Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Hope, Aluko A.; Evering, Teresa H.

doi:10.1016/j.idc.2022.02.004

Cited by 31 publications

(26 citation statements)

References 80 publications

(80 reference statements)

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“…This is an important limitation as there are limited data that have addressed this question. 31,32 Long term follow-up of this cohort can provide important answers.…”

Section: Discussionmentioning

confidence: 99%

Biomarkers and Outcomes in Hospitalized Covid-19 Patients: A Prospective Registry

Khedar

Gupta

Sharma

et al. 2022

Preprint

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Objectives: To determine association of biomarkers high sensitivity C-reactive protein (hsCRP), D-dimer, interleukin-6 (IL-6), lactic dehydrogenase (LDH), ferritin and neutrophil-lymphocyte ratio (NLR) at hospital admission with clinical features and outcomes in Covid-19. Methods: Successive virologically confirmed Covid-19 patients hospitalized from April 2020 to July 2021 were recruited in a prospective registry. Details of clinical presentation, investigations, management and outcomes were recorded. All the biomarkers were divided into tertiles to determine associations with clinical features and outcomes. Numerical data are presented in median and interquartile range (IQR 25-75). Univariate and multivariate (age, sex, risk factor, comorbidity adjusted) odds ratio (OR) and 95% confidence intervals (CI) were calculated to determine association of deaths with each biomarker. Results: We identified 3036 virologically confirmed Covid-19 patients during the study period, 1215 were hospitalized and included in the present study. Men were 70.0%, aged >60y 44.8%, hypertension 44.8% diabetes 39.6% and cardiovascular disease 18.9%. Median symptom duration was 5 days (IQR 4-7) and SpO2 95% (90-97). Total white cell count was 6.9x103/micro-litre, (5.0-9.8), neutrophils 79.2% (68.1-88.2) and lymphocytes 15.8% (8.7-25.5). Medians (IQR) for biomarkers were hsCRP 6.9 mg/dl (2.2-18.9), D-dimer 464 ng/dl (201-982), IL-6 20.1 ng/dl (6.5-60.4), LDH 284 mg/dl (220-396) and ferritin 351 mg/dl (159-676). Oxygen support at admission was in 38.6%, and non-invasive or invasive ventilatory support in 11.0% and 11.6% respectively. 173 (13.9%) patients died and 15 (1.2%) transferred to hospice care. For each biomarker, those in the second and third tertiles, compared to the first, had worse clinical and laboratory abnormalities, and greater oxygen and ventilatory support. Multivariate adjusted OR (95% CI) for deaths in second and third vs first tertiles, respectively, were for hsCRP 2.29(1.14-4.60) and 13.39(7.23-24.80); D-dimer 3.26(1.31-7.05) and 13.89(6.87-28.27); IL-6 2.61(1.31-5.18) and 10.96(5.88-20.43); ferritin 3.19(1.66-6.11) and 9.13(4.97-16.78); LDH 1.85(0.87-3.97) and 10.51(5.41-20.41); and NLR 3.34(1.62-6.89) and 17.52(9.03-34.00) (p<0.001). Conclusions: In Covid-19, high levels of biomarkers- hsCRP, D-dimer, IL-6, LDH, ferritin and NLR are associated with more severe illness and significantly greater in-hospital mortality. NLR, a simple, widely available and inexpensive investigation provides prognostic information similar to the more expensive biomarkers.

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“…This is an important limitation as there are limited data that have addressed this question. 31,32 Long term follow-up of this cohort can provide important answers.…”

Section: Discussionmentioning

confidence: 99%

Biomarkers and Outcomes in Hospitalized Covid-19 Patients: A Prospective Registry

Khedar

Gupta

Sharma

et al. 2022

Preprint

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“…At the simplest level, long COVID is the state of not recovering completely following acute infection with SARS-CoV-2, the precise duration of which is unclear but is generally considered to be within a timeframe of 1–3 months. 1 Long COVID, in the context of this Comment, must be differentiated from the broad umbrella of post-COVID-19 conditions. The term post-COVID-19 conditions describes all maladies occurring after the acute infection period, including those that are probably byproducts of critical illness that have clear, pathologically defined sequelae (such as cardiopulmonary scarring and vital organ infarction), as well as psychological stress typical of post-intensive care unit syndromes that was well recognised before COVID-19.…”

mentioning

confidence: 93%

“…Most studies have revealed similar findings, reporting symptoms that include new-onset fatigue or exacerbation of pre-existing fatigue, often with post-exertional features (ie, enhanced by mild to moderate exercise or emotional or intellectual tasks), neurocognitive complaints (often referred to as brain fog), and musculoskeletal pain (eg, myalgia and arthralgia). 1 As described in this Comment, although the underlying pathobiology of most of the clinical symptoms of long COVID remain poorly understood, there are ongoing efforts on a global scale to investigate these and other domains. Given rheumatologists' familiarity with chronic fatigue states in both inflammatory and non-inflammatory diseases, 7 the frequent presence of neurocognitive complaints in many rheumatic disorders, and rheumatologists' particular expertise in musculoskeletal pain, our field has potential to contribute meaningfully to these efforts.…”

mentioning

confidence: 99%

“…On a global scale, long COVID is common and, although methods differ, is estimated to affect 10–35% of people at 28 days post infection. 1 , 4 A prospective longitudinal cohort analysis from the Netherlands approximated the incidence of long COVID at one (13%) in eight. 5 Given the global burden of COVID-19, this percentage translates into tens of millions of patients worldwide, with potentially detrimental effects on quality of life and productivity.…”

mentioning

confidence: 99%

“…Rehabilitation to improve physical function is also standard in these clinics, but the type of rehabilitation (eg, graded exercise vs pacing, with a more individualised approach advocated for patients with myalgic encephalomyelitis) is not universally agreed on. 1 , 3 Finally, given the global burden of neuropsychological stress and mood disorders associated with long COVID and the pandemic, a role for general mental health support is crucial.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Long COVID: defining the role of rheumatology in care and research

Calabrese

2022

The Lancet Rheumatology

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Persistent post–COVID‐19 neuromuscular symptoms

2023

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Neuromuscular symptoms may develop or persist after resolution of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Besides residual sensorimotor symptoms associated with acute neuromuscular complications of coronavirus disease‐2019 (COVID‐19), such as Guillain–Barré syndrome, critical illness neuromyopathy, and rhabdomyolysis, patients may report persistent autonomic symptoms, sensory symptoms, and muscle symptoms in the absence of these acute complications, including palpitations, orthostatic dizziness and intolerance, paresthesia, myalgia, and fatigue. These symptoms may be associated with long COVID, also known as post–COVID‐19 conditions or postacute sequelae of SARS‐CoV‐2 infection, which may significantly impact quality of life. Managing these symptoms represents a challenge for health‐care providers. Recent advances have identified small‐fiber neuropathy as a potential etiology that may underlie autonomic dysfunction and paresthesia in some long COVID patients. The pathogenic mechanisms underlying myalgia and fatigue remain elusive and need to be investigated. Herein we review the current state of knowledge regarding the evaluation and management of patients with persistent post–COVID‐19 neuromuscular symptoms.

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Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Cited by 31 publications

References 80 publications

Biomarkers and Outcomes in Hospitalized Covid-19 Patients: A Prospective Registry

Biomarkers and Outcomes in Hospitalized Covid-19 Patients: A Prospective Registry

Long COVID: defining the role of rheumatology in care and research

Persistent post–COVID‐19 neuromuscular symptoms

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