Summary: A study of nearly 1,000 people with post-COVID-19 syndrome (PCS) found that two-thirds still had significant symptoms, including reduced exercise capacity and cognitive performance, two years after infection. Persistent symptom clusters included fatigue, neurocognitive impairment, and post-exercise malaise, with more severe outcomes in those who were obese, poorly educated, or initially infected.
Patients with PCS showed reduced oxygen consumption and cognitive test scores, highlighting the need for cognitive exercises and assessments in clinical care. The findings highlight the long-term impact of PCS and the urgent need for research into recovery factors.
Key facts:
- Long-term symptoms: Two-thirds of patients with PCS report persistent symptoms two years after infection.
- Main deficiencies: PCS is associated with reduced exercise capacity, memory, and attention.
- Clinical care needs: Cognitive and stress testing should be prioritized for PCS assessments.
Source: PLOS
Two-thirds of people with post-COVID-19 syndrome have persistent objective symptoms – including reduced exercise capacity and reduced performance on cognitive tests – for a year or more, with no major changes in symptom clusters over time. during the second year of their illness. according to a new study published on January 23rd in the open access journal PLOS Medicine by Winfried Kern of the University of Freiburg, Germany, and colleagues.
Self-reported health problems following SARS-CoV-2 infection have been frequently described and can persist for months. However, the long-term prognosis of post-COVID-19 syndrome (PCS) is unknown.
In the new study, researchers studied 982 people aged 18 to 65 who had previously been identified as having PCS, as well as 576 controls.
All participants visited one of several academic health centers in southwest Germany for comprehensive evaluations, including neurocognitive, cardiopulmonary, and laboratory tests.
The predominant symptom clusters in people with PCS were fatigue/exhaustion, neurocognitive impairment, chest symptoms/shortness of breath, and anxiety/depression/sleep problems. Nearly 68% of people who initially reported PCS still had symptoms in the second year.
Exercise intolerance accompanied by post-exertional malaise was reported by 35.6% of people with persistent PCS, and these people had worse outcomes and more severe symptoms.
People with lower education, obesity, or more severe illness at initial COVID-19 infection were also at greater risk of developing prolonged symptoms.
When they looked at objective measures of health and cognition, the team found that people with persistent PCS had significant reductions in grip strength, peak oxygen consumption, and efficiency. ventilatory.
Patients with persistent PCS and post-exertional malaise performed worse than controls on cognitive tests measuring memory, attention, and processing speed; however, the researchers point out that they had no data on cognition before acute COVID-19 infection.
The team could not identify any differences in heart function or laboratory values, including viral persistence tests.
“The results call for the inclusion of cognitive and exercise testing in the clinical evaluation and follow-up of patients with suspected PCS,” the authors state.
“Observational studies with longer follow-up are urgently needed to assess factors for improvement and non-recovery of PCS.”
The authors add: “Severe symptoms with mental and physical exercise dysfunction, but no laboratory markers in Long Covid/post-Covid syndrome. »
Funding: This work was supported by a grant from the Federal Ministry of Science and Arts Baden-Württemberg (number MR/S028188/1) to WVK, HGK, UM, DR, SG and JS. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
About the latest research on Long COVID and cognition
Author: Claire Turner
Source: PLOS
Contact: Claire Turner – PLOS
Picture: Image is credited to Neuroscience News
Original research: Free access.
“Persistent symptoms and clinical outcomes in adults with post-acute sequelae of COVID-19/post-COVID-19 syndrome during the second year after acute infection: a nested population-based case-control study” by Winfried Kern et al. PLOS Medicine
Abstract
Persistent symptoms and clinical outcomes in adults with post-acute sequelae of COVID-19/post-COVID-19 syndrome during the second year after acute infection: a nested population-based case-control study
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 dyspnea, concentration or memory and sleep problems.
The long-term prognosis of these post-acute sequelae of COVID-19/post-COVID-19 syndrome (PCS) is unknown, and data find and correlate organ dysfunction and pathology with self-reported symptoms in patients not recovering from PCS. is rare.
We aimed to describe clinical features and diagnostic findings in patients with persistent PCS for >1 year and assess risk factors for PCS persistence versus improvement.
