Determinants of the onset and prognosis of the post-COVID-19 condition: a 2-year prospective observational cohort study

The Lancet Regional Health - Europe, Год журнала: 2023, Номер 33, С. 100724 - 100724

Опубликована: Сен. 5, 2023

At least 5-10% of subjects surviving COVID-19 develop the post-COVID-19 condition (PCC) or "Long COVID". The clinical presentation PCC is heterogeneous, its pathogenesis being deciphered, and objective, validated biomarkers are lacking. It unknown if a single entity heterogeneous syndrome with overlapping pathophysiological basis. large US RECOVER study identified four clusters according to their presenting symptoms. However, long-term implications remain unknown.We conducted 2-year prospective cohort COVID-19, including individuals fulfilling WHO definition full recovery. We systematically collected symptoms using prespecified questionnaires performed additional diagnostic imaging tests when needed. Factors associated were modelled logistic regression. Unsupervised clustering analysis was used group recovery direct acyclic graph approach.The included 548 individuals, 341 PCC, followed for median 23 months (IQR 16.5-23.5), 207 fully recovered. In model best fit, who male had tertiary studies less likely whereas history headache, presence tachycardia, fatigue, neurocognitive neurosensitive complaints dyspnea at diagnosis predicted development PCC. cluster revealed three symptom an additive number Only 26 (7.6%) recovered from during follow-up; almost all them (n = 24) belonged symptomatic A, dominated mainly by fatigue. Recovery more in male, required ICU admission, cardiovascular comorbidities, hyporexia and/or smell/taste alterations acute COVID-19. Subjects muscle pain, impaired attention, dyspnea, conversely, recover PCC.Preexisting medical socioeconomic factors, as well symptoms, extremely rare first 2 years, posing major challenge healthcare systems.Fundació Lluita contra les Infeccions.

Язык: Английский

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Complement dysregulation is a prevalent and therapeutically amenable feature of long COVID

Med, Год журнала: 2024, Номер 5(3), С. 239 - 253.e5

Опубликована: Фев. 15, 2024

BackgroundLong COVID encompasses a heterogeneous set of ongoing symptoms that affect many individuals after recovery from infection with SARS-CoV-2. The underlying biological mechanisms nonetheless remain obscure, precluding accurate diagnosis and effective intervention. Complement dysregulation is hallmark acute COVID-19 but has not been investigated as potential determinant long COVID.MethodsWe quantified series complement proteins, including markers activation regulation, in plasma samples healthy convalescent confirmed history SARS-CoV-2 age/ethnicity/sex/infection/vaccine-matched patients COVID.FindingsMarkers classical (C1s-C1INH complex), alternative (Ba, iC3b), terminal pathway (C5a, TCC) were significantly elevated COVID. These combination had receiver operating characteristic predictive power 0.794. Other proteins regulators also quantitatively different between Generalized linear modeling further revealed clinically tractable just four these markers, namely the fragments iC3b, TCC, Ba, C5a, 0.785.ConclusionsThese findings suggest biomarkers could facilitate currently available inhibitors be used to treat COVID.FundingThis work was funded by National Institute for Health Research (COV-LT2-0041), PolyBio Foundation, UK Dementia Institute.

Язык: Английский

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Updated Clinical Practice Guidelines for the Diagnosis and Management of Long COVID

Infection and Chemotherapy, Год журнала: 2024, Номер 56(1), С. 122 - 122

Опубликована: Янв. 1, 2024

"Long COVID" is a term used to describe condition when the symptoms and signs associated with coronavirus disease 2019 (COVID-19) persist for more than three months among patients infected COVID-19; this has been reported globally poses serious public health issue. Long COVID can manifest in various forms, highlighting need appropriate evaluation management by experts from fields. However, due lack of clear clinical definitions, knowledge pathophysiology, diagnostic methods, treatment protocols, it necessary develop best standard guidelines based on scientific evidence date. We developed guideline diagnosing treating long analyzing latest research data collected start COVID-19 pandemic until June 2023, along consensus expert opinions. This provides recommendations diagnosis that be applied practice, total 32 key questions related COVID. The should comprehensive, including medical history, physical examination, blood tests, imaging studies, functional tests. To reduce risk developing COVID, vaccination antiviral during acute phase are recommended. will revised there reasonable updates availability new

