Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Jiang, David H.; Roy, Darius; Gu, Brett; Hassett, Leslie; McCoy, Rozalina G.

doi:10.1016/j.jacbts.2021.07.002

Cited by 56 publications

(73 citation statements)

References 188 publications

(251 reference statements)

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“…A high percentage of COVID-19 patients continue to complain of symptoms, particularly dyspnea and fatigue, in the months following hospital discharge [1][2][3]. Pulmonary functional alterations are frequently detected, in particular a reduction in lung diffusion capacity [1,2].…”

Section: Introductionmentioning

confidence: 99%

One-year evolution of DLCO changes and respiratory symptoms in patients with post COVID-19 respiratory syndrome

et al. 2022

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Purpose During a follow-up program of patients admitted for COVID-19 at our non-ICU Unit, we found that 37% of them had decreased diffusing lung capacity for carbon monoxide (DLCO) 3-6 months after discharge. This prospective observational study aimed to evaluate the evolution of changes in DLCO and respiratory symptoms at the 1-year follow-up visit. Methods Seventeen (mean age 71 years; 8 males) of 19 eligible patients (DLCO < 80% of predicted at the 3-6 months follow-up visit) completed the 1-year follow-up visit. One patient refused to participate and 1 patient had died 3 months earlier from myocardial infarction. The visit included a self-reported structured questionnaire, physical exam, blood tests, ECG, and spirometry with DLCO. Results Mean DLCO was significantly improved at the 1-year visit (from 64% of predicted at 3-6 months to 74% of predicted at 1 year; P = 0.003). A clinically significant increase in DLCO (10% or greater) was observed in 11 patients (65%) with complete normalization (> 80% of predicted) in 6 (35%); in the other 6 (35%) it remained unchanged. The prevalence of exertional dyspnea (65-35%, P = 0.17), cough (24-18%, P = 1), and fatigue (76-35%, P = 0.04) decreased at the 1-year visit. Conclusion These results suggest that DLCO and respiratory symptoms tend to normalize or improve 1 year after hospitalization for COVID-19 in most patients. However, there is also a non-negligible number of patients (about one-third) in whom respiratory changes persist and will need prolonged follow-up.

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Section: Introductionmentioning

confidence: 99%

One-year evolution of DLCO changes and respiratory symptoms in patients with post COVID-19 respiratory syndrome

et al. 2022

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“…Long-COVID is still a very novel disease and the scientific community, health-care administrators, and public opinion leaders have voiced concern about the potential impact as SARS-CoV-2 continues to spread globally and new variants evolve that may evade previous natural or vaccine-induced immunity. [17][18][19] Predictors of long-COVID have been suggested to include female sex, increasing number of symptoms during COVID-19, number of preexisting comorbidities, median SARS-CoV-2 IgG titers, and intensive care unit admission. [19][20][21] Treatment has thus far mainly focused on physiotherapy and occupational rehabilitation for constitutional symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…[17][18][19] Predictors of long-COVID have been suggested to include female sex, increasing number of symptoms during COVID-19, number of preexisting comorbidities, median SARS-CoV-2 IgG titers, and intensive care unit admission. [19][20][21] Treatment has thus far mainly focused on physiotherapy and occupational rehabilitation for constitutional symptoms. Health-care registries may prove helpful by providing population-based estimates on incidence of long-COVID and associated morbidity requiring treatment at hospitals as well as socioeconomic consequences of long-COVID.…”

Section: Discussionmentioning

confidence: 99%

Positive Predictive Value of the ICD-10 Diagnosis Code for Long-COVID

Duerlund

Shakar

Nielsen

et al. 2022

CLEP

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To examine the positive predictive value (PPV) of International Classification version 10 (ICD-10) diagnosis codes for long coronavirus disease 2019 (long-COVID) in a Danish Health registry. Patients and Methods: This was a medical record review of all patients with a diagnosis code of long-COVID (DB948A) at all hospitals in the North Denmark Region from February 27, 2020 through June 30, 2021. Confirmed long-COVID was categorized as fulfillment of all three criteria: (1) a positive polymerase chain reaction (PCR) test for SARS-CoV-2 on a respiratory sample or a positive serum antibody test, (2) symptoms suggestive of long-COVID with no other diagnosis considered more likely, and (3) symptom duration >6 weeks.Results: A total of 306 patients were assigned a hospital diagnosis code for long-COVID corresponding to 1.4% of all SARS-CoV-2 positive individuals during the study period (n=21,727). Next, 40 patients were excluded due to incomplete diagnostic evaluation at time of record review leaving 266 patients for analysis. The patients had a median age of 51 years (interquartile range 43-60) and 175/ 266 (66%) were females. Long-COVID was confirmed in 249/266 yielding an overall PPV of 94% (95%CI: 90-96) and did not differ substantially according to most age groups, sex, previous hospitalization for COVID-19, or by using 12 weeks of symptom duration as cut-off. The PPV was low for children and adolescents (n=5), the very elderly (n=9), and those included by secondary long-COVID diagnoses (n=10). Conclusion:The overall PPV of diagnosis codes for long-COVID in the North Denmark Region was high and was likely suitable for future registry-based studies of long-COVID. Caution is advised at the extremes of age and secondary diagnosis codes.

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“… 10 12 13 Structural inequalities are important in the development and course of COVID and may play a role in long COVID. 5 14–20 …”

Section: Introductionmentioning

confidence: 99%

LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS (LOCOMOTION): protocol for a mixed-methods study in the UK

et al. 2022

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Introduction Long COVID, a new condition whose origins and natural history are not yet fully established, currently affects 1.5 million people in the UK. Most do not have access to specialist long COVID services. We seek to optimise long COVID care both within and outside specialist clinics, including improving access, reducing inequalities, helping self-management and providing guidance and decision support for primary care. We aim to establish a ‘gold standard’ of care by systematically analysing current practices, iteratively improving pathways and systems of care. Methods and analysis This mixed-methods, multisite study is informed by the principles of applied health services research, quality improvement, co-design, outcome measurement and learning health systems. It was developed in close partnership with patients (whose stated priorities are prompt clinical assessment; evidence-based advice and treatment and help with returning to work and other roles) and with front-line clinicians. Workstreams and tasks to optimise assessment, treatment and monitoring are based in three contrasting settings: workstream 1 (qualitative research, up to 100 participants), specialist management in 10 long COVID clinics across the UK, via a quality improvement collaborative, experience-based co-design and targeted efforts to reduce inequalities of access, return to work and peer support; workstream 2 (quantitative research, up to 5000 participants), patient self-management at home, technology-supported monitoring and validation of condition-specific outcome measures and workstream 3 (quantitative research, up to 5000 participants), generalist management in primary care, harnessing electronic record data to study population phenotypes and develop evidence-based decision support, referral pathways and analysis of costs. Study governance includes an active patient advisory group. Ethics and dissemination LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS study is sponsored by the University of Leeds and approved by Yorkshire & The Humber—Bradford Leeds Research Ethics Committee (ref: 21/YH/0276). Participants will provide informed consent. Dissemination plans include academic and lay publications, and partnerships with national and regional policymakers. Trial registration number NCT05057260,NCT15022307.

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Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Abstract: Visual Abstract

Cited by 56 publications

References 188 publications

One-year evolution of DLCO changes and respiratory symptoms in patients with post COVID-19 respiratory syndrome

One-year evolution of DLCO changes and respiratory symptoms in patients with post COVID-19 respiratory syndrome

Positive Predictive Value of the ICD-10 Diagnosis Code for Long-COVID

LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS (LOCOMOTION): protocol for a mixed-methods study in the UK

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