO, PubMed, Embase, Scopus, and Web of sciences, using those keywords. Then, after duplicate removal, we screened all titles, abstracts, and full texts. This resulted in 66 eligible studies. Subsequently, after a forward and backward search of their references and citations an additional 54 publications were found, resulting in a total of 120 publications that formed the basis of the present analysis. The titles, abstracts, and full-texts of non-English articles were translated using Google Translate for further evaluation. We conducted our scoping review based on the PRISMA-ScR Checklist.Results: We found only one randomized clinical trial in our search. Of the 67 original studies, 22 were cohort and 28 were cross-sectional studies totaling 74.6% of the original studies. Of the total of 120 publications, 59 (49.1%) focused on signs and symptoms, 28 (23.3%) were focused on management, and 13 (10.8%) focused on pathophysiology. Ten (9%) publications focused on imaging studies. Ninety-one percent of the original investigations came from high and upper-middle-income countries, highlighting the scarcity of reports originating from low-income and lower-middle-income countries.Conclusion: The predominant symptoms among those with the so-called “Long COVID” were: fatigue, breathlessness, arthralgia, sleep difficulties, and chest pain. Recent reports also point to the risk of long-term sequela with cutaneous, respiratory, cardiovascular, musculoskeletal, mental health, neurologic, and renal involvement in those who survive the acute phase of the illness. The ambiguity and controversies in its definition have impaired proper recognition and management of those requiring additional support following the resolution of the acute phase of this infection. This has resulted in long-standing distress for the patients and their families. Our findings highlight the need for a multidisciplinary approach, support, and rehabilitation for these patients in terms of long-term mental and physical health.

show abstract

Section: ) Pathophysiologymentioning

confidence: 99%

<strong>Long COVID, A Comprehensive Systematic Scoping Review</strong>

Akbarialiabad¹,

Taghrir²,

Abdollahi³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Most studies refer to their patient recruitment in terms of recovery (e.g., "COVID-19 survivors" 56 or "discharged COVID-19 patients" 57 ) or clinical course (e.g., "medium-and long-term consequences" 58 or "delayed return to usual health" 59 ). A number of studies did refer to their participant groups using terms like "Long COVID", 13,[60][61][62][63][64][65][66][67][68] "post-acute COVID-19", 69,70 "post-COVID syndrome", 71 or "post-acute COVID-19 syndrome", 72 but these terms were not standardized among studies. A few studies 46,60 acknowledged the proposed distinction at 12 weeks post-infection between post-acute COVID-19 and chronic COVID-19, 37 but otherwise the definitions used typically did not refer to any proposed operationalizations of Long COVID.…”

Section: Literature Reviewmentioning

confidence: 99%

“…A number of studies did refer to their participant groups using terms like "Long COVID", 13,[60][61][62][63][64][65][66][67][68] "post-acute COVID-19", 69,70 "post-COVID syndrome", 71 or "post-acute COVID-19 syndrome", 72 but these terms were not standardized among studies. A few studies 46,60 acknowledged the proposed distinction at 12 weeks post-infection between post-acute COVID-19 and chronic COVID-19, 37 but otherwise the definitions used typically did not refer to any proposed operationalizations of Long COVID. Therefore, while operational definitions of the constituent components of Long COVID have been proposed, 37,42,44 reviewing the Long COVID literature revealed that they are rarely used when describing cases or identifying study cohorts.…”

Section: Literature Reviewmentioning

confidence: 99%

Challenges in defining Long COVID: Striking differences across literature, Electronic Health Records, and patient-reported information

Rando

Bennett

Byrd

et al. 2021

Preprint

116

124

View full text Add to dashboard Cite

Since late 2019, the novel coronavirus SARS-CoV-2 has introduced a wide array of health challenges globally. In addition to a complex acute presentation that can affect multiple organ systems, increasing evidence points to long-term sequelae being common and impactful. As the worldwide scientific community forges ahead with efforts to characterize a wide range of outcomes associated with SARS-CoV-2 infection, the proliferation of available data has made it clear that formal definitions are needed in order to design robust and consistent studies of Long COVID that consistently capture variation in long-term outcomes. In the present study, we investigate the definitions used in the literature published to date and compare them against data available from electronic health records and patient-reported information collected via surveys. Long COVID holds the potential to produce a second public health crisis on the heels of the pandemic. Proactive efforts to identify the characteristics of this heterogeneous condition are imperative for a rigorous scientific effort to investigate and mitigate this threat.

show abstract

“…While substantial research has sought to characterize the disease natural history and the acute management of COVID-19, comparatively fewer studies have focused on the post-acute sequelae of SARS-CoV-2 infection (PASC) [1][2][3][4][5][6] . Much of the publicly available data on PASC come from case reports and single-institution prospective cohort studies [7][8][9][10][11][12][13] . Patient reported symptom data have shown that prolonged fatigue, headache, dyspnea and anosmia are PASC symptoms 14 .…”

Section: Introductionmentioning

confidence: 99%

Characterizing Post-Acute Sequelae of SARS-CoV-2 Infection across Claims and Electronic Health Record Databases

Spotnitz

Hripcsak

Ryan

et al. 2021

Preprint

View full text Add to dashboard Cite

Structured Abstract Importance: Post-acute sequelae of SARS-CoV-2 infection (PASC) is emerging as a major public health issue. Objective: We characterized the incidence of PASC, or related symptoms and diagnoses, for COVID-19 and influenza patients. Design: Retrospective cohort study. Setting: Our data sources were the IBM MarketScan Commercial Claims and Encounters (CCAE), Optum Electronic Health Record (EHR) and Columbia University Irving Medical Center (CUIMC) databases that were transformed to the Observational Medical Outcome Partnership (OMOP) Common Data Model (CDM) and were part of the Observational Health Sciences and Informatics (OHDSI) network. Participants: The COVID-19 cohort consisted of patients with a diagnosis of COVID-19 or positive lab test of SARS-CoV-2 after January 1st 2020 with a follow up period of at least 30 days. The influenza cohort consisted of patients with a diagnosis of influenza between October 1, 2018 and May 1, 2019 with a follow up period of at least 30 days. Intervention: Infection with COVID-19 or influenza. Main Outcomes and Measures: Post-acute sequelae of SARS-CoV-2 infection (PASC), or related diagnoses, for COVID-19 and influenza patients. Results: In aggregate, we characterized the post-acute experience for over 440,000 patients who were diagnosed with COVID-19 or tested positive for SARS-COV-2. The long term sequelae that had a higher incidence in the COVID-19 compared to Influenza cohorts were altered smell or taste, myocarditis, acute kidney injury, dyspnea and alopecia. Additionally, the long term incidences of respiratory illness, musculoskeletal disease, and psychiatric disorders for the COVID-19 population were higher than expected. Conclusions and Relevance: The long term sequelae of COVID-19 and influenza may be different. Further characterization of PASC on large scale observational healthcare databases is warranted.

show abstract

Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies

Cited by 545 publications

References 28 publications

<strong>Long COVID, A Comprehensive Systematic Scoping Review</strong>

<strong>Long COVID, A Comprehensive Systematic Scoping Review</strong>

Challenges in defining Long COVID: Striking differences across literature, Electronic Health Records, and patient-reported information

Characterizing Post-Acute Sequelae of SARS-CoV-2 Infection across Claims and Electronic Health Record Databases

Contact Info

Product

Resources

About