Язык: Английский

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Persistent symptoms and clinical findings in adults with post-acute sequelae of COVID-19/post-COVID-19 syndrome in the second year after acute infection: A population-based, nested case-control study

PLoS Medicine, Год журнала: 2025, Номер 22(1), С. e1004511 - e1004511

Опубликована: Янв. 23, 2025

Background Self-reported health problems following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are common and often include relatively non-specific complaints such as fatigue, exertional dyspnoea, concentration or memory disturbance sleep problems. The long-term prognosis of post-acute sequelae COVID-19/post-COVID-19 (PCS) is unknown, data finding correlating organ dysfunction pathology with self-reported symptoms in patients non-recovery from PCS scarce. We wanted to describe clinical characteristics diagnostic findings among persisting for >1 year assessed risk factors persistence versus improvement. Methods This nested population-based case-control study included subjects aged 18–65 years ( n = 982) age- sex-matched control without 576) according an earlier questionnaire (6–12 months after infection, phase 1) consenting provide follow-up information undergo comprehensive outpatient assessment, including neurocognitive, cardiopulmonary exercise, laboratory testing four university centres southwestern Germany (phase 2, another 8.5 [median, range 3–14 months] 1). mean age the participants was 48 years, 65% were female. At 67.6% at 1 developed persistent PCS, whereas 78.5% recovered remained free related PCS. Improvement associated mild index previous full-time employment, educational status, no specialist consultation not attending a rehabilitation programme. development new initially intercurrent secondary SARS-CoV-2 status. Patients less frequently never smokers (61.2% 75.7%), more obese (30.2% 12.4%) higher values body mass (BMI) fat, had lower status (university entrance qualification 38.7% 61.5%) than continued recovery. Fatigue/exhaustion, neurocognitive disturbance, chest symptoms/breathlessness anxiety/depression/sleep predominant symptom clusters. Exercise intolerance post-exertional malaise (PEM) >14 h compatible myalgic encephalomyelitis/chronic fatigue reported by 35.6% 11.6% patients, respectively. In analyses adjusted sex-age class combinations, centre qualification, significant differences between those recovery observed performance three different tests, scores perceived stress, subjective cognitive disturbances, dysautonomia, depression anxiety, quality, quality life. handgrip strength (40.2 [95% confidence interval (CI) [39.4, 41.1]] 42.5 CI [41.5, 43.6]] kg), maximal oxygen consumption (27.9 [27.3, 28.4]] 31.0 [30.3, 31.6]] ml/min/kg weight) ventilatory efficiency (minute ventilation/carbon dioxide production slope, 28.8 [28.3, 29.2]] 27.1 [26.6, 27.7]]) significantly reduced relative group adjustment centre, education, BMI, smoking use beta blocking agents. There measures systolic diastolic cardiac function rest, level N-terminal brain natriuretic peptide blood levels other measurements (including complement activity, markers Epstein–Barr virus [EBV] reactivation, inflammatory coagulation markers, serum cortisol, adrenocorticotropic hormone dehydroepiandrosterone sulfate). Screening viral (PCR stool samples spike antigen plasma) subgroup negative. Sensitivity (pre-existing illness/comorbidity, obesity, medical care infection) revealed similar findings. PEM pain worse results almost all tests. A limitation that we objective on exercise capacity cognition before infection. addition, did unable attend clinic whatever reason illness, immobility social deprivation exclusion. Conclusions this study, majority working recover second their illness. Patterns essentially similar, dominated complaints. Despite signs deficits capacity, there major investigations, our do support persistence, EBV adrenal insufficiency increased turnover pathophysiologically relevant history disease might help stratify cases severity.

