Predictors of Post-Acute Sequelae of COVID-19 Development and Rehabilitation: A Retrospective Study

Risk factors and resolution of patient-reported pain and mental health symptoms following rib fracture(s)

BACKGROUND

Rib fractures, constituting 10% to 15% of trauma admissions, contribute significantly to morbidity and mortality. Effective postdischarge patient care remains a challenge. Our system has operationalized patient-reported outcome measures (PROMs) via a mobile platform into routine postdischarge monitoring for rib fracture patients. This study aimed to use PROMs to investigate the association between patient factors and postdischarge pain and mental health.

METHODS

We collected PROMs from nine Midwest trauma hospitals (2021-2022) using a mobile platform. The platform provided automated check-ins, education, health reminders, and 24/7 monitored interventions based on PROM responses. Multivariate logistic regression was used to investigate the association of patient factors for the primary outcome. The primary outcome was pain 2 weeks postdischarge (days 4-14). Secondary outcomes were mental health at 1 week, with long-term assessments at one and 3 months.

RESULTS

Of 72 patients, 55.6% reported moderate to severe pain at 2 weeks, with higher admission pain scores associated with increased pain (odds ratio, 1.69; 95% confidence interval, 1.15-2.5; p < 0.01). By 4 weeks, 29.4% of responding patients reported persistent moderate-to-severe pain, decreasing to 4.0% by 12 weeks. Patients with moderate-to-severe pain within the first 2 weeks also reported significantly higher rates of mental health symptoms at (44.8% vs. 16.7%) compared with mild pain. By weeks 4 and 12, mental health differences between pain groups were insignificant.

CONCLUSION

This study suggests a potential link between early pain and mental health symptoms. In addition, higher pain at admission may predict worse pain outcomes 2 weeks postdischarge. Patients in our cohort showed improvement in both pain and mental health symptoms within 4 to 12 weeks. These findings highlight the opportunity for PROMs and mobile apps to support optimal postdischarge follow-up and help minimize persistent pain, particularly for rib fracture patients with identifiable risk factors.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.

Pre-pandemic leukocyte count is associated with severity of post-acute sequelae of SARS-CoV-2 infection among older women in the Women's Health Initiative

OBJECTIVE

Although dysregulated inflammation has been postulated as a biological mechanism associated with post-acute sequelae of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection (PASC) and shown to be a correlate and an outcome of PASC, it is unclear whether inflammatory markers can prospectively predict PASC risk. We examined the association of leukocyte count and high-sensitivity C-reactive protein (hsCRP) concentrations, measured ~25 years prior to the coronavirus disease 2019 (COVID-19) pandemic, with PASC, PASC severity, and PASC-associated cognitive outcomes at follow-up among postmenopausal women.

METHODS

Using biomarker data from blood specimens collected during pre-pandemic enrollment (1993-1998) and data on 1,237 Women's Health Initiative participants who completed a COVID-19 survey between June 2021 and February 2022, we constructed multivariable regression models that controlled for pertinent characteristics. PASC status was defined according to established World Health Organization criteria.

RESULTS

Controlling for baseline characteristics, log e -transformed leukocyte count (β = 0.27; 95% confidence interval, 0.07-0.47, P = 0.009) and leukocyte count ≥5.5 × 1,000 cells/µL (β = 0.13; 95% confidence interval, 0.02-0.23; P = 0.02) were positively associated with PASC severity, defined as the sum of PASC symptoms, but not associated with overall PASC occurrence or PASC-related cognitive outcomes. Concentration of hsCRP, available on only ~27% of participants, was not associated with any of the PASC outcomes, controlling for the same covariates.

CONCLUSIONS

Leukocyte count, a widely available clinical marker of systemic inflammation, is an independent predictor of PASC severity in postmenopausal women. Heightened inflammation preceding SARS-CoV-2 infection may contribute to PASC development. Limited statistical power to assess hsCRP role warrants further study.

Rehabilitation service utilization among individuals with long COVID in Laval, Canada

PURPOSE

(1) investigate utilization of rehabilitation services (Physical Therapy [PT], Occupational Therapy [OT], Speech Language Pathology [SLP], and Psychology [Psych]) among adults with long-COVID in Laval, Quebec; (2) determine unmet needs; (3) determine factors associated with receiving services; (4) examine satisfaction.

