Characterization of Autonomic Symptom Burden in Long COVID: A Global Survey of 2,314 Adults

Larsen, Nicholas; Stiles, Lauren E.; Shaik, Ruba; Schneider, Logan; Muppidi, Srikanth; Tsui, Cheuk To; Miglis, Mitchell G.

doi:10.1101/2022.04.25.22274300

Cited by 11 publications

(7 citation statements)

References 34 publications

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“…Although it is possible that these conditions were present but unrecognized in some patients before they developed COVID-19, the fact that the majority reported that they were previously healthy suggests that these conditions may have been a consequence of COVID-19. These conditions have been highlighted in other studies of long COVID, [40][41][42][43][44][45] so it is important that clinicians are aware of common management strategies. [46][47][48] Fourth, patients in this cohort experienced significant functional impairment (Supplemental Digital Content 5, http://links.lww.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Follow-up of Referred Children and Young People With Long COVID

Weakley,

Schikler,

Green

et al. 2023

Pediatric Infectious Disease Journal

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Background: Patient-level data on the clinical features and outcomes of children and young people referred for possible long coronavirus disease (COVID) can guide clinicians on what to expect in managing patients and advising families. Methods: A Post-Acute COVID Clinic for persons <21 years of age was established in October 2020. Intake was standardized and management was tailored to presenting symptoms. Data were abstracted from the charts of all patients evaluated through December 2021, and the study cohort consisted of patients who had a history of confirmed severe acute respiratory syndrome coronavirus 2 infection, had ≥1 symptom persisting for ≥12 weeks and had no pre-existing diagnosis that explained the symptoms. A structured follow-up interview was conducted in early 2022. Results: A total of 104 patients were referred, 81 of whom met inclusion criteria. The median age was 14 years (interquartile range, 13–16), and most were female, White/Caucasian and had commercial health insurance. Patients reported previously good health but over half reported moderate-to-severe disability at their first visit. Two clusters of presenting symptoms—fatigue with multiple symptoms, and fatigue and headache with cardiopulmonary symptoms—were identified. Extensive routine testing did not affirm alternative diagnoses. Incident conditions—most commonly anxiety, depression and/or panic disorder; migraines; and autonomic dysfunction—were diagnosed on clinical grounds. Telephone interviews (N = 55) revealed that 78% of patients were improved by about 6 months. Conclusions: Within the limits of a single-center, referral-based, observational cohort, this study provides reassurance to patients and parents in that most cases of long COVID were self-limited. Extensive evaluations may be more useful in ruling out alternative diagnoses than in affirming specific physiologic disturbances.

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Section: Discussionmentioning

confidence: 99%

Clinical Features and Follow-up of Referred Children and Young People With Long COVID

Weakley,

Schikler,

Green

et al. 2023

Pediatric Infectious Disease Journal

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“…Examples include Gaze-evoked nystagmus (HP:0000640), Pericardial effusion (HP:0001698), and Exercise intolerance (HP:0003546) that are typically diagnosed using specialist examinations or medical history that may not be easily coded in structured EHR fields. Additionally, several common manifestations of long COVID, including dysautonomia (57) , are less documented in EHR data in part due to the difficulties in recognizing these illnesses clinically and the fact that relevant findings may not be well represented in structured fields including the OMOP data available in N3C.…”

Section: Discussionmentioning

confidence: 99%

Generalizable Long COVID Subtypes: Findings from the NIH N3C and RECOVER Programs

Reese

Blau

Bergquist

et al. 2022

Preprint

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Accurate stratification of patients with Post-acute sequelae of SARS-CoV-2 infection (PASC, or long COVID) would allow precision clinical management strategies and could enable more focussed investigation of the molecular pathogenetic mechanisms of this disease. However, the natural history of long COVID is incompletely understood and characterized by an extremely wide range of manifestations that are difficult to analyze computationally. In addition, the generalizability of machine learning classification of COVID-19 clinical outcomes has rarely been tested. We present a method for computationally modeling long COVID phenotype data based on electronic healthcare records (EHRs) and for assessing pairwise phenotypic similarity between patients using semantic similarity. Using unsupervised machine learning (k-means clustering), we found six distinct clusters of long COVID patients, each with distinct profiles of phenotypic abnormalities with enrichments in pulmonary, cardiovascular, neuropsychiatric, and constitutional symptoms such as fatigue and fever. There was a highly significant association of cluster membership with a range of pre-existing conditions and with measures of severity during acute COVID-19. We show that the clusters we identified in one hospital system were generalizable across different hospital systems. Semantic phenotypic clustering can provide a foundation for assigning patients to stratified subgroups for natural history or therapy studies on long COVID.