Язык: Английский

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Long COVID clinical evaluation, research and impact on society: a global expert consensus

Annals of Clinical Microbiology and Antimicrobials, Год журнала: 2025, Номер 24(1)

Опубликована: Апрель 20, 2025

Abstract Background Long COVID is a complex, heterogeneous syndrome affecting over four hundred million people globally. There are few recommendations, and no formal training exists for medical professionals to assist with clinical evaluation management of patients COVID. More research into the pathology, cellular, molecular mechanisms COVID, treatments needed. The goal this work disseminate essential information about recommendations definition, diagnosis, treatment, social issues physicians, researchers, policy makers address escalating global health crisis. Methods A 3-round modified Delphi consensus methodology was distributed internationally 179 healthcare professionals, persons lived experience in 28 countries. Statements were combined specific areas: research, society. Results survey resulted 187 comprehensive statements reaching strongest areas being diagnosis assessment, general research. We establish conditions different subgroups within umbrella. Clear reached that impacts COVID-19 infection on children should be priority, additionally need determine effects societies economies. it affects nervous system other organs not likely observed initial symptoms. note, biomarkers critically needed these issues. Conclusions This forms guidance spectrum as disease reinforces translational large-scale treatment trials protocols.

Язык: Английский

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Interventions for the management of long covid (post-covid condition): living systematic review

BMJ, Год журнала: 2024, Номер unknown, С. e081318 - e081318

Опубликована: Ноя. 27, 2024

Abstract Objective To compare the effectiveness of interventions for management long covid (post-covid condition). Design Living systematic review. Data sources Medline, Embase, CINAHL, PsycInfo, Allied and Complementary Medicine Database, Cochrane Central Register Controlled Trials from inception to December 2023. Eligibility criteria that randomised adults (≥18 years) with drug or non-drug interventions, placebo sham, usual care. Results 24 trials 3695 patients were eligible. Four (n=708 patients) investigated eight (n=985) physical activity rehabilitation, three (n=314) behavioural, four (n=794) dietary, (n=309) medical devices technologies, one (n=585) a combination exercise mental health rehabilitation. Moderate certainty evidence suggested that, compared care, an online programme cognitive behavioural therapy (CBT) probably reduces fatigue (mean difference −8.4, 95% confidence interval (CI) −13.11 −3.69; Checklist Individual Strength subscale; range 8-56, higher scores indicate greater impairment) improves concentration −5.2, −7.97 −2.43; problems 4-28; impairment). online, supervised, combined rehabilitation leads improvement in overall health, estimated 161 more per 1000 (95% CI 61 292 more) experiencing meaningful recovery, symptoms depression −1.50, −2.41 −0.59; Hospital Anxiety Depression Scale 0-21; impairment), quality life (0.04, 0.00 0.08; Patient-Reported Outcomes Measurement Information System 29+2 Profile; −0.022-1; less intermittent aerobic 3-5 times weekly 4-6 weeks function continuous 3.8, 1.12 6.48; SF-36 component summary score; 0-100; No compelling was found support other including, among others, vortioxetine, leronlimab, probiotics-prebiotics, coenzyme Q10, amygdala insula retraining, L-arginine vitamin C, inspiratory muscle training, transcranial direct current stimulation, hyperbaric oxygen, mobile application providing education on covid. Conclusion suggests CBT improve Systematic review registration Open Science Framework https://osf.io/9h7zm/ . Readers’ note This article is living will be updated reflect emerging evidence. Updates may occur up two years date original publication.

Язык: Английский

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The efficacy of antivirals, corticosteroids, and monoclonal antibodies as acute COVID-19 treatments in reducing the incidence of long COVID: a systematic review and meta-analysis

Clinical Microbiology and Infection, Год журнала: 2024, Номер 30(12), С. 1505 - 1513

Опубликована: Июль 14, 2024

Язык: Английский

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Exploring the Pathophysiology of Long COVID: The Central Role of Low-Grade Inflammation and Multisystem Involvement

International Journal of Molecular Sciences, Год журнала: 2024, Номер 25(12), С. 6389 - 6389

Опубликована: Июнь 9, 2024

Long COVID (LC), also referred to as Post COVID-19 Condition, Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), and other terms, represents a complex multisystem disease persisting after the acute phase COVID-19. Characterized by myriad symptoms across different organ systems, LC presents significant diagnostic management challenges. Central disorder is role low-grade inflammation, non-classical inflammatory response that contributes chronicity diversity observed. This review explores pathophysiological underpinnings LC, emphasizing importance inflammation core component. By delineating pathogenetic relationships clinical manifestations this article highlights necessity for an integrated approach employs both personalized medicine standardized protocols aimed at mitigating long-term consequences. The insights gained not only enhance our understanding but inform development therapeutic strategies could be applicable chronic conditions with similar features.

