Unfavorable Outcome and Long-Term Sequelae in Cases with Severe COVID-19

Fabbri, Andrea; Voza, Antonio; Riccardi, Alessandro; Vanni, Simone; Iaco, Fabio De

doi:10.3390/v15020485

Cited by 5 publications

(6 citation statements)

References 74 publications

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“…This returned 52 citations, and on review of the abstract and full text to detect data on structural organ pathology, 3 were included. [87][88][89] Second, we searched "Long COVID" OR "Post COVID condition," AND "pathology," AND "systematic review" with the same date restriction. This returned nine citations, and on review of abstract and full text to detect data on structural organ pathology, two more publications were included.…”

Section: Systematic Review Of Sequelae Of the Covid-19 Pandemicmentioning

confidence: 99%

Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response

Joffe,

Elliott

2023

SAGE Open Medicine

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This review proposes a model of Long-COVID where the constellation of symptoms are in fact genuinely experienced persistent physical symptoms that are usually functional in nature and therefore potentially reversible, that is, Long-COVID is a somatic symptom disorder. First, we describe what is currently known about Long-COVID in children and adults. Second, we examine reported “Long-Pandemic” effects that create a risk for similar somatic symptoms to develop in non-COVID-19 patients. Third, we describe what was known about somatization and somatic symptom disorder before the COVID-19 pandemic, and suggest that by analogy, Long-COVID may best be conceptualized as one of these disorders, with similar symptoms and predisposing, precipitating, and perpetuating factors. Fourth, we review the phenomenon of mass sociogenic (functional) illness, and the concept of nocebo effects, and suggest that by analogy, Long-COVID is compatible with these descriptions. Fifth, we describe the current theoretical model of the mechanism underlying functional disorders, the Bayesian predictive coding model for perception. This model accounts for moderators that can make symptom inferences functionally inaccurate and therefore can explain how to understand common predisposing, precipitating, and perpetuating factors. Finally, we discuss the implications of this framework for improved public health messaging during a pandemic, with recommendations for the management of Long-COVID symptoms in healthcare systems. We argue that the current public health approach has induced fear of Long-COVID in the population, including from constant messaging about disabling symptoms of Long-COVID and theorizing irreversible tissue damage as the cause of Long-COVID. This has created a self-fulfilling prophecy by inducing the very predisposing, precipitating, and perpetuating factors for the syndrome. Finally, we introduce the term “Pandemic-Response Syndrome” to describe what previously was labeled Long-COVID. This alternative perspective aims to stimulate research and serve as a lesson learned to avoid a repeat performance in the future.

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Section: Systematic Review Of Sequelae Of the Covid-19 Pandemicmentioning

confidence: 99%

Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response

Joffe,

Elliott

2023

SAGE Open Medicine

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“…To date, the mechanisms causing PASC are still poorly understood, and the treatments and outcomes are still unknown [14]. Comprehensive research is therefore urgently needed with regard to this condition, including the identification of factors that can predispose an individual to its development, or instead have a protective effect [15,16]. This knowledge will enable the prompt identification of vulnerable subjects who can be closely monitored and promptly provided with the necessary care and support and given sufficient resources [17].…”

Section: Introductionmentioning

confidence: 99%

Impact of Age and Sex Interaction on Post-Acute Sequelae of COVID-19: An Italian Cohort Study on Adults and Children

Puntoni

Esposito

Patrizi

et al. 2023

JCM

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Identifying factors predisposing individuals to post-acute sequelae of COVID-19 (PASC) would allow for the timely treatment of those vulnerable. Attention on the role of sex and age is growing, but published studies have shown mixed results. Our objective was to estimate the effect modification of age on sex as a risk factor for PASC. We analyzed data from two longitudinal prospective cohort studies on adult and pediatric subjects positive to SARS-CoV-2 infection that were enrolled between May 2021 and September 2022. Age classes (≤5, 6–11, 12–50, >50 years) were based on the potential role of sex hormones on inflammatory/immune and autoimmune processes. A total of 452 adults and 925 children were analyzed: 46% were female and 42% were adults. After a median follow-up of 7.8 months (IQR: 5.0 to 9.0), 62% of children and 85% of adults reported at least one symptom. Sex and age alone were not significantly associated to PASC, but their interaction was statistically significant (p-value = 0.024): the risk was higher for males aged 0–5 (females vs. males HR: 0.64, 95% CI: 0.45–0.91, p = 0.012) and for females aged 12–50 (HR: 1.39, 95% CI: 1.04–1.86, p = 0.025), especially those in the cardiovascular, neurological, gastrointestinal and sleep categories. Further research on PASC with regard to sex and age is warranted.