MATERIALS AND METHODS

Using an electronic survey, participants completed the Newcastle Post-COVID Syndrome Follow-Up Screening Questionnaire, COVID-19 Yorkshire Rehabilitation Scale, and the COVID-19 Rehabilitation Needs Questionnaire. Descriptive statistics were used to describe rehabilitation services received, reasons for unmet needs, and satisfaction. Bivariate analysis and multivariable logistic regression were used to determine factors associated with receiving services.

RESULTS

Of 1031 persons with long-COVID, 37(3.6%) accessed OT, 80(7.8%) PT, 2(0.2%) SLP, and 63(6.1%) Psych. One quarter of participants who did not access rehabilitation services reported needing them. Factors associated with receiving services included hospitalization, vaccination, comorbidities, ≥1 year since COVID-19, female, ≥55 years, married/living together, and unemployed. Reasons for unmet needs were not knowing who to turn to, no referral, and financial. Most were satisfied with the services they received (70-84%).

CONCLUSION

The majority of participants with long-COVID did not access rehabilitation services to address their impairments and disabilities. Accessible, multidisciplinary rehabilitation services to address the functional needs of people with long COVID is needed.

Pathophysiological, immunological, and inflammatory features of long COVID

The COVID-19 pandemic continues to cause severe global disruption, resulting in significant excess mortality, overwhelming healthcare systems, and imposing substantial social and economic burdens on nations. While most of the attention and therapeutic efforts have concentrated on the acute phase of the disease, a notable proportion of survivors experience persistent symptoms post-infection clearance. This diverse set of symptoms, loosely categorized as long COVID, presents a potential additional public health crisis. It is estimated that 1 in 5 COVID-19 survivors exhibit clinical manifestations consistent with long COVID. Despite this prevalence, the mechanisms and pathophysiology of long COVID remain poorly understood. Alarmingly, evidence suggests that a significant proportion of cases within this clinical condition develop debilitating or disabling symptoms. Hence, urgent priority should be given to further studies on this condition to equip global public health systems for its management. This review provides an overview of available information on this emerging clinical condition, focusing on the affected individuals' epidemiology, pathophysiological mechanisms, and immunological and inflammatory profiles.

Social Inequalities in Long-Term Health Effects After COVID-19-A Scoping Review

Objectives: We aimed to map and synthesize evidence about social inequalities in long-term health effects after COVID-19 (LTHE), often referred to as "long COVID" or "post-COVID-19 conditions." Methods: We conducted a scoping review of peer-reviewed articles by searching the databases Embase and Scopus. According to predefined inclusion criteria, titles/abstracts and full texts were screened for eligibility. Additionally, reference lists of all included studies were hand-searched for eligible studies. This study followed the PRISMA guidelines for scoping reviews. Results: Nineteen articles were included. LTHE were analysed according to ethnicity, education, income, employment and deprivation indices. The studies varied significantly in their definitions of LTHE. Eighty-two analyses showed no statistically significant associations. At least 12 studies had a high risk of type II errors. Only studies associating deprivation indices and long COVID tended to show a higher prevalence of LTHE in deprived areas. Conclusion: Although some studies indicated social inequalities in LTHE, evidence was generally weak and inconclusive. Further studies with larger sample sizes specifically designed to detect social inequalities regarding LTHE are needed to inform future healthcare planning and public health policies.

Single-cell RNA sequencing reveals characteristics of myeloid cells in post-acute sequelae of SARS-CoV-2 patients with persistent respiratory symptoms

Background

Although our understanding of the immunopathology and subsequent risk and severity of COVID-19 disease is evolving, a detailed account of immune responses that contribute to the long-term consequences of pulmonary complications in COVID-19 infection remains unclear. Few studies have detailed the immune and cytokine profiles associated with post-acute sequelae of SARS-CoV-2 infection (PASC) with persistent pulmonary symptoms. The dysregulation of the immune system that drives pulmonary sequelae in COVID-19 survivors and PASC sufferers remains largely unknown.

