Long COVID: Distinction between Organ Damage and Deconditioning

Kersten, Johannes; Baumhardt, Michael; Hartveg, Paul; Hoyo, Luis; Hüll, Elina; Imhof, Armin; Kropf-Sanchen, Cornelia; Nita, Nicoleta; Mörike, Johannes; Rattka, Manuel; Andreß, Stefanie; Scharnbeck, Dominik; Schmidtke-Schrezenmeier, Gerlinde; Tadić, Marijana; Wolf, Alexander; Rottbauer, Wolfgang; Buckert, Dominik

doi:10.3390/jcm10173782

Cited by 34 publications

(32 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…All patients were included independently of their initial disease severity (ranging from asymptomatic to hospitalised courses). As recently published, diagnostic workups followed a strict examination algorithm 11 . In brief, all patients underwent transthoracic echocardiography, body plethysmography, capillary blood gas analysis (BGA) and a 6-min walk test (6-MWT).…”

Section: Methodsmentioning

confidence: 99%

Symptom burden correlates to impairment of diffusion capacity and exercise intolerance in long COVID patients

Kersten

Wolf

Hoyo

et al. 2022

Sci Rep

Self Cite

View full text Add to dashboard Cite

After acute infection with the SARS-CoV-2 virus, a considerable number of patients remains symptomatic with pathological changes in various organ systems. This study aimed to relate the physical and mental burden of symptoms of long COVID patients to the findings of a somatic evaluation. In patients with persistent long COVID symptoms three months after acute infection we assessed physical and mental health status using the SF-36 questionnaire. The cohort was dichotomised by the results (upper two quartiles vs. lower to quartiles) and compared with regard to transthoracic echocardiography, body plethysmography (including diffusion capacity), capillary blood gas analysis and 6-min walk test (6-MWT). From February 22 to September 13, 2021, 463 patients were prospectively examined, of which 367 completed the SF-36 questionnaire. A positive correlation between initial disease severity (need for hospitalization, intensive care medicine) and resulting symptom burden at follow-up could be demonstrated. Patients with impaired subjective physical and mental status were significantly more likely to be women. There was a significant correlation between symptom severity and reduced exercise tolerance in the 6-MWT (495.6 ± 83.7 m vs 549.7 ± 71.6 m, p < 0.001) and diffusion capacity for carbon monoxide (85.6 ± 14.3% of target vs 94.5 ± 14.4, p < 0.001). In long COVID patients, initial disease severity is correlated with symptom burden after at least 3 months of follow-up. Highly symptomatic long COVID patients show impaired diffusion capacity and 6-MWT despite average or mildly affected mechanical lung parameters. It must be further differentiated whether this corresponds to a transient functional impairment or whether it is a matter of defined organ damage.

show abstract

Section: Methodsmentioning

confidence: 99%

Symptom burden correlates to impairment of diffusion capacity and exercise intolerance in long COVID patients

Kersten

Wolf

Hoyo

et al. 2022

Sci Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…30,33 Five studies reported chronotropic incompetence to be a major cause of reduced exercise capacity, 25,30,44,63,64 and most studies reported a lower peak heart rate among individuals with reduced exercise capacity. One study each specifically reported pulmonary fibrosis, 65 pulmonary vascular limitation, 66 impaired microcirculation, 61 endothelial dysfunction, 67 dysautonomia, 64 and loss of mechanical efficiency 28 as the primary etiology of reduced exercise capacity. Despite concerns about pulmonary thromboembolism during acute infection, pulmonary vascular limitations were uncommon.…”

Section: Resultsmentioning

confidence: 99%

Cardiopulmonary exercise testing to evaluate post-acute sequelae of COVID-19 (“Long COVID”): a systematic review and meta-analysis

Durstenfeld

Sun

Tahir

et al. 2022

Preprint

View full text Add to dashboard Cite

Importance: Reduced exercise capacity is commonly reported among individuals with Long COVID (LC). Cardiopulmonary exercise testing (CPET) is the gold-standard to measure exercise capacity to identify causes of exertional intolerance. Objectives: To estimate the effect of SARS-CoV-2 infection on exercise capacity including those with and without LC symptoms and to characterize physiologic patterns of limitations to elucidate possible mechanisms of LC. Data Sources: We searched PubMed, EMBASE, and Web of Science, preprint severs, conference abstracts, and cited references in December 2021 and again in May 2022. Study Selection: We included studies of adults with SARS-CoV-2 infection at least three months prior that included CPET measured peak VO2. 3,523 studies were screened independently by two blinded reviewers; 72 (2.2%) were selected for full-text review and 36 (1.2%) met the inclusion criteria; we identified 3 additional studies from preprint servers. Data Extraction and Synthesis: Data extraction was done by two independent reviewers according to PRISMA guidelines. Data were pooled with random-effects models. Main Outcomes and Measures: A priori primary outcomes were differences in peak VO2 (in ml/kg/min) among those with and without SARS-CoV-2 infection and LC. Results: We identified 39 studies that performed CPET on 2,209 individuals 3-18 months after SARS-CoV-2 infection, including 944 individuals with LC symptoms and 246 SARS-CoV-2 uninfected controls. Most were case-series of individuals with LC or post-hospitalization cohorts. By meta-analysis of 9 studies including 404 infected individuals, peak VO2 was 7.4 ml/kg/min (95%CI 3.7 to 11.0) lower among infected versus uninfected individuals. A high degree of heterogeneity was attributable to patient and control selection, and these studies mostly included previously hospitalized, persistently symptomatic individuals. Based on meta-analysis of 9 studies with 464 individuals with LC, peak VO2 was 4.9 ml/kg/min (95%CI 3.4 to 6.4) lower compared to those without symptoms. Deconditioning was common, but dysfunctional breathing, chronotropic incompetence, and abnormal oxygen extraction were also described. Conclusions and Relevance: These studies suggest that exercise capacity is reduced after SARS-CoV-2 infection especially among those hospitalized for acute COVID-19 and individuals with LC. Mechanisms for exertional intolerance besides deconditioning may be multifactorial or related to underlying autonomic dysfunction.