Methods and results
This population-based, nested case-control study included subjects with PCS aged 18 to 65 years with (n= 982) and control subjects of the same age and sex without PCS (n= 576) according to a previous population-based questionnaire study (6-12 months after acute infection, phase 1) consenting to provide follow-up information and to undergo a comprehensive outpatient assessment, including neurocognitive testing, cardio -pulmonary and laboratory at four university health centers in southwest Germany (phase 2, additional 8.5 months (median, range 3 to 14 months) after phase 1).
The average age of participants was 48 years and 65% were women. In phase 2, 67.6% of patients with PCS in phase 1 developed persistent PCS, while 78.5% of recovered participants remained free of PCS-related health problems.
Improvement in patients with previous PCS was associated with mild acute infection, previous full-time employment, educational status, absence of specialist consultation and absence of rehabilitation program.
Development of new PCS-related symptoms in initially recovered participants was associated with intercurrent secondary SARS-CoV-2 infection and educational status.
Patients with persistent PCS were less frequently never smokers (61.2% vs. 75.7%), more often obese (30.2% vs. 12.4%), with higher mean values for mass index body weight (BMI) and body fat, and had lower education level (college admission). qualification 38.7% versus 61.5%) than participants with continued recovery.
Fatigue/exhaustion, neurocognitive impairment, chest symptoms/shortness of breath, and anxiety/depression/sleep problems remained the predominant symptom clusters. Exercise intolerance with post-exertional malaise (PEM) lasting > 14 h and symptoms consistent with myalgic encephalomyelitis/chronic fatigue syndrome were reported by 35.6% and 11.6% of participants with symptoms, respectively. patients with persistent PCS.
In analyzes adjusted for gender-age group combinations, study center and university entrance qualification, significant differences between participants with persistent PCS and those with continued recovery were observed for the performance on three different neurocognitive tests, scores for perceived stress, subjective cognitive impairment, dysautonomia, depression and anxiety, sleep quality, fatigue and quality of life.
In persistent PCS, grip strength (40.2 (95% confidence interval (CI) (39.4, 41.1)) versus 42.5 (95% CI (41.5, 43.6 )) kg), maximum oxygen consumption (27.9 (95% CI (27.3, 28.4 )) versus 31.0 (95% CI (30.3, 31.6)) ml/min/kg body weight) and ventilatory efficiency (minute ventilation/carbon dioxide production slope, 28.8 (95% CI (28.3, 29. 2)) versus 27.1 (95% CI (26.6, 27.7))) were significantly reduced compared to the control group of participants with recovery after adjustment for combinations sex-age group, study center, education, BMI, smoking status and use of beta-blocking agents.
There were no differences in measures of resting systolic and diastolic cardiac function, blood levels of N-terminal brain natriuretic peptide, or other laboratory measures (including complement activity, markers of Epstein-Barr virus (EBV) reactivation, inflammation and coagulation). markers, serum levels of cortisol, adrenocorticotropic hormone and dehydroepiandrosterone sulfate).
Screening for viral persistence (PCR in stool samples and SARS-CoV-2 peak antigen levels in plasma) in a subgroup of patients with persistent PCS was negative. Sensitivity analyzes (pre-existing disease/comorbidity, obesity, medical management of index acute infection) revealed similar results.
Patients with persistent PCS and PEM reported more pain symptoms and performed worse on almost all tests. A limitation was that we had no objective information on exercise capacity and cognition before acute infection.
Additionally, we did not include patients unable to attend the outpatient clinic for any reason, including serious illness, immobility, or social deprivation or exclusion.
Conclusions
In this study, we observed that the majority of working-age patients with PCS did not recover during the second year of their illness. Reported symptom patterns remained essentially similar, nonspecific, and dominated by fatigue, exercise intolerance, and cognitive impairment.
Despite objective signs of cognitive deficits and reduced exercise capacity, laboratory examinations revealed no major pathology and our results do not support viral persistence, EBV reactivation, adrenal insufficiency or increased complement turnover as pathophysiologically relevant for persistent PCS.
A history of PEM was associated with more severe symptoms and more objective signs of disease and could help stratify cases based on disease severity.
