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Multiple early factors anticipate post-acute COVID-19 sequelae.

ABSTRACT: Post-acute sequelae of COVID-19 (PASC) represent an emerging global crisis. However, quantifiable risk factors for PASC and their biological associations are poorly resolved. We executed a deep multi-omic, longitudinal investigation of 309 COVID-19 patients from initial diagnosis to convalescence (2-3 months later), integrated with clinical data and patient-reported symptoms. We resolved four PASC-anticipating risk factors at the time of initial COVID-19 diagnosis: type 2 diabetes, SARS-CoV-2 RNAemia, Epstein-Barr virus viremia, and specific auto-antibodies. In patients with gastrointestinal PASC, SARS-CoV-2-specific and CMV-specific CD8⁺ T cells exhibited unique dynamics during recovery from COVID-19. Analysis of symptom-associated immunological signatures revealed coordinated immunity polarization into four endotypes, exhibiting divergent acute severity and PASC. We find that immunological associations between PASC factors diminish over time, leading to distinct convalescent immune states. Detectability of most PASC factors at COVID-19 diagnosis emphasizes the importance of early disease measurements for understanding emergent chronic conditions and suggests PASC treatment strategies.

SUBMITTER: Su Y

PROVIDER: S-EPMC8786632 | biostudies-literature | 2022 Mar

REPOSITORIES: biostudies-literature

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Multiple early factors anticipate post-acute COVID-19 sequelae.

Su Yapeng Y Yuan Dan D Chen Daniel G DG Ng Rachel H RH Wang Kai K Choi Jongchan J Li Sarah S Hong Sunga S Zhang Rongyu R Xie Jingyi J Kornilov Sergey A SA Scherler Kelsey K Pavlovitch-Bedzyk Ana Jimena AJ Dong Shen S Lausted Christopher C Lee Inyoul I Fallen Shannon S Dai Chengzhen L CL Baloni Priyanka P Smith Brett B Duvvuri Venkata R VR Anderson Kristin G KG Li Jing J Yang Fan F Duncombe Caroline J CJ McCulloch Denise J DJ Rostomily Clifford C Troisch Pamela P Zhou Jing J Mackay Sean S DeGottardi Quinn Q May Damon H DH Taniguchi Ruth R Gittelman Rachel M RM Klinger Mark M Snyder Thomas M TM Roper Ryan R Wojciechowska Gladys G Murray Kim K Edmark Rick R Evans Simon S Jones Lesley L Zhou Yong Y Rowen Lee L Liu Rachel R Chour William W Algren Heather A HA Berrington William R WR Wallick Julie A JA Cochran Rebecca A RA Micikas Mary E ME Wrin Terri T Petropoulos Christos J CJ Cole Hunter R HR Fischer Trevan D TD Wei Wei W Hoon Dave S B DSB Price Nathan D ND Subramanian Naeha N Hill Joshua A JA Hadlock Jennifer J Magis Andrew T AT Ribas Antoni A Lanier Lewis L LL Boyd Scott D SD Bluestone Jeffrey A JA Chu Helen H Hood Leroy L Gottardo Raphael R Greenberg Philip D PD Davis Mark M MM Goldman Jason D JD Heath James R JR

Cell 20220125 5

Post-acute sequelae of COVID-19 (PASC) represent an emerging global crisis. However, quantifiable risk factors for PASC and their biological associations are poorly resolved. We executed a deep multi-omic, longitudinal investigation of 309 COVID-19 patients from initial diagnosis to convalescence (2-3 months later), integrated with clinical data and patient-reported symptoms. We resolved four PASC-anticipating risk factors at the time of initial COVID-19 diagnosis: type 2 diabetes, SARS-CoV-2 RN ...[more]

PMID: 35216672

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Project description:BackgroundData on the post-acute and post-infectious complications of patients who have recovered from severe coronavirus disease 2019 (COVID-19) are limited. While studies report that approximately 5-15% of COVID-19 hospitalized patients require intensive care and mechanical ventilation, a substantially higher number need non-invasive ventilation and are subject to prolonged hospitalizations, with long periods of immobility and isolation. The purpose of this study is to describe the post-infectious sequelae of severe viral illness and the post-acute complications of intensive care treatments in critically ill patients who have recovered from severe COVID-19 infection.MethodsWe performed a retrospective chart review of adult patients initially hospitalized with confirmed COVID-19 infection, who recovered and were transferred to a general medical ward or discharged home between March 15, 2020 and May 15, 2020, dates inclusive, after an intensive care unit (ICU) or high dependency unit (HDU) admission in a designated COVID-19 hospital in the United Arab Emirates. Demographic data, underlying comorbidities, treatment, complications, and outcomes were collected. Descriptive statistical analyses were performed.ResultsOf 71 patients transferred out of ICU (n = 38, 54%) and HDU (n = 33, 46%), mean age was 48 years (SD, 9.95); 96% men; 54% under age 50. Mean ICU stay was 12.4 days (SD, 5.29), HDU stay was 13.4 days (SD, 4.53). Pre-existing conditions were not significantly associated with developing post-acute complications (Odds Ratio [OR] 1.1, 95% confidence interval [CI] 0.41, 2.93, p = 1.00). Fifty nine percent of patients had complications; myopathy, swallowing impairments, and pressure ulcers were most common. Delirium and confusion were diagnosed in 18% (n = 13); all were admitted to the ICU and required mechanical ventilation. Of note, of all patients studied, 59.2% (n = 42/71) had at least 1 complication, 32.4% (n = 23) had at least 2 complications, and 19.7% (n = 14) suffered 3 or more sequelae. Complications were significantly more common in ICU patients (n = 33/38, 87%), compared to HDU patients (n = 9/33, 27%) (OR 17.6, 95% CI 5.23, 59.21, p <0.05).ConclusionIn a subset of critically ill patients who recovered from severe COVID-19 infection, there was considerable short-term post-infectious and post-acute disability. Long-term follow-up of COVID-19 survivors is warranted.

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Multiple early factors anticipate post-acute COVID-19 sequelae.

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Multiple early factors anticipate post-acute COVID-19 sequelae.

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