Determinants of long COVID among adults hospitalized for SARS-CoV-2 infection: A prospective cohort study

Abstract

RationaleFactors associated with long-term sequelae emerging after the acute phase of COVID-19 (so called “long COVID”) are unclear. Here, we aimed to identify risk factors for the development of COVID-19 sequelae in a prospective cohort of subjects hospitalized for SARS-CoV-2 infection and followed up one year after discharge.MethodsA total of 324 subjects underwent a comprehensive and multidisciplinary evaluation one year after hospital discharge for COVID-19. A subgroup of 247/324 who consented to donate a blood sample were tested for a panel of circulating cytokines.ResultsIn 122 patients (37.8%) there was evidence of at least one persisting physical symptom. After correcting for comorbidities and COVID-19 severity, the risk of developing long COVID was lower in the 109 subjects admitted to the hospital in the third wave of the pandemic than in the 215 admitted during the first wave, (OR 0.69, 95%CI 0.51-0.93, p=0.01). Univariable analysis revealed female sex, diffusing capacity of the lungs for carbon monoxide (DLCO) value, body mass index, anxiety and depressive symptoms to be positively associated with COVID-19 sequelae at 1 year. Following logistic regression analysis, DLCO was the only independent predictor of residual symptoms (OR 0.98 CI 95% (0.96-0.99), p=0.01). In the subgroup of subjects with normal DLCO (> 80%), for whom residual lung damage was an unlikely explanation for long COVID, the presence of anxiety and depressive symptoms was significantly associated to persistent symptoms, together with increased levels of a set of pro-inflammatory cytokines: interferon-gamma, tumor necrosis factor-alpha, interleukin (IL)-2, IL-12, IL-1β, IL-17. In logistic regression analysis, depressive symptoms (p=0.02, OR 4.57 [1.21-17.21]) and IL-12 levels (p=0.03, OR 1.06 [1.00-1.11]) 1-year after hospital discharge were independently associated with persistence of symptoms.ConclusionsLong COVID appears mainly related to respiratory sequelae, prevalently observed during the first pandemic wave. Among patients with little or no residual lung damage, a cytokine pattern consistent with systemic inflammation is in place.

Decreased Gas6 and sAxl Plasma Levels Are Associated with Hair Loss in COVID-19 Survivors

“…A total of 263 patients previously hospitalized for COVID-19 (162 males, 61.6%), with a median age of 60 (IQR: 51–69) years old, were recruited for this study. During the acute phase of the disease, the median duration of the hospital stay was 11 days [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ], the median cumulative illness rating scale (CIRS) in the study population was 2 [ 1 , 2 , 3 , 4 ], and the class of severity was distributed as shown in Table 1 .…”

“…First, we evaluated whether Gas6/sTAM values, along with clinical variables of potential interest according to our previous publications on the same cohort [ 3 , 5 , 13 ], were associated with the persistence of physical symptoms 1 year after hospital discharge. Data are shown in Supplementary Table S1 .…”

“…At present, the underlying processes involved in long COVID pathogenesis are not fully understood [ 9 ]. However, it has been suggested that the persistence of a viral reservoir and the establishment of a pro-coagulant condition driven by SARS-CoV-2 infection, together with a chronic pro-inflammatory status promoted by cytokines, may lead to these long-lasting symptoms [ 10 , 11 , 12 , 13 ].…”

Hospitalized COVID‐19 patients with diabetes have an increased risk for pneumonia, intensive care unit requirement, intubation, and death: A cross‐sectional cohort study in Mexico in 2020

“…7,8 The severity of the disease is modulated by coexisting medical disorders. 9,10 Pneumonia or respiratory failure are common complications in COVID-19 cases and can be deadly. [11][12][13][14] The chance of developing a severe disease from COVID-19 can rise with age and certain preexisting medical conditions.…”

“…Most COVID‐19 infected individuals recover without the need for specialized medical care, and many do not exhibit any symptoms 7,8 . The severity of the disease is modulated by coexisting medical disorders 9,10 . Pneumonia or respiratory failure are common complications in COVID‐19 cases and can be deadly 11‐14 …”