Risk factors and incidence of long-COVID syndrome in hospitalized patients: does remdesivir have a protective effect?

Abstract

Summary Background The definition of ‘long-COVID syndrome’ (LCS) is still debated and describes the persistence of symptoms after viral clearance in hospitalized or non-hospitalized patients affected by coronavirus disease 2019 (COVID-19). Aim In this study, we examined the prevalence and the risk factors of LCS in a cohort of patients with previous COVID-19 and followed for at least 6 months of follow-up. Design We conducted a prospective study including all hospitalized patients affected by COVID-19 at our center of Infectious Diseases (Vercelli, Italy) admitted between 10 March 2020 and 15 January 2021 for at least 6 months after discharge. Two follow-up visits were performed: after 1 and 6 months after hospital discharge. Clinical, laboratory and radiological data were recorded at each visit. Results A total of 449 patients were included in the analysis. The LCS was diagnosed in 322 subjects at Visit 1 (71.7%) and in 206 at Visit 2 (45.9); according to the post-COVID-19 functional status scale we observed 147 patients with values 2–3 and 175 with values >3 at Visit 1; at Visit 2, 133 subjects had the score between 2–3 and 73 > 3. In multivariate analysis, intensive care unit (ICU) admission (OR = 2.551; 95% CI = 1.998–6.819; P = 0.019), time of hospitalization (OR = 2.255; 95% CI = 1.018–6.992; P = 0.016) and treatment with remdesivir (OR = 0.641; 95% CI = 0.413–0.782; P < 0.001) were independent predictors of LCS. Conclusions Treatment with remdesivir leads to a 35.9% reduction in LCS rate in follow-up. Severity of illness, need of ICU admission and length of hospital stay were factor associated with the persistence of PCS at 6 months of follow-up.

Associated-Onset Symptoms and Post-COVID-19 Symptoms in Hospitalized COVID-19 Survivors Infected with Wuhan, Alpha or Delta SARS-CoV-2 Variant

“…In fact, we did not collect laboratory biomarkers, data about COVID-19 severity at hospital admission or treatments received during hospitalization, which could help to elucidate if these variables are associated with post-COVID-19 symptoms on each SARS-CoV-2 variant. There is some evidence suggesting that administration of some medications, e.g., remdesivir, at hospitalization can reduce the risk of long COVID-19 [ 27 ]. Second, current data are based on individuals who did not receive any vaccine dose and were suffering from their first infection.…”

Impact of Pre-Existing Chronic Viral Infection and Reactivation on the Development of Long COVID

“…However, this study also highlights that not all PASC is related to EBV. In fact, other mechanisms, such as persistent SARS-CoV-2 infection in various tissues, may play an even more important role in LC as reflected by the growing case-series level evidence that LC symptoms dramatically improve in the setting of SARS-CoV-2 directed antiviral therapies (Boglione et al, 2022; Geng et al, 2022; Peluso et al, 2022c). Ultimately, further investigation of SARS-CoV-2 and other viruses during both acute infection and convalescence will be needed to clarify the mechanisms driving Long COVID and suggest interventions that may reverse or ameliorate these processes.…”

Long COVID: A growing problem in need of intervention

“…An Italian study provides some evidence that treatment with remdesivir during hospitalization for acute COVID-19 prevents up to one-third of long-COVID cases. 15 Remdesivir must be given as an injection and is, therefore, unlikely to be useful on a large scale for non-hospitalized patients. Two oral and less expensive antiviral drugs have recently been licensed, the protease inhibitor nirmatrelvir/ritonavir and molnupiravir, a drug that introduces mutations in the viral genome, but there are so far no data to support any protective effect on long COVID.…”

“…There is no evidence that corticosteroid treatment in acute COVID-19 can prevent long COVID. 15 However, a small study suggests some beneficial effect on dysgeusia from a short-course treatment with oral corticosteroids in combination with olfactory training. 8 Available data, so far, do not support the widespread use of corticosteroids in otherwise healthy individuals, as the risks of side effects would outweigh the marginal benefits.…”