Post-acute sequelae of COVID-19 (PASC): a meta-narrative review of pathophysiology, prevalence, and management

Seim, Lynsey A.; Dawson, Nancy L.; Knight, Dacre; Dabrh, Abd Moain Abu

doi:10.1007/s42399-022-01167-4

Cited by 50 publications

(45 citation statements)

References 116 publications

(188 reference statements)

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“…Isolated PBMCs (10 × 10 6 ) were centrifuged and resuspended in 75 μl FACS buffer (PBS + 2% FBS) and 5 μl Fc receptor block (BioLegend, no. 422302) for 5 min at room temperature.…”

Section: Methodsmentioning

confidence: 99%

“…Cells were analyzed on a Cytek Aurora flow cytometer using Cytek SpectroFlo software. Up to 3 × 10 6 cells were analyzed using FlowJo v10 (Treestar).…”

Section: Methodsmentioning

confidence: 99%

“… Abstract While significant attention has been paid to the immunologic determinants of disease states associated with COVID-19 1,2 , their contributions to post-acute sequelae of COVID-19 (PASC) remain less clear 3-5 . Due to the wide array of PASC presentations 6 , it is critical to understand if specific features of the disease are associated with discrete immune processes, and whether those processes may be therapeutically targeted. To this end, we performed wide immunologic and serological characterization of patients in the early recovery phase of COVID-19 across a breadth of symptomatic presentations.…”

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confidence: 99%

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Inflammation and autoreactivity define a discrete subset of patients with post-acute sequelae of COVID-19, or long-COVID

Woodruff

Walker

Truong

et al. 2021

Preprint

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Recent studies have demonstrated the significant breadth of emerging autoreactivity in severe SARS-CoV-2 infection. Importantly, we have identified a relaxation of peripheral tolerance within early antibody secreting cells that emerge in patients with COVID-19 as important drivers of those responses. While often viral-specific, these extrafollicular-derived cells also display cross reactivity to autoantigens present in the inflammatory lung environment, and despite resolution of most autoreactivity within 6 months, they persisted in some patients. These results raise questions regarding autoreactive antibodies that arise during acute SARS-CoV-2 infection and their persistence in patients with symptoms in Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Through clinical autoreactive antibody screening of 95 patients with PASC and no history of autoimmune disease, we identify significant autoreactive profiles in patients with ongoing symptoms post-recovery, with 80% of patients returning positive tests for at least one autoantigen, and 40% showing breaks in tolerance to 2 or more. Anti-nuclear antigen positivity was most common, displaying positivity in 63% of patients, however, positive tests were broad and included reactivities against carbamylated protein responses, RNA polymerase III, and phospholipids. We also identify patients with reactivity against dsDNA in the PASC cohort -- a reactivity not observed in acute infection even in the critically ill. These results demonstrate evidence of serum autoantibodies in patients who present to PASC clinics with persistent symptoms up 14 months following SARS-CoV-2 infection, and further confirm the growing linkage between COVID-19 and observed clinical autoreactivity -- even into the recovery phase of disease.

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“…Isolated PBMCs (10 × 10 6 ) were centrifuged and resuspended in 75 μl FACS buffer (PBS + 2% FBS) and 5 μl Fc receptor block (BioLegend, no. 422302) for 5 min at room temperature.…”

Section: Methodsmentioning

confidence: 99%

“…Cells were analyzed on a Cytek Aurora flow cytometer using Cytek SpectroFlo software. Up to 3 × 10 6 cells were analyzed using FlowJo v10 (Treestar).…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Inflammation and autoreactivity define a discrete subset of patients with post-acute sequelae of COVID-19, or long-COVID

Woodruff

Walker

Truong

et al. 2021

Preprint

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“…At present, there is no universally accepted definition, but this health issue is being termed as the "post-acute COVID-19 syndrome" or the "long COVID-19." This review provides a brief descriptive and qualitative summary of the presently researched, studied and health issues of post-acute COVID-19 syndrome which is usually a disease seen in people that recovered from a bout of COVID-19 infection but continue to have health issues [10][11][12][13][14][15][16][17][18].…”

Section: What Is Post-acute Covid-19 Syndrome?mentioning

confidence: 99%

A New Phenomenon: Post-Acute COVID-19 Syndrome

Sharma¹

2022

IJOPRS

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During the last two and half years, the world continues to face public health challenges created by the wave upon wave of COVID-19 (coronavirus disease 2019) infections in the currently ongoing pandemic (being started with the emergence of new, mutated and more transmissible strains of the COVID-19 virus). In the aftermath of the successive waves of the COVID-19 pandemic, many COVID-19 survivors have presented with what has been termed "post-acute COVID-19 syndrome" or "long-term COVID-19." There is an urgent requirement of both a universal framework for recognizing at risk patients for post-acute COVID-19 syndrome and the provision of multidisciplinary care in targeted COVID-19 outpatient facilities.

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“… 3 Long COVID may manifest as persistent fatigue/tiredness, dyspnea, cough, cognitive dysfunction, and dysautonomia, persistent loss of taste and/or smell, headaches, cough, low-grade fevers, palpitations, dizziness, myalgias, and arthralgias. 1 , 4 …”

Section: Introductionmentioning

confidence: 99%

Clinical differences in symptomology, characteristics, and risk factors in patients with post-acute sequelae of COVID-19: an experience from a tertiary-care academic center

Dabrh

Shrivastava

Mohabbat

et al. 2023

Journal of Investigative Medicine

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Coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus SARS-CoV-2 and has caused significant mortality and morbidity since it was first recognized in Wuhan, China in December 2019. Patients may suffer from a constellation of symptoms termed post-acute sequelae of COVID-19 (PASC) . Here we present findings of a retrospective cohort study describing the prevalence and predicting factors of patient-reported post-acute sequelae of COVID-19 (PASC). Categorical variables were summarized as frequency (percentage) and compared between vaccine status groups using Fisher’s exact test. Continuous variables were reported as median (range) and compared between the groups using Kruskal-Wallis test. All tests were two-sided with p value <0.05 considered statistically significant. Survey data from 132 patients with a median age of 45 years, 68% female, 83% Caucasian/Non-Hispanic. The most frequently reported PASC symptoms include fatigue (84.8%), dyspnea (54.5%), cognitive dysfunction (53%), myalgias (37.1%), lightheadedness or vertigo (36.4%), chest pain (34.8%), palpitations (34.8%), headaches (34.1%), arthralgias (31.8%), and unrefreshing sleep (31.1%). There is mounting evidence that supports higher prevalence of PASC in women, White/Caucasian, and middle-aged individuals. This knowledge can provide guidance to clinical practices to anticipate and support healthcare and self-care needs for patients at higher risk to developing PASC.

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Post-acute sequelae of COVID-19 (PASC): a meta-narrative review of pathophysiology, prevalence, and management

Cited by 50 publications

References 116 publications

Inflammation and autoreactivity define a discrete subset of patients with post-acute sequelae of COVID-19, or long-COVID

Inflammation and autoreactivity define a discrete subset of patients with post-acute sequelae of COVID-19, or long-COVID

A New Phenomenon: Post-Acute COVID-19 Syndrome

Clinical differences in symptomology, characteristics, and risk factors in patients with post-acute sequelae of COVID-19: an experience from a tertiary-care academic center

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