Università del Piemonte Orientale (UPO), Novara, Italy.
"AOU Maggiore della Carità", Novara, Italy.
Front Immunol. 2022 Dec 19;13:1038227. doi: 10.3389/fimmu.2022.1038227. eCollection 2022.
Factors associated with long-term sequelae emerging after the acute phase of COVID-19 (so called "long COVID") are unclear. Here, we aimed to identify risk factors for the development of COVID-19 sequelae in a prospective cohort of subjects hospitalized for SARS-CoV-2 infection and followed up one year after discharge.
A total of 324 subjects underwent a comprehensive and multidisciplinary evaluation one year after hospital discharge for COVID-19. A subgroup of 247/324 who consented to donate a blood sample were tested for a panel of circulating cytokines.
In 122 patients (37.8%) there was evidence of at least one persisting physical symptom. After correcting for comorbidities and COVID-19 severity, the risk of developing long COVID was lower in the 109 subjects admitted to the hospital in the third wave of the pandemic than in the 215 admitted during the first wave, (OR 0.69, 95%CI 0.51-0.93, p=0.01). Univariable analysis revealed female sex, diffusing capacity of the lungs for carbon monoxide (DLCO) value, body mass index, anxiety and depressive symptoms to be positively associated with COVID-19 sequelae at 1 year. Following logistic regression analysis, DLCO was the only independent predictor of residual symptoms (OR 0.98 CI 95% (0.96-0.99), p=0.01). In the subgroup of subjects with normal DLCO (> 80%), for whom residual lung damage was an unlikely explanation for long COVID, the presence of anxiety and depressive symptoms was significantly associated to persistent symptoms, together with increased levels of a set of pro-inflammatory cytokines: interferon-gamma, tumor necrosis factor-alpha, interleukin (IL)-2, IL-12, IL-1β, IL-17. In logistic regression analysis, depressive symptoms (p=0.02, OR 4.57 [1.21-17.21]) and IL-12 levels (p=0.03, OR 1.06 [1.00-1.11]) 1-year after hospital discharge were independently associated with persistence of symptoms.
Long COVID appears mainly related to respiratory sequelae, prevalently observed during the first pandemic wave. Among patients with little or no residual lung damage, a cytokine pattern consistent with systemic inflammation is in place.
与 COVID-19 急性期后出现的长期后遗症（即所谓的“长新冠”）相关的因素尚不清楚。在这里，我们旨在确定在因 SARS-CoV-2 感染住院并在出院后进行为期一年的随访的患者队列中，COVID-19 后遗症发展的危险因素。
共有 324 名患者在 COVID-19 出院后一年接受了全面的多学科评估。其中 247/324 名同意捐献血液样本的患者接受了循环细胞因子检测。
在 122 名患者（37.8%）中，至少有一个持续的身体症状。在校正合并症和 COVID-19 严重程度后，与第一波相比，在第三波大流行期间住院的 109 名患者发生长新冠的风险较低（OR 0.69，95%CI 0.51-0.93，p=0.01）。单变量分析显示，女性、一氧化碳弥散量（DLCO）值、体重指数、焦虑和抑郁症状与 1 年后的 COVID-19 后遗症呈正相关。在逻辑回归分析后，DLCO 是残留症状的唯一独立预测因素（OR 0.98，95%CI 0.96-0.99，p=0.01）。在 DLCO 正常（>80%）的患者亚组中，由于残留的肺损伤不太可能是长新冠的原因，焦虑和抑郁症状与持续存在的症状显著相关，同时伴有一组促炎细胞因子水平升高：干扰素-γ、肿瘤坏死因子-α、白细胞介素（IL）-2、IL-12、IL-1β、IL-17。在逻辑回归分析中，抑郁症状（p=0.02，OR 4.57 [1.21-17.21]）和 IL-12 水平（p=0.03，OR 1.06 [1.00-1.11]）在出院后 1 年与症状持续存在独立相关。
长新冠主要与呼吸道后遗症有关，主要发生在第一次大流行浪潮期间。在残留肺损伤较小或没有残留肺损伤的患者中，存在与全身炎症一致的细胞因子模式。
