The Predictors of Long COVID in Southeastern Italy

Abstract

Introduction: Long COVID is now recognized as a common consequence of the SARS-CoV-2 infection, but we are still far from fully understanding its pathogenesis and predictive factors. Many pathophysiological factors have been studied, including ethnicity. To our knowledge, the risk factors for Long COVID have not been studied in Southeastern Italy. Aims: The aim of this study was to evaluate the predictive factors of Long COVID in a cohort of patients from Southeastern Italy. Methods: We conducted a retrospective longitudinal study, enrolling inpatients and outpatients diagnosed with COVID-19 from June 2021 to March 2022. A total of 436 subjects were evaluated in an outpatient setting 12 weeks after a SARS-CoV-2 infection, recording comorbidities, symptoms, therapy, and clinical information. Univariate and multivariate binomial logistic regression analyses were performed on different risk factors to define the probability of developing Long COVID. Results: A total of 71.8% of patients (313) developed Long COVID, while the remaining 123 (28.3%) had a complete remission of symptoms 3 months after acute infection. During the acute phase of COVID-19, 68.3% of patients experienced respiratory failure and 81.4% received corticosteroid therapy. In a multivariate analysis, the female sex (SEX M ODD 0.513) and corticosteroids (ODD 2.25) were maintained as predictive values. Conclusions: From our data and in line with other studies, the female sex emerges as a risk factor for Long COVID in the population of Southeastern Italy. Corticosteroid therapy administered in the acute phase also appears to be associated with an increased risk of Long COVID. Although indications for the prescription of corticosteroid therapy in the acute phase were indicated by the presence of pneumonia complicated by respiratory insufficiency, there was an over-prescription of corticosteroid therapy in the real life of our cohort, with 64% of patients having respiratory insufficiency and 81% having corticosteroid therapy. We hypothesize that a synergistic link between viral infection and the side effects of corticosteroid therapy may arise in selected cases.

Potential Predictors of Long COVID in Italian Children: A Cross-Sectional Survey

“…The incidence rate of LCS resulted in being different among cohorts due to study population heterogeneity, different COVID-19 severities, and the multifactorial pathogenesis of LCS [26]. The frequency of persistent symptoms after a mild COVID-19 infection was lower, ranging from 10% to 35% [27], than the aforementioned prevalence described in the studies including mostly hospitalized COVID-19 patients [23,24]. Indeed, our prevalence of LCS was similar to that observed in outpatients with mild COVID-19.…”

“…In the literature, the prevalence of LCS in adults was higher than in children. In a recent retrospective longitudinal study, including 436 Italian adult inpatients and outpatients previously diagnosed with COVID-19, the authors found LCS in 71.8% of patients [23]. Similarly, in a cohort of 1655 adults, LCS developed in 76% of subjects 6 months after hospitalization for COVID-19 [24].…”

Prevalence, predictors, and patient-reported outcomes of long COVID in hospitalized and non-hospitalized patients from the city of São Paulo, Brazil

“…Previous studies, including those conducted in low-and middle-income countries, have established a link between female gender and long COVID ( 12 , 13 , 21 – 23 ), However, it has not been previously reported that a positive depression screening at day 30 using a validated questionnaire could be a risk factor for diagnosing long COVID at day 90 ( 24 , 25 ). Additionally, few studies have examined depression as a risk factor for COVID-19 or long COVID ( 26 , 27 ).…”

“…Likewise, a study from Southeastern Italy also demonstrated that corticosteroid therapy administered in the acute phase of COVID-19 might be associated with an increased risk of long COVID. One plausible hypothesis posited by the authors is that the administration of corticosteroids during the acute phase of illness may potentially contribute to the persistence of the virus within non-respiratory system among some patients reservoirs ( 24 ). To ascertain the potential association between corticosteroid utilization and an increased risk of prolonged COVID-19, along with its dependence on factors such as dosage, type, or duration of in-hospital steroid therapy, further comprehensive investigations are warranted.…”

Neutrophil degranulation, endothelial and metabolic dysfunction in unvaccinated long COVID patients

“…However, serum biomarkers were comparable between hospitalized and home‐isolated patients, with the unique exception of L‐selectin. This discrepancy might be explained, at least in part, with pharmacological interventions used during the acute infection, that could either increase (in particular corticosteroid therapy 32 ) or decrease (antiviral agents 33 ) the risk of long COVID. The low number of hospitalized subjects without long COVID symptoms and the heterogeneous type and dosage of medications used to manage the infection did not allow, in the present series, to adequately evaluate if the therapeutic approach to the acute event plays a role in the onset of long COVID.…”