Results

To characterize the immunological features of pulmonary PASC (PPASC), we performed droplet-based single-cell RNA sequencing (scRNA-seq) to study the transcriptomic profiles of peripheral blood mononuclear cells (PBMCs) from a participant naïve to SARS-CoV-2 (Control) (n=1) and infected with SARS-CoV-2 with chronic pulmonary symptoms (PPASC) (n=2). After integrating scRNA-seq data with a naïve participant from a published dataset, 11 distinct cell populations were identified based on the expression of canonical markers. The proportion of myeloid-lineage cells ([MLCs]; CD14+/CD16+monocytes, and dendritic cells) was increased in PPASC (n=2) compared to controls (n=2). MLCs from PPASC displayed up-regulation of genes associated with pulmonary symptoms/fibrosis, while glycolysis metabolism-related genes were downregulated. Similarly, pathway analysis showed that fibrosis-related (VEGF, WNT, and SMAD) and cell death pathways were up-regulated, but immune pathways were down-regulated in PPASC. Further comparison of PPASC with scRNA-seq data with Severe COVID-19 (n=4) data demonstrated enrichment of fibrotic transcriptional signatures. In PPASC, we observed interactive VEGF ligand-receptor pairs among MLCs, and network modules in CD14+ (cluster 4) and CD16+ (Cluster 5) monocytes displayed a significant enrichment for biological pathways linked to adverse COVID-19 outcomes, fibrosis, and angiogenesis. Further analysis revealed a distinct metabolic alteration in MLCs with a down-regulation of glycolysis/gluconeogenesis in PPASC compared to SARS-CoV-2 naïve samples.

Conclusion

Analysis of a small scRNA-seq dataset demonstrated alterations in the immune response and cellular landscape in PPASC. The presence of elevated MLC levels and their corresponding gene signatures associated with fibrosis, immune response suppression, and altered metabolic states suggests a potential role in PPASC development.

Bacterial Proteases as Potentially Exploitable Modulators of SARS-CoV-2 Infection: Logic from the Literature, Informatics, and Inspiration from the Dog

(1) Background: The COVID-19 pandemic left many intriguing mysteries. Retrospective vulnerability trends tie as strongly to odd demographics as to exposure profiles, genetics, health, or prior medical history. This article documents the importance of nasal microbiome profiles in distinguishing infection rate trends among differentially affected subgroups. (2) Hypothesis: From a detailed literature survey, microbiome profiling experiments, bioinformatics, and molecular simulations, we propose that specific commensal bacterial species in the Pseudomonadales genus confer protection against SARS-CoV-2 infections by expressing proteases that may interfere with the proteolytic priming of the Spike protein. (3) Evidence: Various reports have found elevated Moraxella fractions in the nasal microbiomes of subpopulations with higher resistance to COVID-19 (e.g., adolescents, COVID-19-resistant children, people with strong dietary diversity, and omnivorous canines) and less abundant ones in vulnerable subsets (the elderly, people with narrower diets, carnivorous cats and foxes), along with bioinformatic evidence that Moraxella bacteria express proteases with notable homology to human TMPRSS2. Simulations suggest that these proteases may proteolyze the SARS-CoV-2 spike protein in a manner that interferes with TMPRSS2 priming.

Long COVID Incidence in a Large US Ambulatory Electronic Health Record System

Estimates of the prevalence of long-term symptoms of coronavirus disease 2019 (COVID-19), referred to as long COVID, vary widely. This retrospective cohort study describes the incidence of long COVID symptoms 12-20 weeks postdiagnosis in a US ambulatory care setting and identifies potential risk factors. We identified patients with and without a diagnosis of or positive test for COVID-19 between January 1, 2020, and March 13, 2022, in the Veradigm (Veradigm LLC, Chicago, Illinois) electronic health record database. We captured data on patient demographic characteristics, clinical characteristics, and COVID-19 comorbidity in the 12-month baseline period. We compared long COVID symptoms between matched cases and controls 12-20 weeks after the index date (COVID-19 diagnosis date (cases) or median visit date (controls)). Multivariable logistic regression was used to examine associations between baseline COVID-19 comorbid conditions and long COVID symptoms. Among 916,894 patients with COVID-19, 14.8% had at least 1 long COVID symptom in the 12-20 weeks postindex as compared with 2.9% of patients without documented COVID-19. Commonly reported symptoms were joint stiffness (4.5%), cough (3.0%), and fatigue (2.7%). Among patients with COVID-19, the adjusted odds of long COVID symptoms were significantly higher among patients with a baseline COVID-19 comorbid condition (odds ratio = 1.91, 95% confidence interval: 1.88, 1.95). In particular, prior diagnosis of cognitive disorder, transient ischemic attack, hypertension, or obesity was associated with higher odds of long COVID symptoms.