Factors Associated with Post-Acute Sequelae of SARS-CoV-2 (PASC) After Diagnosis of Symptomatic COVID-19 in the Inpatient and Outpatient Setting in a Diverse Cohort

Abstract

Background The incidence of persistent clinical symptoms and risk factors in Post-Acute Sequelae of SARS-CoV-2 (PASC) in diverse US cohorts is unclear. While there are a disproportionate share of COVID-19 deaths in older patients, ethnic minorities, and socially disadvantaged populations in the USA, little information is available on the association of these factors and PASC. Objective To evaluate the association of demographic and clinical characteristics with development of PASC. Design Prospective observational cohort of hospitalized and high-risk outpatients, April 2020 to February 2021. Participants One thousand thirty-eight adults with laboratory-confirmed symptomatic COVID-19 infection. Main Measures Development of PASC determined by patient report of persistent symptoms on questionnaires conducted 60 or 90 days after COVID-19 infection or hospital discharge. Demographic and clinical factors associated with PASC. Key Results Of 1,038 patients with longitudinal follow-up, 309 patients (29.8%) developed PASC. The most common persistent symptom was fatigue (31.4%) followed by shortness of breath (15.4%) in hospitalized patients and anosmia (15.9%) in outpatients. Hospitalization for COVID-19 (odds ratio [OR] 1.49, 95% [CI] 1.04–2.14), having diabetes (OR, 1.39; 95% CI 1.02–1.88), and higher BMI (OR, 1.02; 95% CI 1–1.04) were independently associated with PASC. Medicaid compared to commercial insurance (OR, 0.49; 95% CI 0.31–0.77) and having had an organ transplant (OR 0.44, 95% CI, 0.26–0.76) were inversely associated with PASC. Age, race/ethnicity, Social Vulnerability Index, and baseline functional status were not associated with developing PASC. Conclusions Three in ten survivors with COVID-19 developed a subset of symptoms associated with PASC in our cohort. While ethnic minorities, older age, and social disadvantage are associated with worse acute COVID-19 infection and greater risk of death, our study found no association between these factors and PASC.

Impact of COVID-19 vaccination on long COVID: a systematic review and meta-analysis

“…There were several studies that showed symptom changes following vaccination, however they were mostly cross-sectional in nature and thus impossible to establish true causality, and thus excluded. Furthermore, long COVID characteristics and symptomatology are getting well established with global data (1, 5, 18).…”

“…Long COVID, also known as post-acute COVID sequalae or post-acute COVID-19 syndrome, is now recognized as a major concern following COVID-19 infections, and likely to cause significant global morbidity for many years to come (1,2). With global case numbers over 500 million and with a conservative prevalence of 20-30%, more than 100 million people could be affected by long COVID worldwide (3)(4)(5).…”

Identifying Contextual and Spatial Risk Factors for Post-Acute Sequelae of SARS-CoV-2 Infection: An EHR-based Cohort Study from the RECOVER Program

“…Recent research examined a limited set of contextual and spatial risk factors for PASC. For example, one study examined the association between the Social Vulnerability Index (SVI) and PASC using a sample of 1,000 COVID-19 patients from a single health system and found no differences in the likelihood of PASC between patients with higher and lower levels of SVI (Yoo et al, 2022). As individuals are exposed to multiple disadvantaged contextual and spatial factors simultaneously, more research is warranted to examine the totality of the environment using COVID-19 patients from geographically diverse regions.…”

Recommendation: Treatment of clinical long COVID encephalopathies with nasal administered mesenchymal stromal cell extracellular vesicles

“…Furthermore, LCS can occur no matter which SARS-CoV-2 virus variant has been involved, since there is no evidence yet that there are any differences in the subsequent development of LCS between beta and delta or the present omicron infections (Su et al, 2022). Currently there is no clear unified idea on the pathogenesis of these syndromes (Maltezou et al, 2021;Yoo et al, 2022;Zhao et al, 2022), but the general idea is emerging that these are principally vascular diseases; judging by aspects of the active SARS-CoV-2 viral infection of COVID-19 patients (Kalafatis, 2021;Lei et al, 2021;Ostergaard, 2021;Siddiqi et al, 2021) and elements of the subsequent LCS (Charfeddine et al, 2021;Christensen and Berg, 2021). In fact, brain single-photon emission-computed tomography in fourteen LCS Long COVID patients seen in family practice with severe neurocognitive problems demonstrated vascular encephalopathy that was thought due to persistent coagulation disorders (Jamoulle et al, 2021).…”