Persistent Symptoms in Adult Patients 1 Year After Coronavirus Disease 2019 (COVID-19): A Prospective Cohort Study

Abstract

Background Long COVID is defined as the persistence of symptoms beyond 3 months after SARS-CoV-2 infection. To better understand the long-term course and etiology of symptoms we analyzed a cohort of COVID-19 patients prospectively. Methods Patients were included at 5 months after acute COVID-19 in this prospective, non-interventional follow-up study. Patients followed until 12 months after COVID-19 symptom onset (n=96, 32.3% hospitalised, 55.2% females) were included in this analysis of symptoms, quality of life (based on a SF-12 survey), laboratory parameters including antinuclear antibodies (ANA), and SARS-CoV-2 antibody levels. Results At month 12, only 22.9% of patients were completely free of symptoms and the most frequent symptoms were reduced exercise capacity (56.3%), fatigue (53.1%), dyspnoea (37.5%), concentration problems (39.6%), problems finding words (32.3%), and sleeping problems (26.0%). Females showed significantly more neurocognitive symptoms than males. ANA titres were ≥1:160 in 43.6% of patients at 12 months post COVID-19 symptom onset, and neurocognitive symptom frequency was significantly higher in the group with an ANA titre ≥1:160 compared to <1:160. Compared to patients without symptoms, patients with at least one long COVID symptom at 12 months did not differ significantly with respect to their SARS-CoV-2-antibody levels, but had a significantly reduced physical and mental life quality compared to patients without symptoms. Conclusions Neurocognitive long COVID symptoms can persist at least for one year after COVID-19 symptom onset, and reduce life quality significantly. Several neurocognitive symptoms were associated with ANA titre elevations. This may indicate autoimmunity as cofactor in aetiology of long COVID.

“Long COVID” follow-up pathway: results of longitudinal cohort study to investigate 6- and 12-month outcomes after hospitalization for SARS-CoV-2 infection

“…Overall, our ndings are in line with such results, although with a lower proportion of patients experiencing persistent symptoms, with a meaningful proportion of patients of experiencing dyspnea and patterns of neurologic symptoms. Clinical impairment can persist at least until one year after COVID-19 symptom onset and reduce patients' quality of life signi cantly 22 . The persistence of neuropsychiatric long COVID symptoms (which can reduce quality of life signi cantly) one year after COVID-19 symptom onset may be partially explained by the in uence of the extended pandemic situation and consequent psychological impact 22 .…”

“…Since COVID-19 has spread globally, and long COVID became a burgeoning health concern 10 , a growing number of studies has been focused on "long-term effects of COVID-19" [11][12][13][14][15][16][17][18] . However, to date only a few studies [19][20][21][22][23][24] really addressed long term (up to 12 months) sequelae for hospitalized patient populations, as well as temporal trends and longstanding health consequences for "long-haulers" with a whole patient pathway perspective in different populations, timepoints, settings and countries. The full range of long-term health consequences of COVID-19 in patients who were discharged from hospital is largely unclear 25 .…”

Broken Connections: The Evidence for Neuroglial Failure in ME/CFS

“… COVID-19 seems to be among the viruses with the highest likelihood of leaving chronic debilitation in its wake. A subset of PASC patients clearly falls into the ME/CFS category because of the typical persistence of symptoms 413 and the typical syndromatic picture of psychomotor slowing, PEM, hypersensitivity to light and sounds and severe fatigue coupled with mood dysfunctions like anxiety. 414 This group may also share the typical gender and age predilection seen in ME/CFS.…”

“…429 Also, ANA titres have been shown to be elevated in the subset of PASC patients with neurocognitive symptoms. 413 While the level of some of these autoantibodies subside over time, others persist. So there is a potential that in the aftermath of the infection autoimmune targets are being primed, which indeed seems to happen in PASC.…”

Distinguishing Incubation and Acute Disease Stages of Mild-to-Moderate COVID-19

“…Thus, a dysregulated host immune response was identified that causes a life-threatening cytokine storm and subsequent immune paralysis, leading to multiple organ failure and death. And even though mild-tomoderate COVID-19 does not seem to be associated with a fulminant immune activation, more and more data point to long lasting infection related sequelae including persisting nausea, fatigue and loss of smell and taste in up to 30% of patients who recovered from COVID-19 (10)(11)(12). Hence, even non-severe COVID-19 may pose a considerable hazard for global health and economy.…”