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“…Essa incapacidade, por sua vez, desencadeia insegurança e, consequentemente, distúrbios psiquiátricos secundários. [20][21][22][23][24][25][26] Por todos esses motivos, o reconhecimento precoce da síndrome Pós-COVID é de fundamental importância tanto para o seu portador, como para familiares, seu círculo profissional e social de convivência. Todos os indivíduos, após exposição ao SARS COV-2 e à imunização, que apresentem um ou mais sintomas relatados previamente, devem ser avaliados com atenção.…”

Section: Hachul Et Al Disautonomias Pós-covidunclassified

“…A correlação do início dos sintomas com exposição ao vírus ou à vacina, mesmo que o paciente tenha sido oligo ou assintomático, é de extrema importância, já que sintomas da síndrome Pós-COVID podem se iniciar entre dias e semanas após o contato com o vírus e durar muitos meses. 20,25 Um exame físico completo, cardiovascular, respiratório e neurológico é mandatório. Atenção especial deve ser dirigida ao estado nutricional, grau de hidratação, coloração de mucosas, frequência e padrão respiratórios, saturação de O 2 , presença de sarcopenia e acrocianose.…”

Section: Hachul Et Al Disautonomias Pós-covidunclassified

Disautonomias Pós-COVID: Importância do Reconhecimento Precoce e da Implementação de Programas de Recuperação

Hachul¹,

Almeida²,

Scanavacca³

2023

Arquivos Brasileiros De Cardiologia

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A comunidade científica internacional dedicou todo o seu esforço nos últimos três anos, para o melhor entendimento e tratamento da infeção pelo SARS-COV-2, que inicialmente parecia limitar-se a uma síndrome respiratória aguda grave. No entanto, à medida que avançamos no tempo, deparamonos com um número crescente de pacientes com sintomas multissistêmicos, persistentes, intermitentes, ou tardios, que geraram importante comprometimento psico-funcional dos acometidos e que nos revelaram o caráter crônico e imprevisível da doença. 1 A reconhecida Síndrome Pós-COVID, cursa com um número expressivo de queixas, descritas em relatos de casos, estudos populacionais e metanálises. Miocardites, infarto do miocárdio, acidente vascular cerebral, insuficiência cardíaca e arritmias, além de afecções genito-urinárias, gastrointestinais, endocrinológicas, neurológicas centrais e periféricas, de severidades variadas foram descritas na fase subaguda e crônica após contato com o vírus. [1][2][3][4][5][6] Uma primeira série de casos foi publicada em pacientes italianos avaliados em média 60 dias depois da alta hospitalar. Os autores observaram que 87% apresentavam persistência de pelo menos um sintoma, 32% dois sintomas e 55% três ou mais. A fadiga foi a queixa mais frequente (53,1%), seguida de dispneia (43,4%), dor articular (27,3%) e dor torácica (21,7%). 2 Em outro estudo, Huang et al., reportaram que 6 meses pós-alta, 76% dos indivíduos ainda apresentavam pelo menos um sintoma, especialmente fadiga, mialgia, artralgia, cefaleia, dispneia, dor torácica, palpitações, distúrbios do sono, deficiência de memória e da capacidade de concentração. 3 Recentemente, três anos depois do início da pandemia, uma revisão detalhada publicada na Nature Reviews Microbiology estima que no mínimo 65 milhões de indivíduos ao redor do mundo mantenham-se sintomáticos e essa incidência continua aumentando, apesar do arrefecimento da infecção aguda, da menor mortalidade e do aumento de imunizados na população. Esse número pode ser ainda maior, considerando-se que muitos casos não são diagnosticados ou documentados na fase aguda da doença. 5

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Characterization of Autonomic Symptom Burden in Long COVID: A Global Survey of 2,314 Adults

Cited by 11 publications

References 34 publications

Clinical Features and Follow-up of Referred Children and Young People With Long COVID

Clinical Features and Follow-up of Referred Children and Young People With Long COVID

Generalizable Long COVID Subtypes: Findings from the NIH N3C and RECOVER Programs

Disautonomias Pós-COVID: Importância do Reconhecimento Precoce e da Implementação de Programas de Recuperação

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