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“…Efforts to understand potential PCC predictors have largely relied on clinical records and selfreports of demographics, health history, and initial disease sequelae [16][17][18]. These studies have highlighted a number of potential clinical predictors (including age; sex; ethnicities; comorbidities, namely asthma, obesity, immune deficiency, lung disease, heart disease, kidney disease, and diabetes; severity, type, number, and duration of acute symptoms; need for hospitalization; lower socioeconomic status; stress; allergies; and smoking) [5,6,8,[17][18][19], but are often bereft of variations in humoral response profile, which may be driven by severity and trajectory of COVID-19 infection and sequelae. There is a need to explore whether the inclusion of serological data can improve prediction of PCC, as compared with models based solely on clinical predictors.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Serological Predictors of Post Covid-19 Condition – Findings From a Canadian Prospective Cohort Study

Collins,

Galipeau,

Arnold

et al. 2023

Preprint

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Introduction: More than three years into the pandemic, there is persisting uncertainty as to the etiology, biomarkers, and risk factors of Post COVID-19 Condition (PCC). Serological research data remain a largely untapped resource. Few studies have investigated the potential relationships between post-acute serology and PCC, while accounting for clinical covariates. Methods: We compared clinical and serological predictors among COVID-19 survivors with (n=102 cases) and without (n=122 controls) persistent symptoms ≥ 12 weeks post-infection. We selected four primary serological predictors (anti-nucleocapsid (N), anti-Spike, and anti-receptor binding domain (RBD) IgG titres, and neutralization efficiency), and specified clinical covariates a priori. Results: Similar proportions of PCC-cases (66.7%, n=68) and infected-controls (71.3%, n=87) tested positive for anti-N IgG. More cases tested positive for anti-Spike (94.1%, n=96) and anti-RBD (95.1%, n=97) IgG, as compared with controls (anti-Spike: 89.3%, n=109; anti-RBD: 84.4%, n=103). Similar trends were observed among unvaccinated participants. Effects of IgG titres on PCC status were non-significant in univariate and multivariate analyses. Adjusting for age and sex, PCC-cases were more likely to be efficient neutralizers (OR 2.2, 95% CI 1.11 - 4.49), and odds was further increased among cases to report deterioration in quality of life (OR 3.4, 95% CI 1.64 - 7.31). Clinical covariates found to be significantly related to PCC included obesity (OR 2.3, p=0.02), number of months post COVID-19 (OR 1.1, p<0.01), allergies (OR 1.8, p=0.04), and need for medical support (OR 4.1, p<0.01). Conclusion: Despite past COVID-19 infection, approximately one third of PCC-cases and infected-controls were seronegative for anti-N IgG. Findings suggest higher neutralization efficiency among cases as compared with controls, and that this relationship is stronger among cases with more severe PCC. Cases also required more medical support for COVID-19 symptoms, and described complex, ongoing health sequelae. More data from larger cohorts are needed to substantiate results, permit subgroup analyses of IgG titres, and explore for differences between clusters of PCC symptoms. Future assessment of IgG subtypes may also elucidate new findings.

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Unfavorable Outcome and Long-Term Sequelae in Cases with Severe COVID-19

Cited by 5 publications

References 74 publications

Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response

Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response

Impact of Age and Sex Interaction on Post-Acute Sequelae of COVID-19: An Italian Cohort Study on Adults and Children

Clinical and Serological Predictors of Post Covid-19 Condition – Findings From a Canadian Prospective Cohort Study

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