Язык: Английский

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Prevalence of cardiovascular symptoms in post-acute COVID-19 syndrome: a meta-analysis

BMC Medicine, Год журнала: 2025, Номер 23(1)

Опубликована: Фев. 6, 2025

Since its emergence in 2019, COVID-19 has continued to pose significant threats both the physical and mental health of global population, as well healthcare systems worldwide (Raman et al., Eur Heart J 43:1157–1172, 2022). Emerging evidence indicates that may lead post-acute syndrome (PACS) with cardiovascular implications, potentially driven by factors such ACE2 interaction viruses, systemic inflammation, endothelial dysfunction. However, there remains a limited amount research on manifestations PACS, which delay development optimal treatment strategies for affected patients. Therefore, it is crucial investigate prevalence sequelae patients determine whether infection acts an independent risk factor these outcomes. This meta-analysis adhered PRISMA guidelines was registered PROSPERO (CRD42024524290). A systematic search PubMed, Embase, Cochrane Library conducted up March 17, 2024. The primary outcomes included hypertension, palpitations, chest pain, pooled effect estimate reported proportions odds ratios (ORs) 95% confidence intervals (CIs). Sensitivity subgroup analysis were performed assess robustness results identify sources heterogeneity. total 37 studies, encompassing 2,965,467 patients, analysis. Pooled from case–control studies revealed that, compared control group, ORs pain group 4.0 (95% CI: 1.6, 10.0). palpitation hypertension 3.4 1.1, 10.2) 1.7 1.8), respectively. PACS experiencing palpitation, 22% 14%, 33%), 18% 13%, 24%), 19% 12%, 31%), Our findings indicate 15% experience sequelae. Furthermore, significantly increases likelihood developing uninfected individuals. Future should prioritize investigating underlying pathological mechanisms targeted preventive management strategies. CRD42024524290.

Язык: Английский

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Interventions for the management of post-COVID-19 condition (long COVID): protocol for a living systematic review and network meta-analysis

BMJ Open, Год журнала: 2025, Номер 15(2), С. e086407 - e086407

Опубликована: Фев. 1, 2025

Up to 15% of survivors COVID-19 infection experience long-term health effects, including fatigue, myalgia and impaired cognitive function, termed post-COVID-19 condition or long COVID. Several trials that study the benefits harms various interventions manage COVID have been published hundreds more are planned ongoing. Trustworthy systematic reviews clarify critical promote evidence-based practice. To create maintain a living review network meta-analysis addressing pharmacologic non-pharmacologic for treatment management Eligible will randomise adults with interventions, placebo, sham usual care. We identify eligible studies by searching MEDLINE, EMBASE, CINAHL, PsycINFO, AMED CENTRAL from inception, without language restrictions.Reviewers work independently in duplicate screen search records, collect data trials, trial patient characteristics outcomes interest assess risk bias. Our include patient-reported pain, postexertional malaise, changes education employment status, mental health, dyspnoea, quality life, physical recovery serious adverse events.For each outcome, when possible, we perform frequentist random-effects meta-analysis. When there compelling reasons suspect certain only applicable effective subtype COVID, separate meta-analyses. The Grading Recommendations, Assessment, Development Evaluations (GRADE) approach guide our assessment certainty evidence.We update biannually, on publication seminal trial, new evidence emerges may change clinical This provide comprehensive, trustworthy up-to-date summaries make findings available publicly guideline-producing organisations inform their recommendations. describes protocol uses reports. Therefore, is exempt ethics review. intend deposit all public repository publish iteration online.

Язык: Английский

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