show abstract

“…These symptoms are often unspecific and manifest in various organ systems [ 27 ], which makes it difficult to prove causality between prior SARS-CoV-2 infection and patients' complaints. According to a follow-up study carried out by the University of Ulm, there is a discrepancy between functional complaints and barely measurable organ damage in post-COVID-19 patients [ 28 ]. This resembles the contrast between poor self-evaluation and normal physical performance tests in the SARS-CoV-2-positive cohort at hand.…”

Section: Discussionmentioning

confidence: 99%

Seven Months after Mild COVID-19: A Single-Centre Controlled Follow-Up Study in the District of Constance (FSC19-KN)

Haberland

Richter

et al. 2022

International Journal of Clinical Practice

View full text Add to dashboard Cite

Importance. Viral infections can lead to prolonged recovery and secondary diseases among the survivors. Therefore, the management of post-coronavirus infectious disease 2019 (COVID-19) patients needs to be planned efficiently based on significant data. Despite numerous follow-up studies, there still is a lack of knowledge in this field. Objective. The primary aim of the study was to investigate the rate of hospitalization and admission diagnoses in severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) positive patients seven months after initial infection. Secondarily, measurement of long-term effects on physical performance, quality of life, and functional outcome was intended. Design. The study is designed as a controlled follow-up of COVID-19 cases in the district of Constance (FSC19-KN). Setting. A controlled setting is provided due to the recruitment of an equally sized cohort consisting of age- and gender-matched subjects featuring similar cardiovascular risk profiles and negative SARS-CoV-2 antibody titers. Participants. The study examines 206 subjects after polymerase chain reaction (PCR) confirmed SARS-CoV-2 infection seven months after initial infection. Exposure. Infection in the SARS-CoV-2 positive group occurred between March and December 2020. Main Outcome and Measures. The frequency of inpatient admission during the observational period including the related diagnosis was defined as the primary endpoint. Secondary endpoints were health-related quality of life, physical performance, and functional outcome measured by European Quality of Life-5-Dimensions-5-Level (EQ-5D-5L), Short Form Health 36 (SF-36), Six-Minute Walk Test (6MWT), and Post-COVID-19 Functional Status (PCFS). Results. The study population consisted of mainly nonhospitalized subjects. During the first seven months of observation, frequency of inpatient admission was low and did not differ significantly between both groups (2.4% vs. 2.9% controls: OR 0.8, 95% CI 0.2 to 2.8). Calculation of six-minute walk distance ratios showed no significant difference between both cohorts (0.97 ± 0.17 vs. 0.98 ± 0.16 controls; mean difference −0.01; 95% CI −0.04 to 0.02). However, SARS-CoV-2-positive subjects achieved significantly lower EQ-5D-5L index scores (0.92 ± 0.12 vs. 0.95 ± 0.1 controls; mean difference −0.03, 95% CI −0.05 to −0.01) and SF-36 subscores. Reduced PCFS was reported significantly more often in the SARS-CoV-2 positive cohort (30.6% vs 14.6% controls: OR 2.6, 95% CI 1.6 to 4.2). Conclusion. The results suggest that mild COVID-19 has no impact on the hospitalization rate during the first seven months after infection. Despite unimpaired performance in cardiopulmonary exercise, SARS-CoV-2-positive subjects reported reduced quality of life and functional sequelae. Underlying psychoneurological mechanisms need further investigation. Trial Registration. This trial is registered with clinicaltrials.gov (identifier: NCT04724434) and German Clinical Trials Register (identifier: DKRS00022409).

show abstract

Long COVID: Distinction between Organ Damage and Deconditioning

Cited by 34 publications

References 36 publications

Symptom burden correlates to impairment of diffusion capacity and exercise intolerance in long COVID patients

Symptom burden correlates to impairment of diffusion capacity and exercise intolerance in long COVID patients

Cardiopulmonary exercise testing to evaluate post-acute sequelae of COVID-19 (“Long COVID”): a systematic review and meta-analysis

Seven Months after Mild COVID-19: A Single-Centre Controlled Follow-Up Study in the District of Constance (FSC19-KN)

Contact Info

Product

Resources

About